Cervical Disk Herniation Induced Spinal Cord Injury in a Patient with Cerebral Palsy

Case Diagnosis: 20 year old male with spastic Cerebral Palsy develops lower extremity deficits from cervical disk herniations.

Case Description or Program Description: Patient presented with 1.5 months of progressive bilateral lower extremity weakness, gait abnormalities, bladder and bowel incontinence. First, neurosurgery was consulted in the setting of a ventricular shunt to evaluate an enlarged fourth ventricle on MRI brain for concern of a shunt malfunction; this was deemed to be stable and unchanged from prior imaging. Neurology then suggested an MRI lumbar spine due to the lower extremity deficits and incontinence. This imaging was unremarkable, helping to rule out any lumbar spine pathology. Neurology then suggested that symptoms were due to chronic deconditioning. At this point, PM&R was consulted given the sudden change in functional status and coinciding incontinence. MRI imaging of the C and T sections of the spine was recommended for further evaluation of the spinal column. On imaging, the patient was found to have disk herniations at the T2-3 and T3-4 levels with cord impingement and right spinal cord atrophy. Patient ultimately decided to pursue surgical intervention with Neurosurgery, which involved a T2-T5 posterior spinal fusion and removal of lipoma. The patient was then stabilized and transferred to PM&R inpatient rehabilitation for 17 days before continuing with outpatient rehab.

Setting: Tertiary Care Pediatric Hospital.

Assessment/Results: At 2 month follow up, patient was continuing outpatient rehab with assistance from a walker, able to ambulate their home independently, and regained bladder and bowel control.

Discussion (relevance): Though cerebral palsy is already known to be associated with cervical disk herniation, this case demonstrates a presentation limited to lumbar pathology symptoms. PM&R was critical in obtaining the approrpriate diagnosis and, after surgical intervention, provided rehab to maximize patient recovery.

Conclusions: Thorough evaluation is important for diagnosis and, alongside post-operative rehab, contribute to significant improvements in functional status and quality of life.