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1336 - Myelopathy in Cerebral Palsy: Navigating Secondary Complications

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

AS

Austin Sturdivant, MD

Resident Doctor
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Co-Author(s)

MN

Monica Nable, n/a

Medical Student
Vanderbilt University School of Medicine
Nashville, Tennessee, United States
JJ

Jacob Jeffers, MD

Assistant Professor of Physical Medicine & Rehabilitation
VUMC
Nashville, Tennessee, United States

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

Case Description: An 18-year-old male with a history of meningitis in infancy and VP shunt insertion presented for worsening low back and hip pain. Symptoms were initially attributed solely to spastic diplegic CP. On follow-up, examination revealed worsening increased muscle tightness, gait changes, bilateral leg spasticity, and right leg radicular pain. Further workup with an 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 and thoracic spine.

Discussions: 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 that accompany this disease. The increased risk of myelopathy in CP patients stems from abnormal cervical motion accelerating spinal degeneration. Cognitive errors in physician decision-making, such as anchoring bias or premature closure, may lead to overlooking progressive neurological symptoms in CP patients. Multidisciplinary care, involving PM&R and neurosurgery, proved crucial in addressing both 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.

Conclusions: This case highlights the importance of recognizing the increased risk of myelopathy in CP patients and the potential for functional decline when secondary complications are not adequately managed. It demonstrates the need for vigilance in monitoring for complications and avoiding cognitive biases in complex CP cases.