C4 Radiculopathy without Myelopathy

Keimyung Medical Journal 2013;32(1):61-68.

Soyoung Lee; Du Hwan Kim

Abstract

A radiculopathy above C3-C4 level without myelopathy is rare and difficult to diagnose on physical examination and radiologic findings. We report these three C4 radiculopathy without myelopathy; and discuss clinical manifestations and treatment strategy. The first case was a 50-year-old male patient with a 3-week history of persistent pain and severe allodynia in the distribution of the left posterior neck and anterior chest wall area who had no specific trauma history. The second was a 65-year-old female with vague and intermittent shock-like pain in the right posterior neck after traffic accident. The third was a 63-year-old female with tingling sensation and paresthesia in the right posterior neck area who had an underlying cervical dystonia during one year. On physical examination; all patients had no specific motor weakness in the limbs and no upper motor neuron signs. But; the second case showed a suspicious asymmetry of diaphragm. All patients revealed abnormal sensory test findings such as allodynia; hypoesthesia; or dysesthesia on light touch and pin prick in C3-C4 dermatomal area. The plain radiographs and magnetic resonance imaging (MRI) of the cervical spine of all patients showed C3-C4 neural foraminal stenosis and no evidence of cervical spinal cord compression suggesting isolated C4 radiculopathy without myelopathy. Two patients had good results with conservative management; and one patient had an anterior cervical disc discectomy and fusion.

Key Words: Cervical spine, Diaphragm, Radiculopathy