Cervical disc herniation presenting with neck pain and contralateral symptoms: a case report

Cervical disc herniation presenting with contralateral radiculopathy: A case report

INTRODUCTION

Cervical disc herniation, which often results in ipsilateral upper extremity pain corresponding with the side of herniation, is rarely reported to cause contralateral radiculopathy.

CASE PRESENTATION

A 53-year-old man presented to our hospital with left upper arm pain radiating to his left hand. On physical examination, there was hypesthesia in the left thumb, index, and middle finger. Muscle strength was 4 in the left arm and 5 in the other extremities. Hoffmann sign and Babinski's test were negative. The Spurling maneuver gave a positive result on the left side. Computed tomography and magnetic resonance imaging revealed right-sided disc herniation at C4-C5 and C5-C6. The patient received different kind of non-operative therapy but no obvious improvement was achieved. Anterior cervical discectomy and fusion were performed at C4-C5 and C5-C6. The patient reported resolution of all the symptoms immediately after surgery. The patient was followed up for 2 years without pain bothering.

CLINICAL DISCUSSION

Cervical disc herniation causing contralateral symptoms are extremely rare. When it comes to the pathophysiology of contralateral radiculopathy in cervical disc herniation, no definite conclusion can be given. When surgery is considered, any other possible diagnosis should be excluded, and physical examination should be performed carefully to confirm disc herniation is the origin of the pain.

CONCLUSION

Although extremely rare, cervical disc herniation may cause contralateral radiculopathy. If other diagnosis is excluded and cervical disc herniation is thought the only possible origin of the pain, surgery can be considered.

Spinal artery syndrome following kyphoplasty in the setting of a non-compressive extradural cement extravasation: a case report

INTRODUCTION

Cement extravasation (CE) during vertebroplasty or kyphoplasty for vertebral compression fracture (VCF) is not uncommon, though neurological deficits occur rarely and when paraparesis occurs severe cord compression has been described. We report a case of progressive paraparesis in the setting of non-compressive extradural CE during kyphoplasty with evidence for spinal artery syndrome and neurological recovery after treatment.

CASE PRESENTATION

A 77-year-old female with T12 VCF failed conservative treatment and underwent kyphoplasty. In the recovery room, the patient was noted to have bilateral leg weakness, left worse than right, and had urgent CT scan that showed right paracentral CE without cord compression or arterial cement embolization. The patient was transferred to a tertiary hospital and had MRI of the spine that confirmed extradural CE and no cord compression. Because the patient had progression of lower extremity deficits despite medical management, she underwent surgical decompression, cement excision, and spinal fusion with instrumentation. Post op MRI showed T2 hyperintensities in the spinal cord consistent with spinal artery syndrome. One month post op, she had almost complete recovery of her neurological function.

DISCUSSION

Spinal artery syndrome may be considered in patients with neurological deficit s/p kyphoplasty even if the extravasated cement does not compress the spinal cord and even if the deficits are worse contralateral to the cement extravasation. If spinal artery syndrome is present and medical management does not improve the deficits, surgery may be indicated even if there is no cord compression.

Paradoxical contralateral hemiparesis in spontaneous spinal epidural hematoma: a case report

BACKGROUND

Hemiparesis associated with spontaneous spinal epidural hematoma (SSEH) usually occurs ipsilateral to the hematoma. We here report the case of a patient with paradoxical hemiparesis contralateral to a spinal lesion due to SSEH.

CASE PRESENTATION

A 70-year-old woman was identified in routine clinical practice; she presented with acute-onset neck pain and left hemiparesis. Neurological examination showed left-sided sensory-motor hemiparesis without facial involvement. Cervical MRI showed a dorsolateral epidural hematoma compressing the spinal cord at the C2 to C3 level. Axial imaging demonstrated a crescent hematoma on the right side, which is contralateral to the hemiparesis, and lateral displacement of the spinal cord. Spinal angiography revealed no abnormal vessels. Based on clinical presentation and MRI findings, a diagnosis of SSEH was made. The patient was managed conservatively. The symptoms completely resolved without any neurological deficits, and the hematoma disappeared on the follow-up MRI.

CONCLUSIONS

Paradoxical contralateral hemiparesis is one of the possible presenting symptoms in patients with SSEH. This case demonstrates the existence of the paradoxical contralateral hemiparesis associated with spinal compressive lesions. A plausible mechanism of the phenomenon is discussed.

