History :
A 46-year-old woman came in with complaints of neck and upper back pain persisting for a month, along with a history of radicular pain on her right side. She also reported tingling and numbness in her right upper and lower limbs, raising concerns of nerve involvement, She did a consultation with a Spine Pain Doctor in Pune Dr Sangram Rajale. Additionally, she experienced fine motor dysfunction in her right hand for the past 15 days, with difficulties in delicate movements and a noticeable loss of strength. She mentioned that lifting heavy objects overhead and the frequent slipping of her right footwear was problematic, and being right-hand dominant made this more impactful.
ON EXAMINATION OF CERVICAL SPINE:
In the cervical spine, bending backward (extension) was painful and restricted, particularly at the end range of motion. Side bending was painful on the right side, but movement on the left was normal. On the right side:
- Moderate hand grip strength (3/5)
- Moderate ability to spread fingers apart (3/5)
- Strength in biceps and triceps (4/5 for both sides)
- Shoulder abduction strength (4/5)
- Weakness in the right hand muscles and intrinsic muscle weakness over the right hand
She was thoroughly evaluation by the Best Spine Specialist in Pune Dr Sangram Rajale to address her neck pain and related neurological symptoms.
MRI :
MRI findings were consistent with the patient’s reported symptoms.
- Diffuse asymmetrical bulge of C4-C5 disc with superimposed posterior central extrusion and cranial migration reaching up to the pedicle level and accompanied by ossified posterior longitudinal ligament causing moderate compression of spinal cord: Diffuse asymmetrical bulge of C4-C5 disc: The disc between the fourth and fifth vertebrae (C4-C5) has bulged outward in an uneven manner.
- Superimposed posterior central extrusion: There’s also a protrusion of disc material toward the back (posterior) and toward the center (central) of the spinal canal. Cranial migration reaching up to the pedicle level: This protrusion has moved upward (cranial) in the spinal canal, reaching as high as the pedicle level of the vertebrae.
Operation :
On June 26, 2023, a surgical procedure called anterior cervical discectomy and fusion was performed on the C4-C5 and C5-C6 levels of the cervical spine. This procedure involved removing the problematic discs and using a cage and plating system from Parshwa Surgicals to stabilize the spine. The surgery was done under general anesthesia by Slip Disc Doctor in Pune Dr. Sangram Rajale.
Condition On Discharge :
After the surgery, significant improvements were observed in the patient’s motor function. There was notable enhancement in hand grip strength, finger abduction ability, wrist strength, biceps and triceps strength, and shoulder abduction capacity on the right side. Reflexes also showed positive changes, with the normalization of the triceps and biceps reflexes. Furthermore, the intrinsic muscle weakness in the right hand that was present before surgery has resolved. Sensations and distal pulses remained unaffected and were within normal limits both before and after the surgery.