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Oshina M, Kawamura N, Tachibana N, Higashikawa A, Ono T, Takeshita Y, Okazaki R, Fukushima M, Iwai H, Kato S, Matsubayashi Y, Taniguchi Y, Tanaka S, Oshima Y. Comparison of surgical outcomes for cervical radiculopathy by nerve root level. Sci Rep 2024; 14:18891. [PMID: 39143150 PMCID: PMC11324647 DOI: 10.1038/s41598-024-69843-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/09/2024] [Indexed: 08/16/2024] Open
Abstract
Cervical radiculopathy might affect finger movement and dexterity. Postoperative features and clinical outcomes comparing C8 radiculopathies with other radiculopathies are unknown. This prospective multicenter study analyzed 359 patients undergoing single-level surgery for pure cervical radiculopathy (C5, 48; C6, 132; C7, 149; C8, 30). Background data and pre- and 1-year postoperative neck disability index (NDI) and numerical rating scale (NRS) scores were collected. The C5-7 and C8 radiculopathy groups were compared after propensity score matching, with clinical significance determined by minimal clinically important differences (MCID). Postoperative arm numbness was significantly higher than upper back or neck numbness, and arm pain was reduced the most (3.4 points) after surgery among the C5-8 radiculopathy groups. The C8 radiculopathy group had worse postoperative NDI scores (p = 0.026), upper back pain (p = 0.042), change in arm pain NRS scores (p = 0.021), and upper back numbness (p = 0.028) than the C5-7 group. NDI achieved MCID in both groups, but neck and arm pain NRS did not achieve MCID in the C8 group. In conclusion, although arm numbness persisted, arm pain was relieved after surgery for cervical radiculopathy. Patients with C8 radiculopathy exhibited worse NDI and change in NRS arm pain score than those with C5-7 radiculopathy.
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Affiliation(s)
- Masahito Oshina
- Department of Orthopedic Surgery, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
| | - Naohiro Kawamura
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-2, Hiroo, Shibuya-Ku, Tokyo, 150-8935, Japan
| | - Naohiro Tachibana
- Department of Orthopedic Surgery, Musashino Red Cross Hospital, 1-26-1, Kyonancho, Musashino, Tokyo, 180-0023, Japan
| | - Akiro Higashikawa
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, 1-1, Kizukisumiyoshi-Cho, Nakahaha-Ku, Kawasaki, Kanagawa, 211-8510, Japan
| | - Takashi Ono
- Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, 5-1, Tsukudo-Cho, Shinjuku-Ku, Tokyo, 162-8543, Japan
| | - Yujiro Takeshita
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, 3211, Kozukue-Cho, Kohoku-Ku, Yokohama, Kanagawa, 222-0036, Japan
| | - Rentaro Okazaki
- Department of Orthopedic Surgery, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Masayoshi Fukushima
- Department of Orthopedic Surgery, Toranomon Hospital, 2-2-2, Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Hiroki Iwai
- Inanami Spine and Joint Hospital, 3-17-5, Higashishinagawa, Shinagawa-Ku, Tokyo, 140-0002, Japan
| | - So Kato
- Department of Orthopaedic Surgery, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
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Broekema AEH, de Souza NFS, Groen RJM, Soer R, Reneman MF, Kuijlen JMA, van Asselt ADI. Cost-effectiveness of posterior versus anterior surgery for cervical radiculopathy: results from a multicentre randomised non-inferiority trial (FACET). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:3087-3098. [PMID: 38847818 DOI: 10.1007/s00586-024-08340-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/14/2024] [Accepted: 05/26/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE For cervical nerve root compression, anterior cervical discectomy with fusion (anterior surgery) or posterior foraminotomy (posterior surgery) are safe and effective options. Posterior surgery might have a more beneficial economic profile compared to anterior surgery. The purpose of this study was to analyse if posterior surgery is cost-effective compared to anterior surgery. METHODS An economic evaluation was performed as part of a multicentre, noninferiority randomised clinical trial (Foraminotomy ACDF Cost-effectiveness Trial) with a follow-up of 2 years. Primary outcomes were cost-effectiveness based on arm pain (Visual Analogue Scale (VAS; 0-100)) and cost-utility (quality adjusted life years (QALYs)). Missing values were estimated with multiple imputations and bootstrap simulations were used to obtain confidence intervals (CIs). RESULTS In total, 265 patients were randomised and 243 included in the analyses. The pooled mean decrease in VAS arm at 2-year follow-up was 44.2 in the posterior and 40.0 in the anterior group (mean difference, 4.2; 95% CI, - 4.7 to 12.9). Pooled mean QALYs were 1.58 (posterior) and 1.56 (anterior) (mean difference, 0.02; 95% CI, - 0.05 to 0.08). Societal costs were €28,046 for posterior and €30,086 for the anterior group, with lower health care costs for posterior (€12,248) versus anterior (€16,055). Bootstrapped results demonstrated similar effectiveness between groups with in general lower costs associated with posterior surgery. CONCLUSION In patients with cervical radiculopathy, arm pain and QALYs were similar between posterior and anterior surgery. Posterior surgery was associated with lower costs and is therefore likely to be cost-effective compared with anterior surgery.
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Affiliation(s)
- A E H Broekema
- Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, Postal Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - N F Simões de Souza
- Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, Postal Box 30.001, 9700 RB, Groningen, The Netherlands
| | - R J M Groen
- Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, Postal Box 30.001, 9700 RB, Groningen, The Netherlands
| | - R Soer
- Department of Anaesthesiology, Groningen Pain Centre, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Research Group Smart Health, Saxion University of Applied Sciences, Enschede, The Netherlands
| | - M F Reneman
- Department of Rehabilitation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J M A Kuijlen
- Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, Postal Box 30.001, 9700 RB, Groningen, The Netherlands
| | - A D I van Asselt
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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3
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Simões de Souza NF, Broekema AEH, Reneman MF, Koopmans J, van Santbrink H, Arts MP, Burhani B, Bartels RHMA, van der Gaag NA, Verhagen MHP, Tamási K, van Dijk JMC, Groen RJM, Soer R, Kuijlen JMA. Posterior Cervical Foraminotomy Compared with Anterior Cervical Discectomy with Fusion for Cervical Radiculopathy: Two-Year Results of the FACET Randomized Noninferiority Study. J Bone Joint Surg Am 2024:00004623-990000000-01156. [PMID: 39047120 DOI: 10.2106/jbjs.23.00775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND Posterior cervical foraminotomy (posterior surgery) is a valid alternative to anterior discectomy with fusion (anterior surgery) as a surgical treatment of cervical radiculopathy, but the quality of evidence has been limited. The purpose of this study was to compare the clinical outcome of these treatments after 2 years of follow-up. We hypothesized that posterior surgery would be noninferior to anterior surgery. METHODS This multicenter, randomized, noninferiority trial assessed patients with single-level cervical radiculopathy in 9 Dutch hospitals with a follow-up duration of 2 years. The primary outcomes measured reduction of cervical radicular pain and were the success ratio based on the Odom criteria, and arm pain and decrease in arm pain, evaluated with the visual analog scale, with a 10% noninferiority margin, which represents the maximum acceptable difference between the new treatment (posterior surgery) and the standard treatment (anterior surgery), beyond which the new treatment would be considered clinically unacceptable. The secondary outcomes were neck pain, Neck Disability Index, Work Ability Index, quality of life, complications (including reoperations), and treatment satisfaction. Generalized linear mixed effects modeling was used for analyses. The study was registered at the Overview of Medical Research in the Netherlands (OMON), formerly the Netherlands Trial Register (NTR5536). RESULTS From January 2016 to May 2020, 265 patients were randomized (132 to the posterior surgery group and 133 to the anterior surgery group). Among these, 25 did not have the allocated intervention; 11 of these 25 patients had symptom improvement, and the rest of the patients did not have the intervention due to various reasons. At the 2-year