Neck Pain with Radiation into Right Radial Arm
The patient is a 43-year-old female with neck pain with radiation into the right radial arm, thumb and first finger, and ulnar forearm into small and ring fingers.
She has decreased pinprick in right C6 and C7 distribution
The patient has tried physical therapy, medications, traction, and epidural steroid injections, but she has not found relief.
The patient’s cervical spine x-rays were unremarkable.
Figure 1: Sagittal MRI showing disc bulges at C5-C6 and C6-C7
Figure 2: Axial MRI of C5-C6
Figure 3: Axial MRI of C6-C7
Central and lateral herniations at C5-C6 and C6-C7
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Right C5-C6 and C6-C7 foraminotomy was done minimally invasive. Based on the laterality of the disc herniations, this option was chosen.
Post-operatively, the patient had residual C7 radiculopathy which didn’t respond to physical therapy or epidural steroid injection. Evaluation myelogram CT revealed residual C6-C7 disc material.
A year later, C6-C7 ACDF was done.
The patient is doing well following ACDF.
This 43-year-old female presents with neck pain and right arm radiating pain to the radial forearm, thumb and index finger. She has decreased sensation in the right C6 and C7 nerve root distributions.
Additionally, the patient complains of C8 and/or ulnar nerve symptoms involving the ulnar forearm and fifth digit on the right side. Peripheral nerve evaluation is not reported.
The MRI reveals DDD of C5-C6 and C6-C7 with small disc herniations and osteophytes from 6 to 7 o’clock. Both neuroforamen at C5-C6 and C6-C7 are open. Symptom exacerbation with cervical extension, flexion and side-bending is not reported. Given these set of facts, one may surmise that the radial arm pain and altered sensation in the respective nerve roots are related to the disc herniation/osteophyte complexes at both levels.
The patient’s reported neck pain is most likely due to the cervical spondylosis. Electromygraphy/nerve conduction velocity evaluation of the bilateral upper extremities would be helpful to discern pathology from nerve root vs peripheral nerve (cubital tunnel syndrome). Given the patient’s neural findings, and persistent complaints with failure of conservative care, I would consider her a surgical candidate.
In my practice, microscope-assisted anterior cervical discectomy with instrumentation and fusion at the C5-C6 and C6-C7 levels would be considered for the constellation of neck pain and C6 and C7 radiculopathy. Structural allograft with anterior cervical locking plate would restore disc height and enhance segmental lordosis. Another more avant-garde treatment option may be to consider a 2-level anterior cervical disc replacement as a motion-sparing option, but I have no personal experience with this procedure.