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A 58-year-old woman presented with a 6-month history of progressive dysesthesias and weakness involving her hands as well as ambulatory dysfunction. She described a diffuse “tight band” of pain around her upper abdomen. There was no bladder dysfunction. Her history revealed systemic scleroderma diagnosed in 2001 characterized by Raynaud phenomenon, esophageal dysmotility, pulmonary involvement resulting in pulmonary hypertension, and calcinosis cutis. There was no history of trauma or intervertebral disc disease. She was on immunosuppression with methotrexate and mycophenolate. Pulmonary hypertension was treated with bosentan.

Clinical Reasoning: A 58-year-old woman with systemic scleroderma and progressive cervical cord compression