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Archives of Allied Health Sciences, 32, 3, 58-67

Unilateral cervical nerve root compression causing radiculopathy, which does not improve with conservative measures, is safely and effectively treated with surgery. Both anterior and posterior approaches have been described. Overall results from either of these broad categories of approaches are equivalent. Posterior approaches target the cervical root compression directly and allow decompression by widening the neural foramen and/or removing a lateral disc fragment. Following success of the open technique, variations of this technique were introduced to minimize approach-related complications.

Retrospective cohort study.To compare clinical outcomes after anterior cervical discectomy and fusion (ACDF) based on preoperative duration of radiculopathy symptoms.There is no clear indication of when outcomes after ACDF become less effective in the setting of acute versus chronic symptoms from cervical nerve root compression.A retrospective cohort study of consecutive patients who underwent an ACDF between 2008 and 2015 for radiculopathy was performed. Patients were divided into 3 groups: radicular symptoms lasting for6 months, symptoms lasting for 6-12 months, and those with symptoms for ≥12 months. Neck Disability Index (NDI) and Visual Analog Scale (VAS) scores for both the neck and arms were obtained at preoperative and final postoperative visits. Radiographs were assessed for adjacent segment degeneration, fusion, and subsidence. Bivariate and multivariate regressions were subsequently used to compare outcomes between groups.A total of 379 patients were included. Patients with symptoms lasting for 6-12 months and those with symptoms lasting for ≥12 months had worse preoperative VAS neck pain compared with patients with symptoms lasting for6 months (P=0.000 and P=0.004, respectively). Patients with symptoms lasting for ≥12 months had worse baseline functional status compared with patients with symptoms lasting for6 months (P=0.009). At final follow-up, there were no significant differences in VAS neck, VAS arm, or NDI between symptom duration groups. However, differences in outcomes were noted when considering the type of preoperative symptom. Patients with pain symptoms of ≥12 months had worse preoperative VAS neck (P=0.001), VAS arm (P=0.008), and NDI (P0.001) and had significantly worse final VAS arm (P=0.019) and NDI (P=0.016) compared with patients with preoperative pain symptoms lasting for6 months. The overall reoperation rate was 4.5%. Fusion was achieved in 97.6% of the patients, and subsidence was observed in 5.5%. There were no significant differences in the risk of adjacent segment degeneration, reoperations, fusion rates, or subsidence rates based on preoperative symptom duration.Despite worse preoperative neck pain and functional status in patients with preoperative duration of symptoms6 months, there were no differences in final clinical outcomes across groups.

Posterior cervical foraminotomy is an effective surgical treatment method for relieving radicular symptoms that result from cervical nerve root compression. Minimally invasive techniques and tubular retractor systems are available to minimize tissue retraction, but minimally invasive approaches can carry with them the surgical challenge of trying to pass instruments through a long narrow retractor that is also the port for visualizing the surgical pathology. Herein, the authors present a case of a 65-year-old man who presented with symptoms of a left C6 and C7 radiculopathy and left C5-6 and left C6-7 foraminal narrowing on MRI. A minimally-invasive fully endoscopic left C5-6 and C6-7 posterior foraminotomy was performed through a 1cm outer diameter working channel endoscopic with a 6 mm working channel. Clinicians should be aware that new minimally invasive non-fusion approaches for the treatment of cervical radiculopathy that utilize endoscopic visualization are now coming into use in clinical practice.

The relationship of pain relief from a recently presented CT-guided indirect cervical nerve root injection with local anesthetics and steroids to surgical decompression as a treatment for single-level cervical radiculopathy is not clear. This retrospective study aimed to compare the immediate and 6-week post-injection effects to the short- and long-term outcomes after surgical decompression, specifically in regard to pain relief. Patients (n = 39, age 47 ± 10 years) who had undergone CT-guided indirect injection with local anesthetics and steroids as an initial treatment for single cervical nerve root radiculopathy and who subsequently needed surgical decompression were included retrospectively. Pain levels (VAS scores) were monitored before, immediately after, and 6 weeks after injection (n = 34), as well as 6 weeks (n = 38) and a mean of 25 months (SD ± 12) after surgical decompression (n = 36). Correlation analysis was performed to find potential associations of pain relief after injection and after surgery to investigate the predictive value of post-injection pain relief. There was no correlation between immediate pain relief after injection (−32 ± 27 %) and 6 weeks later (−7 ± 19 %), (r = −0.023, p = 0.900). There was an association by tendency between immediate pain relief after injection and post-surgical pain relief at 6 weeks (−82 ± 27 %), (r = 0.28, p = 0.08). Pain relief at follow-up remained high at −70 ± 21 % and was correlated with the immediate pain amelioration effect of the injection (r = 0.37, p = 0.032). Five out of seven patients who reported no pain relief from injection had a pain relief from surgery in excess of 50 %. The amount of immediate radiculopathic pain relief after indirect cervical nerve root injection is associated with the amount of pain relief achieved at long-term follow-up after surgical decompression of single-level cervical radiculopathy. Patients can still expect sufficient pain relief from surgery even if they did not respond to the cervical infiltration.

Neck pain can originate from any number of factors. Perhaps the most difficult symptom complex to resolve is axial neck pain arising from upper cervical nerve root compression. The purpose of this study is to report the results of surgical intervention in a series of patients with neck pain from C4 radiculopathy. Twelve consecutive patients who were diagnosed with C4 radiculopathy were retrospectively reviewed (follow-up, 22+/-16.3 months). Patients underwent either anterior cervical discectomy and fusion or posterior laminoforaminotomy at the C3-C4 segment. The results show that a good to excellent clinical result can be achieved in most patients (92% in our series). The importance of identifying patients with C4 radiculopathy lies in the fact that surgery can alter the natural history of neck pain secondary to upper cervical root radiculopathy, unlike axial neck pain from degenerative disk disease.

