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Surgical Treatment of C3 and C4 Cervical Radiculopathies

Park, Moon Soo, MD, PhD*; Kelly, Michael P., MD; Min, Woo-Kie, MD, PhD; Rahman, Ra'Kerry K., MD§; Riew, K. Daniel, MD

doi: 10.1097/BRS.0b013e318267b0e6
Cervical Spine

Study Design. Case series study.

Objective. To report the results of surgical intervention in a series of patients with high cervical radiculopathy.

Summary of Background Data. Although midcervical (C5–C7) radiculopathy is common and well recognized, high cervical (C3 and C4) radiculopathy is relatively rare and can be missed clinically. To our knowledge, there are few reports regarding the operative treatment of high cervical radiculopathy.

Methods. Two spine surgeons independently reviewed the charts and radiographs of all patients with high cervical radiculopathy or myeloradiculopathy that were surgically treated by the senior author. Dates of inclusion were from July 1997 to March 2008. All patients were observed for either a minimum of 2 years or until they achieved a fusion. Neck Disability Index scores were calculated pre- and postoperatively, when available, and Odom criteria were assessed for all patients.

Results. Twenty-three patients met the inclusion criteria. The mean follow-up period was 4.2 years (1–11.3 yr). The levels involved were C2–C3 (2 patients), C2–C4 (4 patients), and C3–C4 (17 patients). The most common symptom was suboccipital neck pain/headache with or without radiation to the retroauricular or retro-orbital region (21 patients). Preoperative neuroradiological findings were central stenosis with herniated nucleus pulposus, foraminal stenosis with uncinate hypertrophy or facet arthrosis, spondylolisthesis, and pseudarthrosis. Operative treatments included anterior cervical discectomy and fusion, posterior foraminotomy, posterior laminectomy-foraminotomy with fusion, posterior laminoplasty with fusion, and anterior/posterior combined decompression and fusion. By Odom criteria, 12 had excellent results, 8 had good results, 2 had satisfactory results, and 1 had a poor result. One patient underwent a reoperation for pseudarthrosis.

Conclusion. Surgical treatment of high cervical radiculopathies resulted in acceptable outcomes. To our knowledge, this is the largest series of this relatively rare condition.

High cervical radiculopathies may present with suboccipital headache. Spurling maneuver and transforaminal nerve root blocks may aid in confirming the diagnosis of neural compression in the high cervical spine. As with lower levels, the inciting pathology is often a herniated nucleus pulposus or foraminal stenosis from spondylosis.

*Department of Orthopaedic Surgery, Medical College of Hallym University, Pyeongchon-dong, Gyeonggi-do, Republic of Korea

Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO

Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea; and

§Division of Orthopaedics & Rehabilitation, Southern Illinois University School of Medicine, Springfield, IL

Address correspondence and reprint requests to K. Daniel Riew, MD, Department of Orthopedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St. Louis, MO 63110; E-mail:

Acknowledgment date: February 20, 2012. Revision date: June 25, 2012. Acceptance date: June 30, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2013 Lippincott Williams & Wilkins, Inc.