Effectiveness of Multicentric Therapy Post Posterior Cervical Decompression and Fusion for Cervical Disc Disease: A Case Report

In clinical practice, cervical disc abnormalities such as herniated nucleus pulposus (HNP), degenerative disc disease (DDD), and internal disc disturbance are seen. DDD includes degeneration causing annular tears, a decrease in disc height, and nuclear degradation. Cervical stenosis with myelopathy can be caused by anything that narrows the spinal canal and compresses the spinal cord, such as bone spurs, herniated discs, or bulging ligaments.

Posterior cervical decompression and fusion (PCDF) is a standard surgical treatment for treating numerous cervical spine diseases. It has been suggested that more intensive and structured physiotherapy is required to improve clinical outcomes with regard to long-term activity restrictions and participation restrictions and deficits in patients’ physical abilities relating to their neck post-surgery. In this case study a patient presented with complaints of upper back pain with a tingling sensation in the bilateral upper limbs for one year and was diagnosed with cervical disc disease with degenerative changes in the cervical spine along with disc bulges at C3-C4, C4-C5, C5-C6 levels causing severe spinal canal stenosis at C3-C4, C4-C5 disc levels and radiculopathy and then underwent a spinal fusion with posterior decompression surgery at the C4-C5-C6 level.

After surgery, the patient was started with physiotherapy rehabilitation which was planned for 12 weeks. Outcome measures that were included to record the recovery of the patient are Neck Disability Index (NDI) and the Numeric Pain Rating Scale (NPRS). Physiotherapy rehabilitation following posterior cervical spine decompression and fusion surgery for cervical disc disease has been proven to be beneficial in restoring the Range of Motion (ROM), and muscular strength of the bilateral upper limbs, reducing pain, and helping the patient get back to performing activities of daily living (ADLs) independently.

Single level anterior cervical discectomy and fusion in multilevel herniated disc, a case report

Introduction

In managing cervical disc herniation, several treatment options are available. Anterior cervical decompression and fusion (ACDF) remain the gold standard in symptomatic cervical disc herniation. However, multilevel ACDF could diminish the motion of the segment. We planned to salvage the movement by only using single-level ACDF in our patient and osteophyte removal to reduce compression caused by spurs formation related to the herniated nucleus.

Methods

A male patient, 43 years old, came with a chief complaint of neck pain three months ago. The pain was intermittent, radiated into both hands. There was midline tenderness, and his sensation was decreased from the level of C5 below. We managed to diagnose the patient with Cervical Herniated Disc (CHD) using MRI and performed single-level ACDF.

Results

After the operation, osteophyte formation was safely removed, the pain and the tingling sensation was no longer felt. The VAS score was reduced from 4 to 1. We observed good spinal fusion in the post x-ray imaging.

Conclusion

Anterior cervical discectomy and fusion after osteophyte removal proved successful for our patient treatment, with improvement from neck and arms symptoms. However, longer-term evaluation needs to be planned further to assess the result and possible complications of single-level ACDF.

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Cervical disc herniation can be treated by several options, one of which is anterior cervical decompression and fusion (ACDF).

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Multilevel ACDF diminish the motion of the segment of the cervical, therefore we planned single level ACDF for our patient.

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Single level ACDF with osteophyte removal could be one of the option for cervical disc herniation.

Chameleons, red herrings, and false localizing signs in neurocritical care

False localizing signs (FLS) and other misleading neurological signs have long been an intractable aspect of neurocritical care. Because they suggest an incorrect location or etiology of the pathological lesion, they have often led to misdiagnosis and mismanagement of the patient. Here, we reviewed the existing literature to provide an updated, comprehensive descriptive review of these difficult to diagnose signs in neurocritical care. For each sign presented, we discuss the non-false localizing presentation of symptoms, the common FLS or misleading presentation, etiology/pathogenesis of the sign, and diagnosis, as well as any other clinically relevant considerations. Within cranial neuropathies, we cover cranial nerves III, IV, V, VI, VII, VIII, as well as multiple cranial nerve involvement of IX, X, and XII. FLS ophthalmologic symptoms indicate diagnostically challenging neurological deficits, and here we discuss downbeat nystagmus, ping-pong-gaze, one-and-a-half syndrome, and wall-eyed bilateral nuclear ophthalmoplegia (WEBINO). Cranial herniation syndromes are integral to any discussion of FLS and here we cover Kernohan's notch phenomenon, pseudo-Dandy Walker malformation, and uncal herniation. FLS in the spinal cord have also been relatively well documented, but in addition to compressive lesions, we also discuss newer findings in radiculopathy and disc herniation. Finally, pulmonary syndromes may sometimes be overlooked in discussions of neurological signs but are critically important to recognize and manage in neurocritical care, and here we discuss Cheyne-Stokes respiration, cluster breathing, central neurogenic hyperventilation, ataxic breathing, Ondine's curse, and hypercapnia. Though some of these signs may be rare, the framework for diagnosing and treating them must continue to evolve with our growing understanding of their etiology and varied presentations.

