Cervical spinal melorheostosis causing myelopathy: a rare case and review of the literature.

Melorheostosis is a progressive sclerosing bone dysplasia that rarely involves the spine. When spinal involvement occurs, it can lead to significant neurological compromise due to spinal cord compression. We report the case of a previously healthy 22-year-old woman who presented with progressive gait instability and upper motor neuron symptoms secondary to a hyperostotic lesion extending from C2 to C5. Imaging demonstrated severe left-sided spinal canal stenosis, prompting urgent surgical decompression with posterior cervical fusion. Intraoperative neuromonitoring showed complete loss of all sensory and motor potentials from the left side following decompression. Accordingly, she woke up with complete hemiplegia; however, rapid improvement was noted over the following days. Through analysis of 25 documented cases, we highlight the variability in anatomical involvement, clinical presentation, and management strategies. This report underscores the importance of an individually tailored surgical intervention and contributes to the scarce literature on cervical spinal melorheostosis.