Diagnosis and Treatment of C4 Radiculopathy Kelly Bridges MD; Donald Ross MD [Institution] Introduction Results Learning Objectives Cervical dermatomal and myotomal Eleven (79%) of patients underwent By the conclusion of the session, syndromes have been well posterior foraminotomy, and three participants should be able to: 1) described for C2-8 nerve roots with (21%) underwent C3/4 anterior Describe the importance of precisely exception of C4, which has received cervical discectomy and fusion. identifying C4 radiculopathy, 2) little attention. Asymptomatic Preoperative Oswestry Disability Discuss in small groups the nerve radiographic C4 root foraminal scores were 18-26 (mean 21), and 3 root distribution of symptoms and stenosis is relatively common, so month post-operative scores were 2- diagnostic tools used to support the correctly identifying C4 10 (mean 6). There were no diagnosis, 3) Identify effective radiculopathy is necessary for complications. treatments including posterior accurate diagnosis and surgical approach for C3/4 foraminotomy as decision making. The authors Conclusions well as C3/4 anterior cervical describe our experience with Patients with unilateral or bilateral discectomy and fusion. diagnosis and treatment of C4 lateral neck pain with radiation to the radiculopathy. paraspinous muscles, trapezius, References American Spinal Injury Association. Reference manual interscapular region, the posterior of the international standards for neurological Methods shoulder, or the medial clavical, but classification of spinal cord injury. 2003 Chicago The senior author reviewed his not distally, with C4 foraminal American Spinal Injury Association. personal operative registry of 651 stenosis on imaging may be Anderberg L, Annertz M, Rydholm U, Brandt L, surgically treated cervical suspected of C4 radiculopathy. Saveland H: Selective diagnostic nerve root block for evaluation of radicular pain in the multi-level radiculopathy patients, with 14 When confirmed by properly degenerated cervical spine. Eur Spine J 15:794-801, procedures (2%) involving performed diagnostic C4 root block, 2006a. exclusively the C4 root. C4 radicular decompression of C4 can produce Anderberg L, Saveland H, Annertz M: Distribution involvement was suspected if satisfactory results. patterns of transforaminal injections in the cervical spine evaluated by multi-slice computed tomography. patients endorsed unilateral or Eur Spine J 15:1465-1471, 2006b. bilateral cervical pain involving the Anderberg L, Annertz M, Persson L, Brandt L, paraspinous muscles, trapezius Saveland H: Transforaminal steroid injections for the muscle, and/or the posterior deltoid treatment of cervical radiculopathy: a prospective and randomised study. Eur Spine J 16:321-328, 2007. muscles without radiation distal to the shoulder. Imaging had to Apok V, Gurusinghe NT, Mitchell JD, Emsley HCA: Dermatomes and dogma. Pract Neurol 11:100-105, demonstrate compression of C4, 2011. and selective C4 root block had to Benedetti EM, Siriwectchdarek R, Stanec J, provide greater than 50% relief Rosenquist R: Epidural steroids injections: during the anesthetic phase. If so, complications and management. Tech Reg Anesth 13:236-250, 2009. surgery was recommended. SF-36 and Oswestry Disability scores were Brouwers PJ, Kottink EJ, SimonMA, Prevo RL: A cervical anterior spinal artery syndrome after obtained preoperatively and 3 diagnostic blockade of the right C6-nerve root. Pain months post operatively. 91:397-399, 2001..