Isolated C3–C4 disc herniations present as a painless myelopathy

• Published in: The spine journal Vol. 8; no. 5; pp. 729 - 731
• Main Authors: Sayer, Faisal T., MD, MSc, Vitali, Aleksander M., MD, Paquette, Scott, MD, FRCS(C), Honey, Christopher R., MD, DPhil, FRCS(C)
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2008
• Subjects: Adult; C3–C4 disc herniation; Cervical disc; Cervical myelopathy; Cervical Vertebrae - pathology; Cervical Vertebrae - surgery; Diskectomy; Female; Hand - pathology; Humans; Hypesthesia - etiology; Intervertebral Disc Displacement - complications; Intervertebral Disc Displacement - physiopathology; Intervertebral Disc Displacement - surgery; Magnetic Resonance Imaging; Male; Middle Aged; Muscle Weakness - etiology; Orthopedics; Painless myelopathy; Retrospective Studies; Spinal Cord Compression - etiology; Spinal Cord Compression - surgery; Spinal Cord Diseases - etiology; Spinal Cord Diseases - physiopathology; Spinal Cord Diseases - surgery; C3–C4 disc herniation; Cervical disc; Cervical myelopathy; Painless myelopathy
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2007.10.037

Abstract Background context Cervical disc herniations at the C3–C4 level are distinctly uncommon. The authors present the first case series of isolated C3–C4 disc herniations presenting with myelopathy. Purpose To elucidate a rare presentation of the uncommon C3–C4 disc herniation. Study design Case series. Patient sample The four patients who presented with myelopathy caused by isolated C3–C4 disc herniations, at the spine unit, Vancouver General Hospital between 1999 and 2005. Outcome measure Improvement in neurological status. Methods We retrospectively reviewed the files of the patients. The clinical features and outcome of surgery were assessed. Results The C3–C4 disc herniation can present as with no or mild pain, and hand numbness was a prominent symptom. Early recognition and treatment led to favorable outcome. Conclusions Myelopathy is rarely caused by a C3–C4 disc herniation. This etiology may be underdiagnosed but has a more favorable outcome in those cases where rapid diagnosis is followed by spinal cord decompression.