Fever as a rare combined symptom of degenerative cervical myelopathy: a case report and literature review

Abstract

A 60-year-old male patient complained of weakness of both legs for one year, intermittent fever for two months, up to 38.0 °C. Physical examination showed bilateral hyperreflexia of knee tendon and positive Hoffman sign on the right side. MR imaging of the cervical spine showed central herniation of the cervical 5-7 disc and compression of the spinal cord. The WBC was normal, C-reactive protein was 24.42mg/l, ESR was 55mm/h, TB antibody, anti acid staining and T-SPOT were negative. Autoantibody was negative and thyroid function was normal. The JOA score was 9 points. During the operation, the herniated disc tissue was taken out for pathological examination and bacterial culture. The posterior longitudinal ligament was removed and no abscess was found. The symptom of asthenia in both legs was relieved and fever disappeared. No growth of aerobe, anaerobe or tubercle bacilli was found in the culture of resected tissue. One year after the operation, the fever did not recur, JOA score increased to 14 points, and MR imaging showed no protrusion in cervical spinal canal. In this case, the fever disappeared after the operation for cervical spondylosis, which may be a special manifestation of sympathetic nerve stimulation or autonomic dysfunction by chronic compression of spinal cord.

Keywords:

• Anterior cervical fusion
• corpectomy
• cervical
• disc herniation
• degenerative cervical myelopathy
• fever
• combined symptom
• sympathetic nerve

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