Concomitant Cervical Spondylotic Myelopathy and Transverse Myelitis Managed With C4-C6 Anterior Cervical Discectomy and Fusion

Cervical spondylotic myelopathy (CSM) and transverse myelitis (TM) may present with overlapping neurologic deficits, despite requiring distinct therapeutic approaches. We report the case of a 50-year-old female with progressive cervical myelopathy, severe C5-C6 stenosis, and a long-segment cervical cord signal abnormality extending beyond the level of maximal compression. Contrast-enhanced MRI revealed expansile intramedullary T2 hyperintensity with patchy enhancement, raising suspicion for TM. Extensive neurologic workup, including brain MRI, cerebrospinal fluid (CSF) analysis, oligoclonal bands, cytology, and infectious studies, was negative. Following multidisciplinary evaluation, the patient received intravenous methylprednisolone, followed by C4-C6 anterior cervical discectomy and fusion (ACDF). Neurologic function improved substantially, with the modified Japanese Orthopaedic Association (mJOA) score improving from 10 preoperatively to 16 at one year. This report highlights the importance of recognizing concomitant inflammatory and compressive spinal cord pathology and demonstrates favorable outcomes following a coordinated medical and surgical management approach.