Intradiscal Injection of Minimally Manipulated Adipose Tissue for Disc-Driven Cervical Myelopathy: A Case Report With Three-Year Follow-Up

Cervical myelopathy is a progressive condition caused by spinal cord compression, for which surgical decompression is considered the standard treatment. However, alternative minimally invasive options are needed for patients who decline surgery. We report the case of a 53-year-old female who presented with progressive hand clumsiness, lower extremity weakness, and gait disturbance. She was diagnosed with cervical myelopathy at three tertiary referral centers, where surgical decompression was recommended, but she declined surgery. Imaging revealed a multilevel disc protrusion with spinal cord compression and signal change. An initial fluoroscopy-guided provocative discography with contrast was performed at C4-5, C5-6, and C6-7. No fluoroscopic evidence of extra-annular leakage was observed. Following intradiscal confirmation, lidocaine was administered as part of the diagnostic procedure, which reproduced the patient’s typical symptoms at C4-5 and C5-6 and was followed by temporary symptom relief, thereby identifying the clinically relevant segments. Subsequently, minimally manipulated adipose tissue (MFAT) was injected into the C4-5 and C5-6 discs under fluoroscopic guidance. At six months, follow-up radiographs suggested possible partial restoration of disc space height at the treated levels, although this observation was qualitative and may have been influenced by positional variation. Clinically, the visual analog scale (VAS) improved from 8 to 3, the Neck Disability Index (NDI) improved from 28 to 7, and the modified Japanese Orthopaedic Association (mJOA) score improved from 14 to 18 at one year. Sustained clinical improvement was observed at three-year follow-up. This case suggests that intradiscal MFAT injection may provide sustained clinical improvement, with possible qualitative radiographic interval change, in cervical myelopathy when disc protrusion is the primary contributing factor, and may represent a potential minimally invasive alternative in carefully selected patients who decline surgical intervention.