Dyspnea Due to Osteoarthritis. Diaphragmatic Palsy Caused by Cervical Spondylosis

A 64 year old gentleman with cervical spondylosis presented with sudden onset breathlessness associated with significant orthopnea. On clinical examination he had decreased power in his upper extremities with reduced chest excursion. Cervical spine MRI revealed severe spondylosis at multilevel with evidence of cord compression. Chest x ray showed elevated left diaphragm and sniff test confirmed diaphragmatic weakness. Spirometry showed significant decline in FVC and FEV1 when repeating the tests in supine position with reduced maximum expiratory pressures. Based on these findings left diaphragmatic palsy due to phrenic nerve compression by cervical spondylosis was diagnosed. Patient underwent cervical cord decompression with improvement in his respiratory symptoms. Although cervical spondylosis is common, diaphragmatic palsy due to phrenic nerve compression is rare, or rarely reported. With the emerging evidence that phrenic nerve derives innervation from many cervical levels, our case reiterates the possibility of respiratory failure due to osteoarthritis.