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The presentation of malignant spinal cord compression (SCC) can be non-specific, however, benign processes are less frequently suspected in patients with known bony meta-stases presenting with symptoms of SCC. The present report describes the case of a 78-year-old woman with known multi-level vertebral column metastases from non-small cell lung cancer (NSCLC) who presented with symptoms and signs consistent with a malignant cervical SCC. Magnetic resonance imaging surprisingly revealed that the only area of spinal cord compromise was a discrete segment of myelomalacia at the C5/C6 levels adjacent to some chronic posterior longitudinal ligament hypertrophy that had not been appreciated on computed tomography or fluorodeoxyglucose positron-emission tomography-computed tomography. The patient later disclosed a remote history of neck injury sustained during a motor vehicle accident that explained the new finding. This report highlights the importance of thorough work-up for patients with suspected malignant SCC and the need to consider both benign and malignant etiologic processes in its differential diagnosis. This is the first reported case of benign myelomalacia mimicking malignant SCC in a patient with metastatic NSCLC.

Benign myelomalacia mimicking malignant spinal cord compression in a patient with metastatic non-small cell lung carcinoma: a case report