Cause Of Cervical Radiculopathy Research Articles

Microvascular decompression of a vertebral artery loop causing cervical radiculopathy: illustrative case.

Vertebral artery loops are a rare cause of cervical radiculopathy. Surgical options for nerve root decompression include an anterior or posterior approach, with or without additional microvascular decompression. The authors describe a case of a 49-year-old man with a long-standing history of left-sided neck pain and migraines, who was found to have a vertebral artery loop in the left C3-4 neural foramen compressing the left C4 nerve root. The patient underwent a posterior cervical decompression with instrumented fusion and macrovascular decompression of the left C4 nerve root via Teflon felt insertion. In a literature review, we identified 20 similar cases that had also been managed surgically. Although the anterior approach is more frequently described in the literature, a posterior approach for nerve compression by a vertebral artery loop is also a safe and effective treatment. The authors report the third case of this surgical approach with a good outcome.

Functional and Radiological Outcome of Anterior Cervical Discectomy and Titanium Cage Fusion in the Management of Patients with Degenerative Cervical Spine Disease

Background: The causes of cervical radiculopathy include trauma, disc herniation, instability, spondylosis and, in rare cases, malignancies. Degenerative spinal disorders are often treated by anterior cervical discectomy. Objective: To assess the functional and radiological outcome of anterior cervical discectomy and titanium cage fusion in the management of patients with degenerative cervical spine disease Methodology: The current study was descriptive study carried out at the orthopedic department, Qazi Hussain Ahmad Medical College, Nowshera from August 2021 to August 2022. All the relevant laboratory and radiological investigations were carried out for the enrolled patients. Cervical radiographs were examined for fusion, cage subsidence, and kyphosis at each visit. The functional outcomes, quality of life and pain level was determined for all the patients. IBM SPSS version 23 was employed for analysis of data. Results: In the current study, totally 50 patients were enrolled. The male participants in this study were 30 (60%) while female patients were 20 (40%). The mean age of the patients was 53 (±5.32). The pre-operative mean NDI, VAS and EQ-5D-5L index was 42 (5.90), 8.11 (2.11) and 0.54 (0.01) respectively while the post-operative mean NDI, VAS and EQ-5D-5L index was 19 (2.81), 2 (1.88) and 0.75(0.01) respectively (p=˂0.05). In all the enrolled patients radiographical fusion was achieve successfully. Segmental subsidence was reported in 2 (4%) patients while kyphosis was not observed in any of our patients. Conclusion: Our study concludes that in patients with symptomatic degenerative cervical spine disease, the anterior cervical discectomy and titanium cage fusion is an effective and safe surgical procedure with excellent functional and radiological outcome. Our study observed minimal complication rate by using this procedure. Keywords: Radiological outcome; Anterior cervical discectomy; titanium cage fusion; degenerative cervical spine disease

Ayurvedic management of Greevagatavata W.S.R.T. cervical radiculopathy: A case report

Cervical radiculopathy refers to pain that travels from neck towards arm. Cervical radiculopathy most often occurs when a herniated disk or an overgrowth of bone puts pressure on part of the nerve. Herniated disc is common cause of cervical radiculopathy. In this condition patient experiences maximum pain in unilateral direction, which gets aggravated with improper posture of neck or cervical extension. The distribution of pain in the upper extremities is dependent on site of nerve compression but feels relief while at rest. According to Ayurveda, based on resembling clinical manifestation this condition can be co-related with Greevagatavata. Aim: To understand the efficacy of Ayurveda treatment protocol in the management of Cervical radiculopathy (Greevagatavata). Materials and Method: A 38 years old female suffering from complaints of Greevashoola (neck pain), radiating to right upper limb, which increased while working on laptop/mobile, while reading and while lifting heavy weights since past 2-3years on and off, presented in the OPD of SDACH, Chandigarh. The above complaints exasperated over the last 1 month. Based on clinical presentation and X-RAY findings the condition was diagnosed as cervical radiculopathy (Greevagata vata). A multimodal therapeutic intervention as per Ayurveda with greeva basti, nadi swedan, basti, nasya, were prescribed. Clinical assessment was done before and after treatment based on Neck disability index/questionnaire. Observation and Results: Before treatment Neck disability index score was 28 and after the complete treatment patient reported relief in symptoms of Ruk (pain), Stambha (stiffness), Spandan (cramping), distribution of pain significantly reduced and score was only 5. Conclusion: The present case study revealed that the multiple Ayurveda treatment modalities including Shaman and Shodhan Chikitsa (palliative and purification therapies) were effective in the management of Cervical radiculopathy.

