J Korean Soc Spine Surg.  2018 Sep;25(3):128-132. 10.4184/jkss.2018.25.3.128.

Diagnosis of C2 Spondylotic Radiculopathy by Physical Examination and Imaging Studies and Treatment by Microscopic Posterior Foraminotomy: A Case Report

• Jung YH
• Lee YS
• Eun DC
• Lee JH

• KMID: 2421605
• DOI: http://doi.org/10.4184/jkss.2018.25.3.128

Abstract

STUDY DESIGN: Case report.
OBJECTIVES
We report the case of a patient with C2 spondylotic radiculopathy who was treated by microscopic posterior foraminotomy. SUMMARY OF LITERATURE REVIEW: C2 spondylotic radiculopathy is rare, but it can occur due to spondylosis, compression by a venous plexus or vertebral artery, or hypertrophy of the atlantoepistrophic ligament.
MATERIALS AND METHODS
A 64-year-old woman was hospitalized with severe occipital pain radiating toward the left cervical area and posterior to the left ear. It started 3 years previously, and became aggravated 3 months previously. Foraminal stenosis of C1-2 was observed on magnetic resonance imaging (MRI) and degenerative changes of the facet joint of C1-2 and osteophytes originating from the left atlantoaxial joint were shown on computed tomography (CT). Dynamic rotational CT showed narrowing of the left C1-2 neural foramen when it was rotated to the left. Selective C2 root block was done, but the pain was aggravated. Thus, we decompressed the C2 nerve root by microscopic posterior laminotomy of the C1 vertebra. After surgery, the patient's occipitocervical pain mostly resolved. By the 6-month follow up, pain had not recurred, and instability was not observed on plain radiographs.
RESULTS
C2 Spondylotic radiculopathy was diagnosed by physical examination and imaging studies and it was treated by a surgical approach.
CONCLUSIONS
C2 spondylotic radiculopathy should be considered when a patient complains of occipitocervical pain triggered by cervical rotation and C1-2 foraminal stenosis is observed on MRI and CT.

Keyword

Spine; Atlantoaxial joint; Radiculopathy

MeSH Terms

Atlanto-Axial Joint
Constriction, Pathologic
Diagnosis*
Ear
Female
Follow-Up Studies
Foraminotomy*
Humans
Hypertrophy
Laminectomy
Ligaments
Magnetic Resonance Imaging
Middle Aged
Osteophyte
Physical Examination*
Radiculopathy*
Spine
Spondylosis
Vertebral Artery
Zygapophyseal Joint

Figure

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  Fig. 2. (A) The white arrow indicates the symptomatic left neural foramen with foraminal stenosis. (B) The white arrow indicates the asymptomatic right neural foramen.

• 

  Fig. 1. A 64-year-old woman with the chief complaint of occipitocervical pain on the left side. (A) The patient complained of occipitocervical pain on the left side that originated from the upper cervical spine and radiated towards the left occipital area. (B, C) There was no obvious atlantoaxial instability between the flexion and extension positions.

• 

  Fig. 3. (A) a coronal image shows unilateral spondylosis. The disc space is narrowed and the vertebral body is collapsed on the left side. (B) An axial image at C1-2 shows osteoarthritis and an osteophyte. (C, D) The left C1-2 neural foramen (white arrow) is narrower in the left rotation position (d) than the neutral position (c).

• 

  Fig. 4. Intraoperative photos from the surgical microscope. (A) The C2 nerve root was found to be compressed by the inferior part of the C1 lamina. (black arrow: C1 posterior arch, white arrow: diffuse venous engorgement above the C2 nerve root) (B) Partial resection of the inferior edge of the C1 posterior arch was performed and nerve root impingement disappeared (white arrow: C2 nerve root).

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