Third cervical nerve root and ganglion compression: clinical syndrome, surgical anatomy, and pathological findings

The aim of this study is to determine whether C3 nerve root and ganglion compression occurs and, if so, to provide a preliminary description of the associated clinical syndrome and surgical pathological findings.

The normal anatomy of the C2-C3 foramen was studied bilaterally in five fresh cadaver dissections and on 10 normal vertebral angiograms. Six patients were selected whose C3 dermatome sensory deficits resolved after C2-C3 facetectomy for C3 nerve root and ganglion decompression.

Patients with C3 nerve root and ganglion compression presented with radiating pain, dysesthesias, and numbness referred to the C3 pain dermatome: the scalp area behind and over the ear, the pinna, and the angle of the mandible. At physical examination, the presence of analgesia/dense hypalgesia in the C3 pain dermatome established the diagnosis. Imaging studies were suggestive but inconclusive. Surgical pathological findings showed the C3 nerve root and medial portion of the ganglion flattened by C2-C3 facet and uncovertebral joint spurs and the lateral part of the ganglion stretched and flattened by C2-C3 arthrosis and the C2-C3 vertebral loop. Decompression was obtained by a complete facetectomy. Complications required four operations: recurrence, contralateral C3 root decompression, bilateral C2 nerve root decompression, and C2-C3 fusion.

C3 nerve root and ganglion compression, although uncommon, does occur. It presents with radiating pain, dysesthesias, numbness, and a C3 dermatome sensory deficit. The associated clinical syndrome resolves after facetectomy and C3 root and ganglion decompression.