Cervical Radiculopathy Focus on Characteristics and Differential Diagnosis.

Cervical radiculopathy is characterized by neurological dysfunction caused by compression and inflammation of the spinal nerves or nerve roots of the cervical spine. It mainly presents with neck and arm pain, sensory loss, motor dysfunction, and reflex changes according to the dermatomal distribution. The most common causes of cervical radiculopathy are cervical disc herniation and cervical spondylosis. It is important to find the exact symptomatic segment and distinguish between conditions that may mimic certain cervical radicular compression syndromes through meticulous physical examinations and precise reading of radiographs. Non-surgical treatments are recommended as an initial management. Surgery is applicable to patients with intractable or persistent pain despite sufficient conservative management or with severe or progressive neurological deficits. Cervical radiculopathy is treated surgically by anterior and/or posterior approaches. The appropriate choice of surgical treatment should be individualized, considering the patient’s main pathophysiology, specific clinical symptoms and radiographic findings thoroughly.

Tortuous vertebral artery triggering vertebral foramen expansion and radiculopathy in a 19-year-old patient: a case report

BackgroundArterial tortuosity is a widespread condition commonly occurring in cerebral arteries and often associated with the elderly. Moderate arterial tortuosity is often not symptomatic, but if there is severe tortuosity, various symptoms may occur, depending on the localization. In the literature, many factors have been reported as causing tortuosity in the vertebral arteries. In this case report, considering the age of our patient, we propose that, in addition to these previously reported reasons, congenital factors may also contribute to this situation.Case presentationWe present a case of a 19-year-old Turkish patient with a tortuous vertebral artery causing pain and tingling in the right shoulder and neck. Magnetic resonance imaging revealed vertebral foramen enlargement thought to be secondary to a loop formation in the vertebral artery. The diagnosis was confirmed by magnetic resonance angiography.ConclusionsThere are many causes of cervical radiculopathy. Arterial tortuosity, a rare cause of radiculopathy, should be considered as a differential diagnosis. Consideration of the existence of this variation is of great importance in preventing possible dangerous complications during surgery.

Vertebral Artery Loops and Cervicobrachial Pain

AbstractVertebral artery loop formation is an uncommon anatomical variation which may be asymptomatic or can cause cervicobrachial pain, radiculopathy, or even bone erosions and enlargement of neural foramina. As this entity is one of the uncommon causes of cervical radiculopathy, this report aims to create awareness among radiologists and clinicians, as vertebral artery loops may be seen incidentally in routine neuroimaging. magnetic resonance imaging (MRI) with magnetic resonance (MR) angiography or multislice computerized tomography (CT) angiography plays an important role in diagnosing as well as creating a roadmap for the surgery.Vertebral artery loop formation as a cause of radiculopathy is an uncommon condition. An abnormal course of vessel can lead to vascular injury during surgery, hence preoperative evaluation with CT or MRI is essential.1 2 Anomalous looping of vertebral artery can cause neurovascular compression apart from bony erosion, widening of vertebral foramen, and even vertebrobasilar insufficiency. Clinical features of vertebral artery loop formation can be radiculopathy, compression over cervical cord leading to sensory and motor deficit, and vertigo when associated with vertebra–basilar insufficiency, which is known as vascular vertigo. It has also been postulated that loop formation of vertebral artery can also lead to posterior circulation infarcts. Left vertebral artery is more prone for loop formation than the right vertebral artery, probably due to increased caliber in greater proportion of individuals. Multilevel and bilateral tortuosity can occur in younger patients rarely where imaging plays an important role.

Technique for Open Posterior Cervical Foraminotomy: 2-Dimensional Operative Video.

Foraminal stenosis is an important cause of cervical radiculopathy, which can be treated with an anterior or posterior approach, depending on a number of factors. These include the etiology of the foraminal stenosis, individual patient risk factors, and surgeon preference. We provide a step-by-step technique guide for performing an open posterior cervical foraminotomy on a 33-yr-old male with a history of left-sided pain radiating down the medial aspect of his left arm and left triceps weakness. Magnetic resonance imaging demonstrated a left-sided C6-7 disc herniation causing foraminal stenosis. Guidance on positioning, relevant anatomy, and appropriately planning the extent of bony decompression is also provided in this video. The patient, who consented to the recording of this surgical video, tolerated the procedure without complication, and upon follow-up had a significant improvement in his symptoms.

