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

제 2경추증성 신경근증: 이학적 소견 및 영상촬영을 이용한 진단 및 현미경적 추간공 감압술을 통한 치료 - 증례 보고 -

  • Jung, Yu-Hun (Department of Orthopedic Surgery, Bundang Jesaeng General Hospital) ;
  • Lee, Young-Sang (Department of Orthopedic Surgery, Bundang Jesaeng General Hospital) ;
  • Eun, Dong-Chan (Department of Orthopedic Surgery, Bundang Jesaeng General Hospital) ;
  • Lee, Joon-Ha (Department of Orthopedic Surgery, Bundang Jesaeng General Hospital)
  • 정유훈 (분당제생병원 정형외과학교실) ;
  • 이영상 (분당제생병원 정형외과학교실) ;
  • 은동찬 (분당제생병원 정형외과학교실) ;
  • 이준하 (분당제생병원 정형외과학교실)
  • Received : 2018.05.04
  • Accepted : 2018.07.06
  • Published : 2018.09.30

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.

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