Rapid recovery in degenerative cervical myelopathy: A case report highlighting neuroplasticity following surgical decompression

• Early surgical decompression can support neuroplasticity in degenerative cervical myelopathy (DCM). This case highlights how timely intervention led to significant neurological recovery, reinforcing the importance of early surgical management in patients with progressive spinal cord compression. • Intraoperative neurophysiological monitoring (IONM) helps predict neurological recovery. The reappearance of motor evoked potentials (MEP) during surgery corresponded with the patient’s postoperative improvement, emphasizing the value of IONM in guiding surgical decision-making. • The absence of spinal fusion in decompressive surgery may contribute to recurrent spinal cord compression. In this case, the lack of intervertebral stabilization after the first procedure likely led to C1-C2 instability and worsening neurological symptoms, underlining the importance of proper surgical planning. • Neuroplasticity may play a key role in recovery from spinal cord injury. This patient’s rapid functional improvement following decompression suggests that, even in adults, the spinal cord retains some capacity for reorganization and repair, challenging the traditional view of permanent neuronal damage. • Advanced imaging techniques are essential for diagnosing and monitoring spinal cord compression. MRI and CT findings played a critical role in identifying disease progression, guiding surgical decisions, and assessing postoperative improvement. Degenerative cervical myelopathy (DCM) causes progressive compression of the spinal cord, leading to permanent and sometimes irreversible nerve damage if left untreated or not promptly treated. The nerve damage is associated with impaired sensory and motor function below the spinal cord injury (SCI) level, leading to a functional disability that affects the patient and the patient’s family quality of life. Early surgical decompression of the spinal canal remains one of the preferred options among physicians. Neuronal plasticity (NP) can take place after the initial injury and has been shown to be a complex process where the neurons use different adaptive strategies to regain their functions. In this article, we present a case of a 65-year-old male with a history of obesity and rheumatologic disease, who, without prior medical monitoring, presented with posterior cervical pain, right-sided hemicranial headache, and progressive right hemiparesis that advanced to severe quadriparesis. Magnetic resonance imaging (MRI) and computed tomography (CT) revealed a narrowed cervical canal with evidence of compressive myelopathy. During the second surgical intervention, Intraoperative Neurophysiological Monitoring (IONM) was performed, showing Motor Evoked Potentials (MEP) in the right hemibody following decompression. The patient experienced an early and successful recovery, regaining sensory and motor functions sooner than expected after the second decompression. Spinal cord injury (SCI) in adults is believed to cause definitive and non-treatable damage to the neurons. However, the presence of early MEP during the IONM and the rapid recovery of the patient after the surgical decompression demonstrated the potential for neuroplasticity and the opportunity to enhance it with different therapy strategies.