A 26-year-old male professional football player presented with severe left arm pain. He was initially aware of some neck discomfort immediately following a match. Over the subsequent 48 hours he then developed severe left arm pain.
On examination the player appeared distressed. He had a global restriction in cervical movements and a positive Spurling’s test. He had 4/5 weakness of elbow flexion and wrist extension and had an absent biceps reflex on the left side.
The lateral x-ray image of the cervical spine shows a loss of the normal cervical lordosis. There is also equivocal narrowing of the C5/6 disc. The MRI images show a large left paracentral disc protrusion (9mmAP x 7mmW x 8mmH) that fills the left lateral angle of the canal and impinges on the left C6 nerve root at the inner margin of the neural foramen. A central annular tear and broad disc bulge mildly narrow the central canal, slightly indenting the ventral surface of the cord. The cord signal remains normal.
This player was initially managed with a trial of conservative treatment. They had a short period of rest, physiotherapy treatments and used regular analgesics. A foraminal steroid injection provided temporary relief however the symptoms recurred. He eventually underwent an anterior cervical discectomy and fusion (ACDF) and returned to football approximately six months following surgery.
Cervical radiculopathy typically resolves spontaneously (90% have a resolution of symptoms at three months compared with six weeks in the lumbar spine). Adequate analgesia is needed initially as the pain can be severe. It is not uncommon for patients to require a number of different analgesics. Physiotherapy treatments can also provide symptomatic relief. A nerve root injection can also be effective, however this must be done by experienced specialists and using an image intensifier.
Surgery, usually in the form of an ACDF, is an option when there is focal neurology or persisting symptoms and failed conservative treatment. A partial discectomy and laminectomy can also be considered where there is a single-level pathology and no underlying degenerative disease. There is a faster return to sport in this situation, however, the final decision should be made by a neurologist and spinal surgeon.
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