The Cause of Dissociated Motor Loss in the Upper Extremity with Cervical Spondylosis

A Case Report

Restricted access

If the inline PDF is not rendering correctly, you can download the PDF file here.

Article Information

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Patient, K.G., bilateral atrophy and paralysis of shoulder and arm muscles.

  • View in gallery

    Lateral x-ray of cervical spine with extensive spondylosis of C3–4, 4–5, 5–6 and 6–7 intervertebral discs.

  • View in gallery

    Right oblique x-ray of cervical spine showing major encroachment by hyperostosis on C3–4, 4–5 and 5–6 intervertebral canals.

  • View in gallery

    Chart of mild sensory reduction outlined by Dr. Derek Denny-Brown, indicating 4th, 5th and 6th cervical nerve root involvement.

  • View in gallery

    Postmortem posteroanterior myelogram showing normal nerve root-pouches and spinal cord outline at involved C3–4, 4–5 and 5–6 intervertebral levels.

  • View in gallery

    Postmortem lateral myelogram showing prominent defects posteriorly and anteriorly at C3–4, 4–5 and 5–6 intervertebral levels.

  • View in gallery

    Formalin fixed cervical spinal cord with dura opened. Note cephalad-caudad separation of sensory and motor nerve roots intradurally at C6N.

  • View in gallery

    Drawing of left 5th, 6th and 7th cervical nerve roots, cord and dentate ligaments from Fig. 7, showing rounded elevation of separated C6 motor nerve root.

  • View in gallery

    Left cervical cord and nerve roots with dentate ligament retracted.

  • View in gallery

    Posterior left oblique photograph of cleaned cervical spine, showing prominent medial “high spots” of C4–5, 5–6 and 6–7 posterior hyperostoses, lesser midline ridging, narrowing of C3–4, 4–5, 5–6 and 6–7 intervertebral canals and large rounded hyperostosis over right C3–4 disc.

  • View in gallery

    Cross section of spinal cord at C6 segmental level, myelin stain, showing normal anterior columns and horns, mild myelin pallor of posterior columns.

  • View in gallery

    Midsagittal laminograph x-ray of cleaned cervical spine showing less posterior and anterior hyperostosis than appears in later x-ray shown in Fig. 2.

  • View in gallery

    Dermatome hypalgesia chart of upper extremity (Keegan), for comparison of C4, 5 and 6 dermatomes with sensory reduction shown in Fig. 4.

  • View in gallery

    Patient C.N.S., showing great atrophy of spinati and deltoid muscles from bilateral 5th cervical nerve root loss; no spinal cord symptoms.

  • View in gallery

    Patient C.N.S., cervical myelogram showing a discrete transverse defect at the C4–5 intervertebral level.

References

  • 1.

    AllenK. L. Neuropathies caused by bony spurs in the cervical spine with special reference to surgical treatment. J. Neurol. Neurosurg. Psychiat.1952n.s. 15: 2036.Allen K. L. Neuropathies caused by bony spurs in the cervical spine with special reference to surgical treatment. J. Neurol. Neurosurg. Psychiat. 1952 n.s. 15:20–36.

    • Search Google Scholar
    • Export Citation
  • 2.

    FrykholmR. Lower cervical nerve roots and their investments. Acta chir. scand.1951101: 457471.Frykholm R. Lower cervical nerve roots and their investments. Acta chir. scand. 1951 101:457–471.

    • Search Google Scholar
    • Export Citation
  • 3.

    FrykholmR. Cervical nerve root compression resulting from disc degeneration and root-sleeve fibrosis. A clinical investigation. Acta chir. scand.1951suppl. 160149 pp.Frykholm R. Cervical nerve root compression resulting from disc degeneration and root-sleeve fibrosis. A clinical investigation. Acta chir. scand. 1951 suppl. 160 149 pp.

    • Search Google Scholar
    • Export Citation
  • 4.

    KahnE. A. The role of the dentate ligaments in spinal cord compression and the symdrome of lateral sclerosis. J. Neurosurg.19474: 191199.Kahn E. A. The role of the dentate ligaments in spinal cord compression and the symdrome of lateral sclerosis. J. Neurosurg. 1947 4:191–199.

    • Search Google Scholar
    • Export Citation
  • 5.

    KaplanL. and KennedyF. The effect of head posture on the manometrics of the cerebrospinal fluid in cervical lesions: a new diagnostic test. Brain195073: 337345.Kaplan L. and Kennedy F. The effect of head posture on the manometrics of the cerebrospinal fluid in cervical lesions: a new diagnostic test. Brain 1950 73:337–345.

    • Search Google Scholar
    • Export Citation
  • 6.

    KeeganJ. J. Dermatome hypalgesia with posterolateral herniation of lower cervical intervertebral disc. J. Neurosurg.19474: 115139.Keegan J. J. Dermatome hypalgesia with posterolateral herniation of lower cervical intervertebral disc. J. Neurosurg. 1947 4:115–139.

    • Search Google Scholar
    • Export Citation
  • 7.

    MaGeeK. R. and DeJongR. N. Paralytic brachial neuritis. Discussion of clinical features with review of 23 cases. J. Amer. med. Ass.1960174: 12581262.MaGee K. R. and DeJong R. N. Paralytic brachial neuritis. Discussion of clinical features with review of 23 cases. J. Amer. med. Ass. 1960 174:1258–1262.

    • Search Google Scholar
    • Export Citation
  • 8.

    MairW. G. P. and DruckmanR. The pathology of spinal cord lesions and their relation to the clinical features in protrusion of cervical intervertebral discs. (A report of four cases.) Brain195376: 7091.Mair W. G. P. and Druckman R. The pathology of spinal cord lesions and their relation to the clinical features in protrusion of cervical intervertebral discs. (A report of four cases.) Brain 1953 76:70–91.

    • Search Google Scholar
    • Export Citation
  • 9.

    MayfieldF. H. Symposium on cervical trauma. Neurosurgical aspects. Clin. Neurosurg.19552: 83100.Mayfield F. H. Symposium on cervical trauma. Neurosurgical aspects. Clin. Neurosurg. 1955 2:83–100.

    • Search Google Scholar
    • Export Citation
  • 10.

    ScovilleW. B. Cervical spondylosis treated by bilateral facetectomy and laminectomy. J. Neurosurg.196118: 423428.Scoville W. B. Cervical spondylosis treated by bilateral facetectomy and laminectomy. J. Neurosurg. 1961 18:423–428.

    • Search Google Scholar
    • Export Citation
  • 11.

    StoopsW. L. and KingR. B. Neural complications of cervical spondylosis: their response to laminectomy and foramenotomy. J. Neurosurg.196219: 986999.Stoops W. L. and King R. B. Neural complications of cervical spondylosis: their response to laminectomy and foramenotomy. J. Neurosurg. 1962 19:986–999.

    • Search Google Scholar
    • Export Citation
  • 12.

    SymondsC. The interrelation of trauma and cervical spondylosis in compression of the spinal cord. Lancet19531: 451454.Symonds C. The interrelation of trauma and cervical spondylosis in compression of the spinal cord. Lancet 1953 1:451–454.

    • Search Google Scholar
    • Export Citation

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 235 235 24
Full Text Views 249 210 6
PDF Downloads 120 95 3
EPUB Downloads 0 0 0

PubMed

Google Scholar