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Abstract: Neurogenic cervical spondylosis is a common type of cervical spondylosis. In this case, the patient came to the clinic with pain and stiffness in the neck and shoulder as well as pain and numbness in the left upper limb, and after imaging, he was diagnosed with neurogenic cervical spondylosis. As medication was ineffective, the patient was advised to undergo surgery, and the patient agreed. After treatment with anterior cervical decompression graft fusion internal fixation, the patient’s upper extremity pain disappeared and the symptoms of numbness and weakness were significantly relieved.
Basic information】Male, 42 years old
Disease Type】Neurogenic cervical spondylosis
Hospital】The First Hospital of Harbin Medical University
Time of consultation】January 2022
Treatment plan】Anterior cervical decompression graft fusion internal fixation + drug treatment (mannitol injection, parecoxib sodium for injection)
Treatment period】10 days of inpatient treatment and outpatient review after 3 months
Treatment effect] Pain in the upper limb disappeared, and numbness and weakness were significantly relieved.
I. Initial consultation
The patient is a bank teller who needs to face computer work every day. One month ago, she suddenly developed neck and shoulder pain with neck stiffness, which was thought to be a drop pillow. On examination, the patient could be found to have loss of anterior cervical convexity, restricted movement, numbness of the left fingers, weakness of dorsal extension of the left wrist, and positive left brachial plexus nerve pull test. A black disc protrusion could be seen at the level of the cervical 5-6 intervertebral disc through cervical spine nuclear magnetic examination, and the nerve root was obviously compressed, thus confirming the diagnosis of neurogenic cervical spondylosis.
II. Treatment history
The patient had persistent pain in the left upper limb, and oral pain medication was ineffective, so she decided to be hospitalized for surgery. After admission, mannitol injection and parecoxib sodium for injection were given intravenously. At the same time, the cervical frontal and lateral radiographs, cervical hyperextension and hyperflexion radiographs and cervical disc CT examination were completed, and the imaging examination could reveal that the patient had a significant rightward protrusion at the level of the cervical 5-6 intervertebral disc, which was compressing the nerve root. On the 3rd day of admission, the patient underwent an anterior cervical decompression graft fusion surgery, in which the herniated disc was removed and the intervertebral fusion was performed. The patient was discharged after 10 days of hospitalization and was instructed to review the patient in 3 months.
III. Treatment effect
On the day after surgery, the patient felt that the pain and numbness of the left upper limb were significantly relieved. On the second day after surgery, a soreness and swelling in the neck and shoulder area, accompanied by mild numbness and pain in the left upper limb appeared, and mannitol injection was given intravenously to reduce swelling, and the above symptoms were relieved on the fifth day after surgery. The patient was able to wear a neck brace and start to move out of bed on the second day after surgery, and could walk on his own with his hands on the railing at the time of discharge. The surgical incision healed well, and the incision healed smoothly 7 days after surgery, and the pain symptoms of the upper limb disappeared, and the numbness and weakness were significantly relieved.
IV. Notes
We are glad that the pain of the upper limb disappeared and the numbness and weakness were significantly relieved after the treatment. The patient should try to avoid cervical twisting movements for 6 weeks after discharge from the hospital, and the cervical brace should be worn until 3 months after surgery, and then decide whether it is necessary to continue wearing it according to the bone healing condition. Bad habits such as prolonged head lowering should be avoided after taking off the neck brace, and trauma to the neck should be avoided to avoid loosening of internal fixation. Positive and lateral cervical spine films should be reviewed at 3 months, 6 months and 1 year after surgery. If mild pain and numbness of the upper limbs appear again after surgery, it may be due to neuroedema, so you can follow up promptly and use some anti-swelling drugs. If there is no obvious discomfort, the internal fixation of cervical spine can be retained in the body for a long time.
V. Personal insight
Neurogenic cervical spondylosis is caused by nerve root compression, and when the nerve compression is surgically released, it often leads to rebound edema of the nerve, showing symptoms similar to those of neurogenic cervical spondylosis, but it usually disappears within a few days or weeks. In this case, the nerve root compression was relatively severe, so the nerve rebound edema appeared more obviously after surgery. On the second day after surgery, the patient again developed neck and shoulder soreness and swelling, accompanied by mild numbness and pain in the left upper limb, which was effectively relieved on the fifth day after surgery by dehydration and swelling reduction treatment, although sometimes this nerve edema can last for 2 weeks or even longer.