The Journal of Bone and Joint Surgery

Image Quiz

Nontraumatic Cervical Myelopathy¹ (continued)

Relatively urgent operative intervention was indicated for complete reduction and decompression, stabilization, and tissue biopsy.

The first stage of the surgical procedure consisted of anterior discectomies at the third and fourth and the fourth and fifth cervical levels, reduction, autogenous bone-grafting, and plate application (Fig. 3).

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Fig. 3: Postoperative lateral radiograph of the cervical spine, made after anterior and posterior stabilization.

Fig. 4

Then, in the second stage, performed during the same operation and through a posterior approach, it was noted that most of the right fourth cervical lateral mass was eroded. Tissue from this site and tissue from the iliac crest was obtained for biopsy (Fig. 4).

Postoperatively, the patient wore a cervical orthosis and was able to walk short distances. The neurologic deficits decreased, but she continued to feel unwell and lethargic.

What is the diagnosis?