Clinical Review Lesson of the week

Degenerative cervical disc disease causing cord compression in adults under 50

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7283.414 (Published 17 February 2001) Cite this as: BMJ 2001;322:414
  1. P I Bentley, senior house officer,
  2. C J Grigor, senior house officer,
  3. J D McNally, specialist registrar,
  4. S Rigby, specialist registrar,
  5. C S Higgens, consultant,
  6. A O Frank, consultant,
  7. A Keat, consultant (andrew.keat@nph.npstm-tr.nthames.nhs.uk)
  1. Department of Rheumatology, Northwick Park and St Mark's NHS Trust, Harrow HA1 3UJ
  1. Correspondence to: A Keat
  • Accepted 20 January 2000

Cervical disc prolapse is a cause of an insidious myelopathy without necessary neck symptoms

Patients who present with a combination of back pain and neurological symptoms in the legs naturally prompt an initial search for pathology at the level of the lumbar spine, with lumbar disc prolapse being the most likely cause in patients under 50. Upper motor neurone signs in the legs, however, indicate that the abnormality must be above L1 on the neural axis. We describe three adults (aged 28-40) with these symptoms who were subsequently found to have severe degenerative cervical disc prolapse requiring prompt surgery.

Case reports

Case 1

A Sri Lankan man with insulin dependent diabetes initially presented at the age of 40 with lower back pain radiating to the left leg, in association with paraesthesia of both feet. Straight leg raising on the left was limited to 60° and the left foot had mild weakness. Reflexes of the lower limbs were symmetrically brisk, with equivocal plantar responses, and “stiffness” in the legs was attributed to painful movements. Results of sensory tests on the feet were normal. Symptoms of constipation and nocturia were ascribed to analgesics and diabetes. Computed tomography of the lumbar spine identified a disc prolapse at L4-5 with spinal stenosis, but magnetic resonance imaging failed to identify clear root compression and so surgery was not indicated.

He was referred again four years later, now using a wheelchair because of continued lower back pain and weakness in both legs. Repeat computed tomography of the lumbar …

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