背景:颈椎间盘突出症,这通常会导致与疝侧相对应的同侧上肢疼痛,很少报道引起对侧神经根病。
方法:一名53岁的男子到我院就诊,左上臂疼痛放射到他的左手。在体检时,左手拇指感觉减退,索引,中指。左臂肌肉力量为4,其他四肢为5。霍夫曼星座和巴宾斯基的测试结果均为阴性。冲刷动作在左侧给出了积极的结果。计算机断层扫描和磁共振成像显示C4-C5和C5-C6右侧椎间盘突出。患者接受了不同类型的非手术治疗,但没有明显的改善。在C4-C5和C5-C6进行颈椎前路椎间盘切除和融合。患者报告所有症状在手术后立即消失。患者随访2年,无疼痛困扰。
■引起对侧症状的颈椎间盘突出症极为罕见。当谈到颈椎间盘突出症对侧神经根病的病理生理学时,没有明确的结论。当考虑手术时,应排除任何其他可能的诊断,应仔细进行体格检查,以确认椎间盘突出是疼痛的根源。
结论:虽然极为罕见,颈椎间盘突出可能导致对侧神经根病。如果排除其他诊断,并且颈椎间盘突出被认为是疼痛的唯一可能起源,手术可以考虑。
BACKGROUND: Cervical disc herniation, which often results in ipsilateral upper extremity pain corresponding with the side of herniation, is rarely reported to cause contralateral radiculopathy.
METHODS: A 53-year-old man presented to our hospital with left upper arm pain radiating to his left hand. On physical examination, there was hypesthesia in the left thumb, index, and middle finger. Muscle strength was 4 in the left arm and 5 in the other extremities. Hoffmann sign and Babinski\'s test were negative. The Spurling maneuver gave a positive result on the left side. Computed tomography and magnetic resonance imaging revealed right-sided disc herniation at C4-C5 and C5-C6. The patient received different kind of non-operative therapy but no obvious improvement was achieved. Anterior cervical discectomy and fusion were performed at C4-C5 and C5-C6. The patient reported resolution of all the symptoms immediately after surgery. The patient was followed up for 2 years without pain bothering.
UNASSIGNED: Cervical disc herniation causing contralateral symptoms are extremely rare. When it comes to the pathophysiology of contralateral radiculopathy in cervical disc herniation, no definite conclusion can be given. When surgery is considered, any other possible diagnosis should be excluded, and physical examination should be performed carefully to confirm disc herniation is the origin of the pain.
CONCLUSIONS: Although extremely rare, cervical disc herniation may cause contralateral radiculopathy. If other diagnosis is excluded and cervical disc herniation is thought the only possible origin of the pain, surgery can be considered.