Cervical disc herniation presenting with contralateral radiculopathy: A case report.

ABSTRACT

INTRODUCTION: Cervical disc herniation, which often results in ipsilateral upper extremity pain corresponding with the side of herniation, is rarely reported to cause contralateral radiculopathy. CASE PRESENTATION A 53-year-old man presented to our hospital with left upper arm pain radiating to his left hand. On physical examination, there was hypesthesia in the left thumb, index, and middle finger. Muscle strength was 4 in the left arm and 5 in the other extremities. Hoffmann sign and Babinski's test were negative. The Spurling maneuver gave a positive result on the left side. Computed tomography and magnetic resonance imaging revealed right-sided disc herniation at C4-C5 and C5-C6. The patient received different kind of non-operative therapy but no obvious improvement was achieved. Anterior cervical discectomy and fusion were performed at C4-C5 and C5-C6. The patient reported resolution of all the symptoms immediately after surgery. The patient was followed up for 2 years without pain bothering. CLINICAL DISCUSSION: Cervical disc herniation causing contralateral symptoms are extremely rare. When it comes to the pathophysiology of contralateral radiculopathy in cervical disc herniation, no definite conclusion can be given. When surgery is considered, any other possible diagnosis should be excluded, and physical examination should be performed carefully to confirm disc herniation is the origin of the pain. CONCLUSION: Although extremely rare, cervical disc herniation may cause contralateral radiculopathy. If other diagnosis is excluded and cervical disc herniation is thought the only possible origin of the pain, surgery can be considered.