High Cervical Disc Herniation in Young Patient, Case Report and Review of the Literature

Abstract

Case Presentation: High cervical disc herniation (C2–C3) is extremely rare particularly in young patients, and various approaches has been used to treat C2–C3. In this report, we presented a young patient with C2-3 extruded cervical disc herniation with radiculopathy. A 46-year-man was admitted to the hospital with a 3 months history of progressive neck and occipital pain after head trauma. After trauma he had admitted to our hospital for right arm weakness. The neurologic examination, power of flexion and extension of the right elbow and grasping of the right hand was decreased. Hoffmann sign was positive in both hands. Magnetic resonance imaging of the cervical spine revealed that right paramedian, extruded C2– C3 disc material was compressing the spinal cord and the right C3 nerve root. An anterior cervical approach was done to remove the extruded disc material at the C2–C3 level with interbody fusion. The extruded disc material was carefully removed, the anterior approach to a C2–C3 disc herniation is a an easy and good alternative for the other methods, Conclusion: A high level cervical disc herniation occurs generally in elderly patients, and seen extremely rare in young patients. Symptoms may be various limited to C-2 radiculopathy to myelopathy. The pathophysiological of herniation may be related to trauma or exuberant motion at C2–3 when spondylosis involves lower cervical levels. Anterior approach, as demonstrated by this case, suffices for the resection of such lesions if they are eccentric within the spinal canal. Caution must be exercised when positioning elderly patients to avoid causing or exacerbating rupture of a disc