Spinal cord neurosarcoidosis as a rare mimicker of cervical spondylotic myelopathy: A review of the literature

Abstract

Objective: Spinal cord sarcoidosis is a rare disorder with diverse clinical and radiographic presentations. Neurosarcoidosis may be misdiagnosed as it presents similarly to cervical spondylotic myelopathy (CSM), a more common neurosurgical pathology. Although uncommon, there is a need to distinguish these entities and identify an approach to diagnosis and treatment. A review of the current literature is provided to guide neurosurgeons receiving these patient referrals. Methods: A systematic literature review was conducted through the PubMed database with keywords “sarcoid”, “cervical”, and “myelopathy” to identify case reports of patients presenting with myelopathic symptoms due to neurosarcoidosis. All articles discussing patients with a presumed diagnosis of cervical spondylotic myelopathy (CSM) treated surgically with decompression but later diagnosed with neurosarcoidosis were reviewed. Results: PubMed identified 83 candidate articles, of which five met inclusion criteria. Nine total patients were reviewed. 55 % were male with a mean age of 57 ± 11.5 years (range 29–69 years). All patients underwent surgical decompression for a presumed diagnosis of CSM. Post-operative course led to subsequent neurologic decline within average of 1.4 ± 1.7 months (range 0–5 months) after surgery. Sarcoidosis was diagnosed with further testing and steroid, or immunosuppressant therapy was initiated with variable improvement. Conclusions: Although rare, neurosarcoidosis is an important differential diagnosis when considering etiologies of myelopathy and requires a high degree of suspicion. In patients with suspected findings, early diagnosis and medical treatment may prevent avoidable surgery and associated complications.

Keywords

• Neurosarcoidosis
• Spondylosis
• Myelopathy
• Laminectomy