Large C4/5 spondylotic disc bulge resulting in spinal stenosis and myelomalacia in a Klippel-Feil patient.

OBJECTIVES The purpose of this report is to document a case of cervical spinal stenosis and myelomalacia in a patient with Klippel-Feil (KF) syndrome with a large C4/5 disc bulge presenting with cervical radiculopathy. SUBJECT A 39-year-old man was referred to a private chiropractic practice for a consultation. He complained of limited motion in his neck with pain and numbness radiating down both arms and left leg. Diagnostic imaging revealed KF syndrome and a large spondylotic disc bulge at C4/5 compressing the cord and causing myelomalacia. A plethora of symptoms and objective findings associated with KF syndrome were also present. RESULTS After reviewing the previous diagnostic imaging, examining this patient, and discovering that upper motor neuron pathological reflexes were present, the patient was recommended to proceed with the surgical intervention as recommended by his neurosurgeon. No chiropractic care was rendered. CONCLUSIONS This patient presented with primary complaints consistent with cervical radiculopathy. However, due to the severity of the neurologic findings and presence of myelomalacia, the patient was not treated. The patient had not previously been diagnosed with KF syndrome, although he presented clinically with many of the congenital issues commonly associated with the condition. This case demonstrates the vital importance of differential diagnostic skills as well as the need to continue fostering improved communication and integration of care among various clinical disciplines for patients presenting with challenging symptoms.