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There can be a reluctance to order repeat cross­sectional im­ force can help the provider elucidate acute neurologic deficits
aging, whether it be due to pressure to return Soldiers to duty in the presence of suspected compressive myelopathy, prevent
faster or fear of ordering it unnecessarily. The American Col­ catastrophic injury to our Servicemembers, and last, avoid
lege of Radiology Appropriateness Criteria for Cervical Neck costly and lifelong disability.
Pain or Cervical Radiculopathy supports ordering repeat MRI
on this patient given the presence of new radicular signs and This research was presented at the USU Research Days, Uni­
13
suspected cervicogenic headaches. Referencing this criteria formed Services University, Bethesda, MD, 14–17 May 2018,
can assist the provider in justifying repeating a study, should and the USU Founders Day, Uniformed Services University,
resistance occur. Bethesda, MD, 21 September 2018.

The ASIA Spine scale is a versatile tool used by providers to Disclosures
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systematically document radicular findings. With the high The authors have no financial relationships relevant to this
prevalence of cervical radiculopathy in the military, it can be article to disclose.
difficult to recognize a deviation from a patient’s longstanding
baseline. Given this, there exists justification for document­ Disclaimer
ing baseline findings on all troops. The ASIA Spine Scale as­ The opinions and assertions expressed herein are those of the
sessment was not performed on this patient, yet the authors author(s) and do not necessarily reflect the official policy or
believe it should have been. Although this patient’s change position of the Uniformed Services University or the Depart­
from his baseline was very explicit, others may present with ment of Defense.
subtle radicular changes that may otherwise be missed. Sim­
ilar systems already exist in the military. For example, some References
unit providers historically documented baseline Mini Mental 1. Fehlings MG, Tetreault LA, Riew KD, et al. A Clinical Practice
Status Exam scores on their troops prior to deployment, in Guideline for the management of degenerative cervical myelopa­
anticipation of reassessment in the event of traumatic brain thy: Introduction, rationale, and scope. Global Spine J. 2017;7
(3 Suppl):21S–27S.
injury. The hearing conservation program compares service­ 2. Schoenfeld AJ, George AA, Bader JO, Caram PM, Jr. Incidence
14
members’ audiograms to previously established baselines. and epidemiology of cervical radiculopathy in the United States
Documenting baseline ASIA findings on servicemembers can military: 2000 to 2009. J Spinal Disord Tech. 2012;25(1):17–22.
assist with evaluation of radiculopathy later on and assist with 3. Lestini WF, Wiesel SW. The pathogenesis of cervical spondylosis.
identifying myelopathy sooner. Clin Orthop Relat Res. 1989(239):69–93.
4. Katirji B. Neuromuscular disorders in clinical practice. Boston,
MA: Butterworth­Heinemann; 2002.
With the decision for operative management of DCM, the 5. Murakami N, Muroga T, Sobue I. Cervical myelopathy due to
deviation of the military subset from the general DCM de­ ossification of the posterior longitudinal ligament: a clinicopath­
mographic should be considered. The patients are likely to be ologic study. Arch Neurol. 1978;35(1):33–36.
younger, with less comorbidities. In general, their periopera­ 6. Gkasdaris G, Chourmouzi D, Karagiannidis A, Kapetanakis S.
tive morbidity and mortality would be lower than that of the Spinal cord edema with contrast enhancement mimicking intra­
general population. Thus, the pendulum of risk versus benefit medullary tumor in patient with cervical myelopathy: A case re­
port and a brief literature review. Surg Neurol Int. 2017;8:111.
with surgical correction likely swings toward the operative 7. Takasawa E, Sorimachi Y, Iizuka Y, et al. Risk factors for rapidly
side. With this in mind, more aggressive surgical management progressive neurological deterioration in cervical spondylotic my­
of the military DCM patient is likely justified. Furthermore, elopathy. Spine (Phila Pa 1976). 2019;44(12):E723–E730.
as demonstrated with this patient, timely surgical intervention 8. Theologou M, Zevgaridis D, Theologou T, Tsonidis C. Severe
and relief of cord compression can lead to return of prior neu­ cervical spondylotic myelopathy with complete neurological and
rologic deficits. With this patient, surgical decompression was neuroradiological recovery within a month after surgery. J Surg
performed within 12 hours of identification of DCM. The out­ Case Rep. 2016;2016(11).
come was resolution of many previously bothersome deficits, 9. Cabraja M, Abbushi A, Costa-Blechschmidt C, et al. Atypical
cervical spondylotic myelopathy mimicking intramedullary tu­
not to mention elimination of impending quadriplegia. mor. Spine (Phila Pa 1976). 2008;33(6):E183–187.
10. Karadimas SK, Erwin WM, Ely CG, et al. Pathophysiology and
natural history of cervical spondylotic myelopathy. Spine (Phila
Conclusion Pa 1976). 2013;38(22 Suppl 1):S21–36.
Although DCM is a rare occurrence on the large­prevalence 11. Osunronbi T, Sharma H. International Standards for Neurolog­
spectrum of DCS, it carries catastrophic consequences if not ical Classification of Spinal Cord Injury: factors influencing the
frequency, completion and accuracy of documentation of neurol­
quickly identified and reversed. This case demonstrates the dif­ ogy for patients with traumatic spinal cord injuries. Eur J Orthop
ficulty of diagnosis as the presentation of an ambulating male Surg Traumatol. 2019;29(8):1639–1648.
with isolated neurologic findings is not congruent with mid­ 12. Teoli D, Rocha Cabrero F, Ghassemzadeh S. Lhermitte Sign. [Up­
high cervical compression that he was experiencing. Keeping dated 2021 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL):
in mind risk factors, history, and physical exam findings more StatPearls Publishing; 2021 Jan– . Available from: https://www
.ncbi.nlm.nih.gov/books/NBK493237/
specific for DCM will assist the military provider in identi­ 13. McDonald MA, Kirsch CFE, Amin BY, et al. ACR Appropriate­
fying this needle in the haystack of more common and more ness criteria cervical neck pain or cervical radiculopathy. J Am
benign causes of cervical radiculopathy. Systematic spinal cord Coll Radiol. 2019;16(5s):S57–S76.
evaluation, augmented by the utilization of the ASIA Spine 14. Garcia SL, Smith KJ, Palmer C. Cost­effectiveness analysis of a
Scale, will further contribute to earlier identification of this military hearing conservation program. Mil Med. 2018;183(9–
pathology. Implementing a baseline evaluation for the entire 10):e547–e553.

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