follow-up, of 243 patients, primary outcome data were available for 236 patients (97%). Predicted proportions of a successful outcome were 0.81 after posterior surgery and 0.74 after anterior surgery (difference in rate, -0.06 [1-sided 95% confidence interval (CI), -0.02]), indicating the noninferiority of posterior surgery. The between-group difference in arm pain was -2.7 (1-sided 95% CI, 7.4) and the between-group difference in the decrease in arm pain was 1.5 (1-sided 95% CI, 8.2), both confirming the noninferiority of posterior surgery. The secondary outcomes demonstrated small between-group differences. Serious surgery-related adverse events occurred in 9 patients (8%) who underwent posterior surgery, including 9 reoperations, and 11 patients (9%) who underwent anterior surgery, including 7 reoperations (difference in reoperation rate, -0.02 [2-sided 95% CI, -0.09 to 0.05]). CONCLUSIONS This trial demonstrated that, after a 2-year follow-up, posterior surgery was noninferior to anterior surgery with regard to the success rate and arm pain reduction in patients with cervical radiculopathy. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nádia F Simões de Souza
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne E H Broekema
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan Koopmans
- Department of Neurosurgery, Martini Hospital Groningen, Groningen, The Netherlands
| | - Henk van Santbrink
- Care and Public Health Research Institute School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Heerlen, The Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mark P Arts
- Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands
| | - Bachtiar Burhani
- Department of Neurosurgery, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Niels A van der Gaag
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Neurosurgery, Haga Teaching Hospital, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Katalin Tamási
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Remko Soer
- Department of Anesthesiology, Groninger Pain Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- mProve Hospitals, Zwolle, The Netherlands
| | - Jos M A Kuijlen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Yoganandan N, Choi H, Purushothaman Y, Vedantam A, Harinathan B, Banerjee A. Comparison of Load-Sharing Responses Between Graded Posterior Cervical Foraminotomy and Conventional Fusion Using Finite Element Modeling. JOURNAL OF ENGINEERING AND SCIENCE IN MEDICAL DIAGNOSTICS AND THERAPY 2024; 7:021006. [PMID: 37860789 PMCID: PMC10583278 DOI: 10.1115/1.4063465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/23/2023] [Indexed: 10/21/2023]
Abstract
Following the diagnosis of unilateral cervical radiculopathy and need for surgical intervention, anterior cervical diskectomy and fusion (conventional fusion) and posterior cervical foraminotomy are common options. Although patient outcomes may be similar between the two procedures, their biomechanical effects have not been fully compared using a head-to-head approach, particularly, in relation to the amount of facet resection and internal load-sharing between spinal segments and components. The objective of this investigation was to compare load-sharing between conventional fusion and graded foraminotomy facet resections under physiological loading. A validated finite element model of the cervical spinal column was used in the study. The intact spine was modified to simulate the two procedures at the C5-C6 spinal segment. Flexion, extension, and lateral bending loads were applied to the intact, graded foraminotomy, and conventional fusion spines. Load-sharing was determined using range of motion data at the C5-C6 and immediate adjacent segments, facet loads at the three segments, and disk pressures at the adjacent segments. Results were normalized with respect to the intact spine to compare surgical options. Conventional fusion leads to increased motion, pressure, and facet loads at adjacent segments. Foraminotomy leads to increased motion and anterior loading at the index level, and motions decrease at adjacent levels. In extension, the left facet load decreases after foraminotomy. Recognizing that foraminotomy is a motion preserving alternative to conventional fusion, this study highlights various intrinsic biomechanical factors and potential instability issues with more than one-half facet resection.
