Sagittal realignment as a strategy for indirect multilevel decompression in severe cervical myelopathy: a case report.

Degenerative cervical myelopathy is the leading cause of non-traumatic spinal cord dysfunction in older adults and may occasionally present with rapid neurological deterioration. A 78-year-old man presented with rapidly progressive cervical myelopathy characterized by bilateral upper-limb weakness and acute urinary retention. Neurological evaluation demonstrated advanced myelopathy with a modified Japanese Orthopaedic Association (mJOA) score of 6/18. Magnetic resonance imaging revealed cervical canal stenosis with dominant anterior compression at C3-C4 and multilevel degenerative changes. Given comorbidities and high perioperative risk, a focused short-segment anterior cervical decompression and fusion at C3-C4 was performed using a lordotic interbody cage to restore sagittal alignment and facilitate indirect decompression of adjacent levels. Operative time was 85 min with an estimated blood loss of 120 ml. At 1-year follow-up, the mJOA improved to 15/18 (75% recovery), indicating that limited anterior decompression with restoration of cervical lordosis can provide neurological recovery in high-risk elderly patients.