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Patients with cervical (CDRS) or lumbar dorsal ramus syndrome (LDRS) are characterized by neck or low back pain with referred pain to upper or lower extremities. However, we experienced some CDRS or LDRS patients with unusual motor or bladder symptoms. We analyzed and reviewed literatures on the unusual symptoms identified in patients with CDRS or LDRS.
This study included patients with unusual symptoms and no disorders of spine and central nervous system, a total of 206 CDRS/LDRS patients over the past 3 years. We diagnosed by using double diagnostic blocks for medial branches of dorsal rami of cervical or lumbar spine with 1% lidocaine or 0.5% bupivacaine for each block with an interval of more than 1 week between the blocks. Greater than 80% reduction of the symptoms, including unusual symptoms, was considered as a positive response. The patients with a positive response were treated with radiofrequencyneurotomy.
The number of patients diagnosed with CDRS and LDRS was 86 and 120, respectively. Nine patients (10.5%) in the CDRS group had unusual symptoms, including 4 patients with motor weakness of the arm, 3 patients with tremors, and rotatory torticollis in 2 patients. Ten patients (8.3%) in the LDRS group showed unusual symptoms, including 7 patients with motor weakness of leg, 2 patients with leg tremor, and urinary incontinence in 1 patient. All the unusual symptoms combined with CDRS or LDRS were resolved after treatment.
It seems that the clinical presentationssuch as motor weakness, tremor, urinary incontinence without any other etiologic origin need to be checked for unusual symptoms of CDRS or LDRS.
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The crowned dens syndrome (CDS), also known as periodontoid calcium pyrophosphate dehydrate crystal deposition disease, is typified clinically by severe cervical pain, neck stiffness and atlantoaxial synovial calcification which could be misdiagnosed as meningitis, epidural abscess, polymyalgia rheumatica, giant cell arthritis, rheumatoid arthritis, cervical spondylitis or metastatic spinal tumor. Crystalline deposition on cervical vertebrae is less well known disease entity and only a limited number of cases have been reported to date. Authors report a case of CDS and describe the clinical feature.
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A 45-year-old female patient visited the hospital complaining of severe sudden headache and posterior neck pain. The patient did not have any traumatic history or abnormal neurologic finding. The patient had sudden quadriplegia and sensory loss. Cervical spine MRI scan was taken, and the compatible findings to acute epidural hematoma were shown. The emergency operation was performed. After the operation, the patient recovered all motor and senses. As there was CSF leakage in the postoperative wound, this was confirmed by cervical spinal computed tomography (CT). Then lumbar drainage was thus performed. The opening pressure upon lumbar puncture was not measured as it was very low. As a result of continous CSF leakage, dural repair was performed. After the operation, the patient had been discharged without neurologic deficits. In this case, it is sensible to suspect intracranial hypotension as a possible cause of spinal EDH.
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Cervical spondylosis and shoulder disorders share with neck and shoulder pain. Differentiating between the two can be challenging and patient with combined pathologies is less likely to have pain improvement even after successful cervical operation. We investigated clinical characteristics of the patients who were diagnosed as cervical spondylosis however, were turned out to have shoulder disorders or the patients whose pain was solely originated from shoulder.
Between January 2008 and October 2009, the patients presenting neck and shoulder pain with diagnosis of cervical spondylosis were enrolled. Among them, the patients who met following inclusion criteria were grouped into shoulder disorder group and the others were into cervical spondylosis group. Inclusion criteria were as follows. (1) To have residual or unresponsive neck and shoulder pain despite of optimal surgical treatment due to concomitant shoulder disorders. (2) When the operation was cancelled for the reason that shoulder and neck pain was proved to be related with unrecognized shoulder disorders. The authors retrospectively reviewed and compared clinical characteristics, level of pathology, diagnosis of cervical spondylosis and shoulder disorders.
A total of 96 patients were enrolled in this study. Shoulder disorder group was composed of 15 patients (15.8%) and needed additional orthopedic treatment. Cervical spondylosis group was composed of 81 patients (84.2%). There was no significant differences in mean age, sex ratio and major diagnosis in both shoulder disorder and cervical spondylosis group (p=0.33, 0.78, and 0.68 respectively). However, the distribution of pathologic levels was found to be significantly different (p=0.03). In shoulder disorder group, the majority of lesions (15 of 19 levels, 78.9%) were located at the level of C4-5 (36.8%) and C5-6 (42.1%). On the other hand, in cervical spondylosis group, C5-6 (39.0%) and C6-7 (37.1%) were the most frequently observed level of lesions (80 of 105 levels, 16.1%).
It is very important for spine surgeons to perform a complete history taking and physical examination using the special tests, and to discover the underlying shoulder disorders causing of symptom in treatment of cervical spondylosis presenting neck and shoulder pain.
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