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False localizing signs in upper cervical spinal cord compression

W J Sonstein1, P A LaSala, W J Michelsen

  • 1Department of Neurological Surgery, Montefiore Medical Center of The Albert Einstein College of Medicine, Bronx, New York, USA.

Neurosurgery
|March 1, 1996
PubMed
Summary
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Upper cervical spinal cord compression can mimic lower cord issues, causing hand numbness and pain. Early recognition of this distinct syndrome improves surgical outcomes.

Area of Science:

  • Neurology
  • Neurosurgery
  • Spinal Cord Medicine

Background:

  • Disorders of the upper cervical spinal cord can present with symptoms mimicking lower cervical conditions.
  • Accurate diagnosis is crucial to prevent misdirected treatment.

Observation:

  • Eleven patients with extradural lesions above C4 exhibited hand/finger dysesthesia, hand atrophy, and neck/occipital pain.
  • These symptoms often preceded spasticity and gait disturbances.
  • Common initial misdiagnoses included brachial plexopathy and lower cervical spondylosis.

Findings:

  • Cervical spondylosis and herniated discs were frequent causes of upper cervical compression.
  • The C3-C4 level was most commonly affected.
  • Surgical intervention in nine patients resulted in significant improvement for eight.

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Implications:

  • Recognizing this specific upper cervical syndrome is vital for accurate diagnosis.
  • It can prevent unnecessary or incorrect surgical procedures for lower cervical pathologies.
  • Understanding the pathophysiology may involve spinal artery ischemia or venous obstruction.