John E O'Toole1, Ty J Olson, Michael G Kaiser. 1. Department of Neurological Surgery, The Neurological Institute, Columbia-Presbyterian Medical Center, New York, New York 10032, USA.
Abstract
STUDY DESIGN: A case of surgical management of dissociated motor loss after decompression of the cervical spine is reported. OBJECTIVES: To present a rationale for surgical treatment of postdecompressive cervical radiculopathy with an illustrative case example. SUMMARY OF BACKGROUND DATA: The unusual complication of radiculopathy after multilevel cervical decompressive procedures is characterized by pain or dissociated motor weakness of the C5 and C6 nerve roots. Conservative management paradigms, including analgesics and steroids, are the rule, but symptoms often persist for many months. There are currently no reports describing foraminotomy as a means of more rapidly alleviating the symptoms of radicular pain and deltoid and biceps brachii weakness seen in the postoperative setting. METHODS: We present a case of bilateral C5 and C6 radiculopathy following multilevel cervical decompression for cervical spondylotic myelopathy, which we treated with posterior foraminotomies. RESULTS: The patient reported complete resolution of his dermatomal pain and demonstrated rapid improvement in upper extremity strength as compared to traditional conservative treatments. The historical experience and pathogenesis regarding this postoperative complication are reviewed. The rationale of root-specific posterior decompression for this debilitating complication is discussed. CONCLUSIONS: Foraminal decompression of the affected nerve roots as demonstrated here has not been described for postdecompressive dissociated motor loss. Such an approach may offer earlier and more complete relief to patients suffering from this unfortunate complication.
STUDY DESIGN: A case of surgical management of dissociated motor loss after decompression of the cervical spine is reported. OBJECTIVES: To present a rationale for surgical treatment of postdecompressive cervical radiculopathy with an illustrative case example. SUMMARY OF BACKGROUND DATA: The unusual complication of radiculopathy after multilevel cervical decompressive procedures is characterized by pain or dissociated motor weakness of the C5 and C6 nerve roots. Conservative management paradigms, including analgesics and steroids, are the rule, but symptoms often persist for many months. There are currently no reports describing foraminotomy as a means of more rapidly alleviating the symptoms of radicular pain and deltoid and biceps brachii weakness seen in the postoperative setting. METHODS: We present a case of bilateral C5 and C6 radiculopathy following multilevel cervical decompression for cervical spondylotic myelopathy, which we treated with posterior foraminotomies. RESULTS: The patient reported complete resolution of his dermatomal pain and demonstrated rapid improvement in upper extremity strength as compared to traditional conservative treatments. The historical experience and pathogenesis regarding this postoperative complication are reviewed. The rationale of root-specific posterior decompression for this debilitating complication is discussed. CONCLUSIONS: Foraminal decompression of the affected nerve roots as demonstrated here has not been described for postdecompressive dissociated motor loss. Such an approach may offer earlier and more complete relief to patients suffering from this unfortunate complication.