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Affiliation(s)
| | - Hoon Choi
- Cleveland Clinic Florida, Weston, FL 33331
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Laskay NMB, Yang LC, Estevez-Ordonez D, Warner JD, Trahan D, Stone C, Grayson JW, Withrow K, Hadley MN. Early Voice and Swallowing Disturbance Incidence and Risk Factors After Revision Anterior Cervical Discectomy and Fusion Using a Multidisciplinary Surgical Approach: A Retrospective Cohort Evaluation of a Prospective Database. Neurosurgery 2024; 94:444-453. [PMID: 37830799 DOI: 10.1227/neu.0000000000002704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/01/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Dysphagia and vocal cord palsy (VCP) are common otolaryngological complications after revision anterior cervical discectomy and fusion (rACDF) procedures. Our objective was to determine the early incidence and risk factors of VCP and dysphagia after rACDF using a 2-team approach. METHODS Single-institution, retrospective analysis of a prospectively collected database of patients undergoing rACDF was enrolled from September 2010 to July 2021. Of 222 patients enrolled, 109 patients were included in the final analysis. All patients had prior ACDF surgery with planned revision using a single otolaryngologist and single neurosurgeon. MD Anderson Dysphagia Inventory and fiberoptic endoscopic evaluation of swallowing (FEES) were used to assess dysphagia. VCP was assessed using videolaryngostroboscopy. RESULTS Seven patients (6.7%) developed new postoperative VCP after rACDF. Most cases of VCP resolved by 3 months postoperatively (mean time-to-resolution 79 ± 17.6 days). One patient maintained a permanent deficit. Forty-one patients (37.6%) reached minimum clinically important difference (MCID) in their MD Anderson Dysphagia Inventory composite scores at the 2-week follow-up (MCID decline of ≥6), indicating new clinically relevant swallowing disturbance. Forty-nine patients (45.0%) had functional FEES Performance Score decline. On univariate analysis, there was an association between new VCPs and the number of cervical levels treated at revision ( P = .020) with long-segment rACDF (≥4 levels) being an independent risk factor ( P = .010). On linear regression, there was an association between the number of levels treated previously and at revision for FEES Performance Score decline ( P = .045 and P = .002, respectively). However, on univariate analysis, sex, age, body mass index, operative time, alcohol use, smoking, and individual levels revised were not risk factors for reaching FEES Performance Score decline nor MCID at 2 weeks postoperatively. CONCLUSION VCP is more likely to occur in long-segment rACDF but is often temporary. Clinically relevant and functional rates of dysphagia approach 37% and 45%, respectively, at 2 weeks postoperatively after rACDF.
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Affiliation(s)
- Nicholas M B Laskay
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Lydia C Yang
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | | | - Jeffrey D Warner
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Duane Trahan
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Caitlin Stone
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Jessica W Grayson
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Kirk Withrow
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Mark N Hadley
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
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Thomson S, Ainsworth G, Selvanathan S, Brown S, Croft J, Kelly R, Mujica-Mota R, Rousseau N, Higham R, Stocken D. Clinical and cost-effectiveness of PCF versus ACD in the treatment of cervical brachialgia (FORVAD trial). Br J Neurosurg 2024; 38:141-148. [PMID: 37807634 DOI: 10.1080/02688697.2023.2267119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Cervical radiculopathy occurs when a nerve root is compressed in the spine, if symptoms fail to resolve after 6 weeks surgery may be indicated. Anterior Cervical Discectomy (ACD) is the commonest procedure, Posterior Cervical Foraminotomy (PCF) is an alternative that avoids the risk of damage to anterior neck structures. This prospective, Phase III, UK multicentre, open, individually randomised controlled trial was performed to determine whether PCF is superior to ACD in terms of improving clinical outcome as measured by the Neck Disability Index (NDI) 52 weeks post-surgery. METHOD Following consent to participate and collection of baseline data, subjects with cervical brachialgia were randomised to ACD or PCF in a 1:1 ratio on the day of surgery. Clinical outcomes were assessed on day 1 and patient reported outcomes on day 1 and weeks 6, 12, 26, 39 and 52 post-operation. A total of 252 participants were planned to be randomised. Statistical analysis was limited to descriptive statistics. Health economic outcomes were also described. RESULTS The trial was closed early (n = 23). Compared to baseline, the median (interquartile range (IQR)) NDI score at 52 weeks reduced from 44.0 (36.0, 62.0) to 25.3 (20.0, 42.0) in the PCF group and increased from 35.6 (34.0, 44.0) to 45.0 (20.0, 57.0) in the ACD group. ACD may be associated with more swallowing, voice and other complications and was more expensive; neck and arm pain scores were similar. CONCLUSIONS The trial was closed early, therefore no definitive conclusions on clinical or cost-effectiveness could be made.
