Case Report (Precis): Patient with MR-Documented Large Lateral Cervical Disc Misdiagnosed as Neurodegenerative Disease

BACKGROUND: Patients who present to neurologists with cervical radiculopathy typically undergo initial MR scans. If reports show “abnormal” findings they, and other physicians, should review the studies with the interpreting radiologists/neuroradiologists. When patients’ neurological deficits progress, neurologists should review their electromyographic (EMG) findings (i.e. especially if documenting neurodegenerative disease), the initial “abnormal” MR scans/reports (i.e. review with radiologists/neuroradiologists), and obtain spinal surgical consultations to rule out “surgical” disease. CASE DESCRIPTION: A middle aged patient presented several months previously to a neurologist with the chief complaint of unilateral neck/arm pain, accompanied by focal weakness, and numbness in a specific distal cervical nerve root distribution. The patient’s initial MR showed a large lateral disc herniation in the lower cervical spine on the symptomatic side. However, as the neurologist interpreted the EMG as consistent with a neurodegenerative syndrome, the patient was not referred to a spine specialist. Frustrated by progressive worsening, the patient ultimately referred himself for a spinal surgical consultation. By this time, he had developed severe unilateral upper extremity motor weakness (3/5), pin loss, atrophy, and fasciculations in the nerve root distribution that correlated with the location of the distal cervical disc seen on the original MR. When the repeat MR confirmed the same large distal lateral disc herniation, the patient successfully underwent an anterior cervical discectomy/fusion (ACDF). CONCLUSION: This Case Report (Precis) highlights two “teachable moments”. First, physicians, including neurologists and spinal surgeons, who order MR studies that show “abnormal” findings should review these studies with the interpreting radiologists/neuroradiologists. This is particuarly true if patients continue to demonstrate progressive neurological deterioration. Second, before patients are told that they have neurodegenerative syndormes, repeated review of the MR reports and/or repeating these studies, and obtaining spinal surgical consultations are warranted to rule out “surgical” disease.