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Pain and Spine Medicine

Functional Recovery in a Case of Neurofibromatosis-Associated Cervical Myelopathy

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 4

    Poster Presenter(s)

  • Eileen Lu, DO

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Brooklyn, New York

    • Co-Author(s)

  • HP

    Henna Purewal, Other

    Medical Student
    University of Rochester Medical Center
    Rochester, New York

  • Benjamin Drukman, MD

    Resident
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Brooklyn, New York

  • JM

    Jack Mensch, MD

    Associate Chairman Department of Rehabilitation Medicine, Staten Island University Hospital
    Staten Island University Hospital
    Edison, New Jersey

  • SA

    Sanjeev Agarwal, MD

    Program Director
    SUNY Downstate Health Sciences University
    Brooklyn, New York

Disclosure(s):
Eileen Lu, DO: No financial relationships to disclose
Benjamin Drukman, MD: No financial relationships to disclose
Sanjeev Agarwal, MD: No financial relationships to disclose
Case Diagnosis: Neurofibromatosis with cervical myelopathy secondary to multiple intradural neurofibromas, resulting in progressive upper extremity weakness, sensory deficits, and gait impairment.

Case Description or Program Description: A 49-year-old female with a history of neurofibromatosis presented with progressive bilateral upper extremity weakness, numbness, and gait instability over two to three years. Her strength was grossly 4/5 in all extremities (weaker in upper extremities). Magnetic resonance imaging (MRI) revealed multiple enhancing neuroforaminal masses consistent with neurofibromas, with the most significant lesion at C6-7 causing severe spinal cord compression and signal changes consistent with myelomalacia. She underwent suboccipital craniectomy, C1 and C5-7 laminectomy, right C5-6 foraminotomy, intradural tumor resection (C1, C6), and posterior C4-7 fusion.

Setting: Acute Inpatient Rehabilitation Facility

Assessment/Results: Postoperatively, she was admitted to an acute inpatient rehabilitation program for intensive therapy following surgical decompression and stabilization. Postoperatively, she had improvement in strength to 4+/5 grossly throughout, with persistent sensory deficits and neuropathic pain. She was initially dependent for transfers and required assistance for ambulation (30 feet with rolling walker and one-person assist). After an intensive rehabilitation program, she was discharged home with supervision for ambulation (100 feet with walker or cane), transfers, and stair negotiation (four steps with handrail).

Discussion (relevance): This case highlights the neurological impact of neurofibromatosis-associated spinal tumors and the role of rehabilitation in optimizing functional outcomes. The patient demonstrated significant recovery in strength and mobility, emphasizing the importance of early surgical intervention and comprehensive rehabilitation in mitigating long-term disability. Despite persistent sensory deficits, her functional independence improved notably, supporting the efficacy of multimodal rehabilitation post-surgical decompression.

Conclusions: Multidisciplinary rehabilitation following spinal decompression for cervical myelopathy in neurofibromatosis can significantly improve functional outcomes. This case underscores the importance of early surgical and rehabilitative interventions to enhance recovery and quality of life in patients with spinal cord compression from neurofibromas.