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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0044-1788632
Case Report

Successful Rectification of Cervical Nerve Root Irritation with Sequential Surgical Maneuvers during Posterior Cervical Instrumentation

Balaji Vaithialingam 
1   Division of Neuroanaesthesiology, International Institute of Neurosciences, Aster Whitefield Hospital, Bengaluru, Karnataka, India
,
Ramachandran Govindasamy
2   Division of Spine and Deformity Surgery, International Institute of Neurosciences, Aster Whitefield Hospital, Bengaluru, Karnataka, India
,
Swaroop Gopal
3   Department of Neurosurgery and Spine Surgery, International Institute of Neurosciences, Aster Whitefield Hospital, Bengaluru, Karnataka, India
,
Satish Rudrappa
3   Department of Neurosurgery and Spine Surgery, International Institute of Neurosciences, Aster Whitefield Hospital, Bengaluru, Karnataka, India
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Abstract

Posterior cervical instrumentation is used to treat a variety of cervical pathologies, including cervical spondylotic myelopathy, severe canal stenosis, and degenerative diseases. A 55-year-old man with severe cervical canal stenosis underwent a C3–C6 laminectomy and lateral mass screw fixation under general anesthesia. After lateral mass screw fixation and rod placement on the right side, raw electromyography (EMG) revealed irritative discharges in the right biceps brachii muscle. Following a suspicion of irritation/mechanical stretching of the C5–C6 nerve root, a posterior foraminotomy was performed on the right side as a rescue measure. The amplitude of raw EMG irritative discharges in the right biceps brachii muscle decreased significantly after posterior foraminotomy. Following rod reapplication with decreased rod lordosis, the irritative EMG discharges were eliminated. Before implementing further measures, posterior foraminotomy can be a crucial initial intervention for minimizing nerve root irritation due to mechanical factors after cervical lateral mass screw fixation.

Keywords

raw electromyography - foraminotomy - posterior cervical instrumentation - lateral mass screw fixation

Authors' Contributions

B.V. was responsible for design, conceptualization, medical writing, and initial draft of the manuscript. R.G., S.G., and S.R. were responsible for manuscript review and editing.




Publication History

Article published online:
18 July 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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