Materials for the Spine: Anatomy, Problems, and Solutions

Disc degeneration affects 12% to 35% of a given population, based on genetics, age, gender, and other environmental factors, and usually occurs in the lumbar spine due to heavier loads and more strenuous motions. Degeneration of the extracellular matrix (ECM) within reduces mechanical integrity, shock absorption, and swelling capabilities of the intervertebral disc. When severe enough, the disc can bulge and eventually herniate, leading to pressure build up on the spinal cord. This can cause immense lower back pain in individuals, leading to total medical costs exceeding $100 billion. Current treatment options include both invasive and noninvasive methods, with spinal fusion surgery and total disc replacement (TDR) being the most common invasive procedures. Although these treatments cause pain relief for the majority of patients, multiple challenges arise for each. Therefore, newer tissue engineering methods are being researched to solve the ever-growing problem. This review spans the anatomy of the spine, with an emphasis on the functions and biological aspects of the intervertebral discs, as well as the problems, associated solutions, and future research in the field.

Cervical disc herniation causing Brown-Sequard syndrome: Case report and review of literature (CARE-compliant)

RATIONALE

Brown-Sequard syndrome (BSS) is manifested as ipsilateral motor deficit and contralateral sensory loss. BSS caused by herniated cervical disc is extremely rare and easily be misdiagnosed, and clinical features of this problem were not fully understood.

PATIENT CONCERNS

A 57-year-old man presented with a 3-month history of weakness in his right arm, and he experienced progressive right hemiparesis at 2 days before admission, along with contralateral deficit in sensation of pain and temperature below T2.

DIAGNOSES

Magnetic Resonance Imaging (MRI) showed severe cord compression due to a large paracentral extradural C4-C5 cervical disc herniation (CDH).

INTERVENTIONS

Subtotal cervical corpectomy, decompression, and fusion through anterior approach were performed. The patient recovered rapidly after surgery.

OUTCOMES

Complete recovery of sensory and motor functions was obtained at a 4-months follow-up after surgery.

LESSONS

Our case, along with a review of the literature, highlights that careful medical history inquiries, detailed neurologic examinations, and cervical spinal MRI scans are essential for diagnosis of CDH caused BSS. Prompt surgical decompression according to individual condition is commonly warranted. Early diagnosis with prompt surgical decompression could lead to favorable recovery.

A Comparison of the Quality of Sleep between Pre and Post-Surgery Cervical Herniated Nucleus Pulposus Patients Utilizing the Anterior Discectomy Method

BACKGROUND

Herniated Nucleus Pulposus (HNP) is the prolapse of the intervertebral disk through a tear in the annulus fibrosus. This causes nerve root compression with clinical pain manifestation and affects the quality of sleep.

AIM

The aim of this study was find out the comparison in the quality of sleep between before (pre) and after (post) surgery cervical HNP patients.

METHODS

This study was a retrospective cohort study. Ninety patients were asked to complete the Pittsburgh Sleep Quality Index (PSQI) questionnaire. All data which has been computed were analysed with the McNemar test.

RESULT

The outcome reveals that from 90 patient`s cervical HNP, 81 (90%) were 40 years old age group and 66 (73.3%) of them were women. The result showed that 66 (73.3%) patients have a bad sleep quality before surgery. Surgery has increased the quality of sleep after surgery 66 (73.3%) patients had good sleep quality. There was a significant difference in the quality of sleep pre and post operation (p = 0.001).

CONCLUSION

There was a significant difference in the quality of sleep between pre and post operation cervical HNP patient utilising anterior discectomy methods.

Shoulder Pain-Is It From the Shoulder, Neck, or Both?

A thorough history and physical examination, revisited on subsequent follow-up, was necessary to properly diagnose pain emanating from both the shoulder and upper arm.