Total Anterior Uncinatectomy During Anterior Discectomy and Fusion for Recurrent Cervical Radiculopathy: A Two-dimensional Operative Video and Technical Report.

A common cause of cervical radiculopathy from degenerative foraminal stenosis is severe uncovertebral hypertrophy. It is difficult to accomplish complete foraminal decompression in these cases with posterior techniques without the removal of a large portion of the facet joint. Total removal of the uncovertebral joint from an anterior approach allows for complete decompression of the exiting cervical nerve root and has been shown to be a safe technique. In this surgical video and technical report, we demonstrate the surgical anatomy and operative technique of a two-level anterior uncinatectomy during anterior discectomy and fusion (ACDF) for recurrent cervical radiculopathy after a previous multi-level posterior foraminotomy. The patient is a 67-year-old male with a progressive left arm and neck pain with radiographic, clinical, and electrophysiologic diagnostic evidence of active C6 and C7 radiculopathies from degenerative foraminal stenosis at the C5-6 and C6-7 levels. Posterior foraminotomies had been performed without significant improvement in his radicular pain. A repeat MRI demonstrated lateral foraminal stenosis from severe uncovertebral joint hypertrophy at the C5-6 and C6-7 levels. After acquiring informed consent from the patient, an anterior approach was performed with complete removal of the uncovertebral joints at both levels with discectomy and fusion. Postoperatively, the patient had complete resolution of his radicular pain and remained pain-free at the latest follow-up. Complete uncinatectomy and ACDF is an effective technique for complete foraminal decompression in cases of refractory radiculopathy and neck pain after unsuccessful posterior decompression.

The Necessity of Upper Extremity Neurologic Examination while Evaluating Breast Pain

Introduction: Breast pain is one of the most frequent complaints and occurs in 45–69% of all women. Cervical disc herniation is a common cause of cervical radiculopathy with an incidence rate of 18.6 per 100,000, and it should be considered as a cause of breast pain. Objective: To identify the extent to which upper extremity neurologic findings and cervical root disorders accompany breast pain. Methods: We prospectively collected clinical features of patients with breast pain. An upper extremity neurologic examination was performed in patients and controls. Patients who had neurologic findings underwent cervical spine magnetic resonance imaging (MRI) to identify cervical root disorders. Results: Out of the 554 participants, 233 had breast pain, and 321 were controls. Women with breast pain had more numbness (116 [49.8%] vs. 104 [32.4%], p < 0.001) and more dysesthesia (36 [15.5%] vs. 17 [5.3%], p < 0.001) than the controls, but they had similar upper extremity weakness (10 [4.3%] vs. 14 [4.4%], p > 0.05). The number of women with one neurologic finding was significantly greater in the group with breast pain (119 [51.1%] vs. 111 [34.6%], p < 0.001). Ninety (16.2%) patients underwent a cervical vertebra MRI, which showed that 86 (95.6%) patients had cervical root disorders including 21 (23.3%) cases of bulging, 9 (10%) of annular tear, and 56 (62.2%) of central disc protrusion; 4 (4.4%) patients had normal findings. The multivariate logistic regression analysis revealed that age was the only significant predictor of neurologic findings in patients with breast pain (p < 0.05, OR: 1.02, CI: 1.002–1.053). Conclusions: Cervical root disorders should be considered as a cause of extramammary breast pain.

Cervical arachnoid cyst mimicking the cause of cervical radiculopathy: A case report

Abstract We herein present a case involving an asymptomatic cervical intradural arachnoid cyst that was suspected to be the cause of the patient's radicular pain. Magnetic resonance imaging showed a small, round intradural mass beside the cervical nerve root. An arachnoid cyst of this shape has not been previously reported. Intraoperative examination revealed that the cyst was not compressing the nerve root and was asymptomatic. Intradural spinal surgery is sometimes associated with serious complications. The knowledge that arachnoid cysts of this shape are asymptomatic can help to avoid unnecessary surgery.

