C4 Radiculopathy without Myelopathy

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.