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Chiropractic Research Review

Clinical Presentation of Upper Cervical Disc Herniation

Disc herniations above the C3-C4 level can be difficult to identify on clinical examination, and have been poorly detailed in the literature. Patients usually reveal no specific motor weakness or reflex abnormality, and diagnosis often takes place only after symptoms persist and a herniation is confirmed by magnetic resonance imaging (MRI) or computed tomography (CT).

This study sought to clarify the clinical presentation of the C2-C3 cervical herniated disc.

Eight patients with C2-C3 disc herniations with cord compression participated in a detailed clinical and radiologic review to determine early detection and clarify potential hazards. Past clinical histories were traced back to the onset of symptoms, neurologic function was assessed and recorded, and motor examination and sensory testing provided data on muscle strength, range of motion (ROM), and other variables.

Results: Most patients presented with ascending radicular symptoms secondary to trivial trauma. The nature of the trauma was typically motor vehicle accidents. Patients also experienced suboccipital pain, loss of hand dexterity, and paresthesia over the face and unilateral lateral arm. Nonspecific neck and shoulder pain, cervical radiculopathy, and myelopathy were also potential variables to consider. Positive Lhermittes sign and Spurlings maneuver were present in five patients.

The author concludes that clinical suspicion of radiculopathy in the upper cervical cord should be heightened in the presence of the following symptomatology: ascending dysesthesia at upper limbs; patch regions of hypesthesia over perioral distribution; faint myelopathic finding; positive Lhermmites sign; and history of recent trauma.

Chen T-Y. The clinical presentation of uppermost cervical disc protrusion. Spine, Feb. 15, 2000:25(4), pp439-42.

Chiropractic Research Review

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