Cervical radiculopathy is a condition caused by the compression of a nerve root in the cervical spine. Among the various pathologies which affect the nerve root, degenerative processes of the spine are the most common. In the 1920s, two degenerative changes, spondylotic spur and disc herniation, were first recognized as causes of cervical radiculopathy. In 1926, Elliot described how radicular symptoms could arise through narrowing of the intervertebral foramen secondary to spur formation in either the Luschka or zygoapophyseal joint. ~ In 1928, Stookey described a clinical syndrome of cervical nerve root compression caused by herniated masses, although he mistakenly identified them as extradural chondromas. 2 It is now well known that cervical radiculopathy is one of the most common lesions causing neurological symptoms and signs related to the spine. We describe the clinical features, management and unsolved problems of cervical radiculopathy based on our experience.

The burner syndrome is the result of two distinct injury patterns: brachial plexus stretch injury and cervical nerve root compression. This clinical entity is discussed with emphasis on diagnosis and management. A review of the literature is included.

A 35-year-old woman presented with 10 years of stabbing pain in her neck and upper back above her right scapula, sometimes radiating into both arms. Examination results were normal. Somatosensory evoked potentials showed significantly prolonged latency of the right …

Relationships between nerve root compression, behavioral sensitivity, spinal cytokines, and glial reactivity are not fully defined for painful cervical nerve root compression. Spinal cytokines were quantified after mechanical root compression (10gf), root exposure to inflammatory chromic gut material (chr), the combination of both insults together (10gf + chr) or sham. TNFalpha and IL-1beta significantly increased at 1 h (p0.029). IL-1alpha was significantly increased over normal, sham and chr at 1 h following 10gf and over normal and sham after 10gf + chr (p0.048). By day 1, only IL-1beta after 10gf remained elevated over normal (p = 0.038). Accordingly, the soluble TNF receptor-1 (sTNFR1) and the IL-1 receptor antagonist (IL-1ra) were separately administered at early time points after each injury. With sTNFR1, behavioral sensitivity was significantly decreased for 7 days after both 10gf and 10gf + chr (p0.005). Treatment with IL-1ra significantly reduced sensitivity for 10gf + chr (p0.034) but not for 10gf. Sensitivity remained significantly elevated over sham at all time points (p0.044). Spinal astrocytic reactivity significantly decreased for both treatments after 10gf (p0.002); but, only IL-1ra following 10gf + chr significantly reduced astrocytic reactivity (p0.001). Early increases in spinal TNFalpha, IL-1beta, and IL-1alpha may induce pain, affect spinal astrocytic responses, and appear to have differential effects in mediating the behavioral hypersensitivity produced by different types of painful cervical radicular injuries.

Cervical radiculopathy secondary to compression from congenital anomalous vertebral arteries (VAs) is a known entity. Patients present with a variety of symptoms ranging from upper-extremity numbness to true occipital neuralgia. Treatment options for extracranial tortuous VAs include conservative management or some form of surgical microvascular decompression (MVD). The authors report on a patient with a congenital anomalous VA loop causing cervical nerve root compression. Successful MVD was conducted with relief of the patient's symptoms. A novel sling technique was used for mobilization of the VA. To the authors' knowledge, this is the first MVD described utilizing this technique.

Lesions affecting the roots of the cervical plexus can cause a syndrome not previously described. The C3-C4 disc space is the most likely to be involved, but pressure on the C5 root can also produce facial, auricular, or retroauricular pain. Motor innervation to the diaphragm can be affected, and even the uppermost disc space at C2-C3 might be implicated. Findings on examination findings are sparse, although sensory impairment in areas of cervical plexus innervation has been observed. In a series of 1000 cervical decompression cases (both anterior and posterior); for disc disease or similar processes, only 10 instances of this syndrome have been found. Paresthesia or episodic shock-like pain affecting the ear, para-auricular, lower occipital, and mandibular areas prompted by head turning or extension are the most common complaints.

The posterior surgical approach to nerve root compression remains a safe, effective method of relieving the pain of cervical nerve root compression and of restoring function. Myelopathy, often caused by extensive cervical spondylosis associated with a small cervical canal, may be reversed or alleviated by adequate posterior decompression.

After many years of unsuccessful conservative treatment 16 patients suffering from hemicrania are relieved of their pain or are improved by operative treatment. Hemicranial attacks or permanent hemicrania is found to be caused by upper cervical nerve root compression. Vascular compression of C2 ( n = 9) or scar tissue surrounding C2 ( n = 1) or C3 ( n = 1) is the pathology identified in cases of cervicogenic headache or “cluster headache-like” headache. Compression attributable to tumor, prolapsed disc, or spondylotic changes is found to be a cause of permanent headache. Only in those patients with permanent headache are radiological or electrophysiological findings helpful for diagnosis. In patients with hemicranial attacks and compression of nerve root C2 ( n = 10) or C3 ( n = 1), only vasoactive tests (provoking or relieving pain) or local anaesthesia prove to be helpful in diagnosing and localizing the origin of pain. The operation involves freeing the nerve roots from vascular compression. In two patients the C2 ganglion is resected. Thirteen patients subsequently become pain free. In three patients, hemicrania improves. Four of the 16 patients experience a recurrence of pain after the decompressive operation. After additional thermorhizotomy two patients have no further complaints and one patient has improved. One patient can tolerate his pain with occasional analgesics. The problem of referred pain into the fronto-ocular region is discussed.

We report on 40 patients operated on because of a cervical radiculomyelopathy since October 1977. Surgical intervention was indicated on account of definite radicular deficit with or without spinal syndromes. In 90% of the cases, the segmental clinical findings were verified by electromyography.