UNSTRUCTURED
Degenerative cervical myelopathy (DCM) is a common neurological condition, with disease progression that is both variable and difficult to predict1. Management of the clinically stable patient is challenging, particularly if there is evidence of radiological disease progression. A gentleman in his late sixties, with a background of congenital stenosis of the cervical spine, initially presented complaining of lower limb weakness and impaired balance. Over the course of two years of close clinical follow up his symptoms and clinical assessments remained stable, with a modified Japanese Orthopaedic Association (mJOA) score of 13. This was despite worsening stenosis and multilevel spinal cord compression on MRI imaging. His management was also challenged by surgical service disruption at the height of the COVID-19 pandemic. The case serves as a reminder of an enduring medical aphorism that clinical history and examination should be prioritised above more complex data, such as imaging investigations. Equally that guidelines are a guide and need to be tailored to the individual circumstances.