Myelopathy in Cerebral Palsy: Case Report On Navigating Secondary Complications

Case Diagnosis: Spastic diplegic cerebral palsy (CP) with secondary myelopathy due to congenital spinal stenosis and degenerative changes.

Case Description or Program Description: An 18-year-old male with a history of meningitis in infancy and VP shunt insertion presented with worsening low back pain, increased muscle tightness, gait changes, bilateral leg spasticity, right leg radicular pain, and mildly increased upper extremity ataxia. Examination revealed upper extremity coordination deficits, clonus, and positive Hoffman's. Symptoms were initially attributed solely to spastic diplegic CP.

Setting: Outpatient PM&R Clinic

Assessment/Results: Workup with MRI showed a congenitally narrow spinal canal, significant ligamentous hypertrophy, focal kyphotic deformity with myelomalacia at T7, congenitally fused vertebrae at C3/4 and C5/6, cord signal changes at C4-5 and T3-4, and severe stenosis throughout the cervical/thoracic spine. The patient was referred to Neurosurgery for further care and underwent a laminectomy with a positive outcome and decreased radicular pain.

Discussion (relevance): CP is a non-progressive neurological disorder, but patients may experience functional decline due to secondary complications. As the number of adults living with CP continues to rise due to improved medical care, there is also an increase in the musculoskeletal disorders accompanying this disease. The increased risk of myelopathy in CP patients stems from abnormal cervical motion accelerating degeneration. Cognitive errors in physician decision-making, such as anchoring bias or premature closure, may lead to overlooking progressive neurological symptoms in CP.

Conclusions: This case highlights the importance of recognizing the increased risk of myelopathy in CP patients and potential for functional decline when secondary complications are not adequately managed. It demonstrates the need for vigilance in monitoring complications and avoiding cognitive biases in complex CP cases. Multidisciplinary care, involving PM&R and neurosurgery, proved crucial in addressing immediate symptoms and long-term management plans. This case emphasizes the need for ongoing surveillance and proactive management strategies in adult CP patients to optimize outcomes and quality of life.