C4-C7 Spondylosis with Foraminal Stenosis
History
The patient is 58-year-old female. She's right-hand dominant. She presented with a one-year history of progressively worsening right-sided neck and arm pain. The pain radiates down her right arm in a C6 dermatomal distribution. She has associated paresthesias in her thumb and index finger.
Examination
The patient is 5’5” and weighs 130 pounds. She has limited range of motion with extension and right lateral bending/rotation. She has a positive Spurling’s test to the right side.
Manual motor testing: 4/5 right bicep, tricep, and wrist extension/wrist flexion.
The patient has decreased sensation in a right C6 dermatomal distribution.
She has VAS scores of 8/10 for the right arm and 3/10 for the neck.
Prior Treatment
The patient has tried oral medications, physical therapy, and epidural steroid injections (ESIs). A right C5-C6 transforaminal ESI resulted in notable relief of right arm pain during the anesthetic phase.
Pre-treatment Images
Diagnosis
The patient was diagnosed with C4-C7 spondylosis with foraminal stenosis.
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Selected Treatment
The patient had MIS C4-C7 laminoforaminotomies.
Intraoperative Images
Outcome
The patient reported relief of her neck and arm pain
Case Discussion
This patient presents with a C6 radiculopathy recalcitrant to non-operative management. Imaging studies demonstrate substantial degenerative disease, regional kyphosis, and multilevel foraminal stenosis.
In treating this patient, the key issue is to determine what is causing her symptoms. Given the classic C6 radiculopathy presentation and response to nerve root block, a C5-C6 MIS foraminotomy would be a viable option.
In the setting of myelopathy or debilitating neck pain, consideration of a more aggressive multilevel reconstructive procedure would be reasonable. Since this patient did not have myelopathy or debilitating neck pain, then a focal decompression without destabilizing the spine makes sense.
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