26th August 2024

A 45-year-old man presents to clinic having been referred by his GP for a two-month history

A 45-year-old man presents to clinic having been referred by his GP for a two-month history of progressive severe neck pain. This radiates up to his occiput and down his spine and has been progressively worsening despite his GP escalating analgesia. More recently, he has noticed numbness and tingling in his arms, along with clumsiness and progressive weakness. You noted as he walked into the room that his gait was mildly spastic, and indeed on examination, he has mild spasticity in both lower limbs. He has a background of hypertension, type 2 diabetes mellitus, severe rheumatoid arthritis and asthma. His father died of a heart attack aged 67 and his mother is alive and well. He lives with his wife and 2 small children and works as a painter and decorator. He smokes 10 cigarettes a day and does not drink. He denies recreational drug use.

You refer him for an MRI, which is reported as showing narrowing of the lumbar canal contacting the cord with an increased atlantoaxial distance with posterior subluxation of the dens. There is only mild degenerative disease of the cervical spine in keeping with age.

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.