Vertebral artery loop: A rare cause of cervical radiculopathy

Vertebral artery loop: A rare cause of cervical radiculopathy

The prevalence of fibromyalgia among patients with cervical radiculopathy due to cervical disc herniation: A pilot study

Cervical disc herniation (CDH) is the most common cause of cervical radiculopathy and could overlap with fibromyalgia (FM). The primary aim of the present study was to investigate the prevalences of FM and widespread pain in patients with cervical radiculopathy diagnosed as CDH in a cross-sectional study. The secondary aim was to analyze the localization of tender points (TPs) and associated symptoms in these patients comparing patients with FM. Fifty-two patients with cervical radiculopathy who carried the diagnosis of CDH and 51 patients with FM included to the study. The patients were questioned for the distribution and the duration of pain and for a group of symptoms related to FM such as headache, fatigue with a two-point scale (0 "no", 1 "yes"). The diagnosis of CDH was made with patients' clinical evaluation and radiological findings with Magnetic Resonans Imaging Study. FM was diagnosed using the American College of Rheumatology criteria. Widespread pain was defined as all of the following parameters were present: pain in the left side of the body; pain in the right side of the body; pain above the waist; pain below the waist; axial skeletal pain; and duration of pain for more than 3 months. The number of TPs were counted by digital palpation. Six female patients (11.5%) with CDH fulfilled the ACR 1990 criteria for FM. Of the patients with CDH 71.8% of TPs were located around the neck and shoulder regions, while 58.7% of TPs of the patients with FM were located around these regions. There were statistically significant differences between the patients with CDH and the patients with FM in terms of the duration of widespread pain, the number of TPs and the localization of TPs (p< 0.05). The prevalences of FM and widespread pain in patients with CDH were found as 11.5% and 78.8% respectively.

Vertebral Artery Dissection as a Cause of Cervical Radiculopathy

The acute onset of neck pain and arm weakness is most commonly due to cervical radiculopathy or inflammatory brachial plexopathy. Rarely, extracranial vertebral artery dissection may cause radiculopathy in the absence of brainstem ischemia. We describe a case of vertebral artery dissection presenting as cervical radiculopathy in a previously healthy 43-year-old woman who presented with proximal left arm weakness and neck pain aggravated by movement. Cervical magnetic resonance imaging (MRI) and angiography revealed dissection of the left vertebral artery with an intramural hematoma compressing the left C5 and C6 nerve roots. Antiplatelet treatment was commenced, and full power returned after 2 months. Recognition of vertebral artery dissection on cervical MRI as a possible cause of cervical radiculopathy is important to avoid interventions within the intervertebral foramen such as surgery or nerve root sleeve injection. Treatment with antithrombotic agents is important to prevent secondary ischemic events.

Cervical Radiculopathy Caused by Vertebral Artery Loop Formation : A Case Report and Review of the Literature

Vertebral artery loop formation causing encroachment on cervical neural foramen and canal is a rare cause of cervical radiculopathy. We report a case of 61-year-old woman with vertebral artery loop formation who presented with right shoulder pain radiating to her arm for 2 years. Plain radiograph and computed tomography scan revealed widening of the right intervertebral foramen at the C5-6 level. Magnetic resonance imaging and angiogram confirmed the vertebral artery loop formation compressing the right C6 nerve root. We had considered microdecompressive surgery, but the patient's symptoms resolved after conservative management. Clinician should keep in mind that vertebral artery loop formation is one of important causes of cervical radiculopathy. Vertebral artery should be visualized using magnetic resonance angiography in suspected case.

Vertebral artery dissection presenting with ispilateral acute C5 and C6 sensorimotor radiculopathy: A case report

Spinal manifestations of vertebral artery dissection (VAD) are rare events and are typically symptomatic with neck pain and ischemic brain injury. We report a patient presenting with unusual peripheral paresis of the right upper limb due to an intramural hematoma of the right vertebral artery with local compression of C5 and C6 as the cause of cervical radiculopathy. These symptoms completely resolved after anticoagulation and physical therapy.

Cervical Radiculopathy Caused by Vertebral Artery Loop Formation

Vertebral artery tortuosity and loop formation are rare causes of cervical radiculopathy. The criterion standard for the detection of vertebral artery loop formation is digital subtraction angiography. Computed tomography (CT) and magnetic resonance imaging provide good accuracy in the evaluation of vertebral arteries. A case of vertebral artery loop formation is reported. The diagnosis was confirmed by 16-row multisection CT angiography findings of vertebral artery loop formation.