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Affiliation(s)
- Simon Thomson
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Senthil Selvanathan
- Academic Unit of Health Economics, Institute of Health Sciences, University of Leeds, UK
| | - Sarah Brown
- Clinical Trials Research Unit, University of Leeds, UK
| | - Julie Croft
- Clinical Trials Research Unit, University of Leeds, UK
| | - Rachel Kelly
- Clinical Trials Research Unit, University of Leeds, UK
| | | | | | - Ruchi Higham
- Clinical Trials Research Unit, University of Leeds, UK
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Brook I, Sirdar B, Stemer A. Cervical Radiculopathy Presenting as Ischemic Stroke After Carotid Artery Stent Placement. J Med Cases 2023; 14:387-392. [PMID: 38029053 PMCID: PMC10681767 DOI: 10.14740/jmc4162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
Abrupt loss of focal brain function is the main characteristic of the beginning of ischemic stroke. However, individuals with disorders other than stroke can also present with similar features. These conditions include seizure disorders, migraine, central nervous system abscess or tumor, head trauma, subdural hematoma, cerebral venous thrombosis, viral encephalitis, conversion reaction, hypertensive encephalopathy, multiple sclerosis, and spinal cord disorder. An 82-year-old man presented with a sudden onset of numbness in his left forearm in the distribution of C6 and C7 spinal nerves, 2 days after undergoing endarterectomy and stent placement in his right carotid artery because of stenosis. He was diagnosed with hypo-pharyngeal squamous cell carcinoma (T1, L0, M0) 17 years earlier (2006) which was treated with 70 Gy intensity-modulated radiotherapy (IMRT). The patient underwent stent insertion into his left carotid artery 3.5 years earlier because of 80% carotid artery stenosis. He was initially suspected to have an ischemic stroke. However, computed tomography angiography of the head and neck did not show stenosis or occlusion of the major intracranial arteries and no aneurysms were identified. It showed interval stenting of the cervical portion of the right carotid artery and stable appearance of left carotid artery stent. Both carotid artery stents and the vertebral arteries were patent. The cervical spine showed bilateral moderate to severe foramen stenosis in C3-C4 and C5-C6, and moderate to severe stenosis in the right C2-C3 and left C4-C5. His symptoms subsided after performing neck extension exercises. This is the first report of a patient whose cervical radiculopathy symptoms were suspected to be caused by ischemic stroke. The recent angioplasty and stent placement in the right carotid artery made the association more likely and had to be excluded. Clinicians should be aware that cervical radiculopathy could present as ischemic stroke. It is therefore important that disorders that cause symptoms similar to ischemic stroke are also considered in these individuals.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics, Georgetown University School of Medicine, and the Neurology Center, Washington DC, USA
| | - Bilaal Sirdar
- Department of Neurology, Georgetown University School of Medicine, and the Neurology Center, Washington DC, USA
| | - Andrew Stemer
- Department of Neurology, Georgetown University School of Medicine, and the Neurology Center, Washington DC, USA
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Helgeson MD, Pisano AJ, Fredericks DR, Wagner SC. What's New in Spine Surgery. J Bone Joint Surg Am 2023:00004623-990000000-00792. [PMID: 37141447 DOI: 10.2106/jbjs.23.00125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Melvin D Helgeson
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Alfred J Pisano
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Donald R Fredericks
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Scott C Wagner
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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