Idiopathic localizing signs and atypical symptoms of cervical disk pathology: A case report

Cervical disc herniations most often present with neck and arm pain resulting from direct nerve root compression from a paramedian or foraminal disc herniation. It is unusual to encounter unilateral lower extremity symptoms in the absence of other neurological symptoms due to a centrally herniated cervical disc. Because this clinical presentation is uncommon, there can be misdiagnosis, or delay in treatment of patients who suffer from debilitating pain or weakness. We treated a patient who presented with acute progressive unilateral lower extremity weakness and paresthesia from a large herniated cervical disk. His lower extremity symptoms resolved post-operatively after undergoing anterior cervical discectomy and fusion. This case provides an example of the importance of neuroanatomical knowledge in surgical decision-making; clinicians should recognize that unilateral leg weakness can result from cervical disc herniation in absence of other neurological symptoms.