Contralateral neurological symptoms after ACDF for radiculopathic cervical spondylosis:A case report

TL;DR

A patient developed new symptoms on the opposite side after cervical spine surgery, leading to revised surgical guidelines for managing foraminal stenosis.

Contribution

Highlights the importance of posterior disc height restoration over cervical lordosis in cervical radiculopathy surgery.

Findings

Restoring posterior disc height is critical for enlarging the foramen in cervical foraminal stenosis.

Increasing the lordotic angle of the fused segment does not significantly improve foraminal dimensions.

Stable vertebral slippage without nerve compression does not require inclusion in the fusion construct.

Abstract

Anterior cervical discectomy and fusion (ACDF) is the standard surgical procedure for cervical radiculopathy. However ACDF has certain limitations, a small number of patients may require a second surgery after ACDF, we further analyzed and summarized our experience regarding curvature restoration and management of the asymptomatic side in cervical radiculopathy.

A 67-year-old male patient experienced neck and left arm pain for over a decade, worsening recently. Following admission, the patient underwent an anterior cervical discectomy and fusion (ACDF) procedure. Postoperatively, the patient began to exhibit symptoms on the opposite (right) side. Follow-up imaging showed a reduction in disc space height at the posterior aspect of the C5/6 level, along with a slight posterior shift of the C5 vertebra. A revision surgery was performed. The symptoms were alleviated.

For patients with cervical foraminal stenosis, restoring posterior disc height is critical for enlarging the foramen. In contrast, increasing the lordotic angle of the fused segment does not significantly improve foraminal dimensions.

For patients suffering from radiculopathy caused by foraminal stenosis, we suggest the following guidelines:1) It is not necessary to excessively focus on the restoration of cervical lordosis，maintaining the height and width of the intervertebral foramen is more critical. 2)When distracting the intervertebral space, placing the cage in a relatively posterior position helps to preserve the height of the posterior disc space 0.3)In the short term, stable vertebral slippage without nerve compression does not necessitate inclusion in the fusion construct.

•Although indirect decompression on the asymptomatic side has demonstrated favorable therapeutic outcomes in previous surgical cases, this particular patient exhibited postoperative symptom exacerbation on the initially asymptomatic side.•For patients with cervical foraminal stenosis, restoring posterior disc height is critical for enlarging the foramen. In contrast, increasing the lordotic angle of the fused segment does not significantly improve foraminal dimensions.•It is not necessary to excessively focus on the restoration of cervical lordosis，maintaining the height and width of the intervertebral foramen is more critical.•When distracting the intervertebral space, placing the cage in a relatively posterior position helps to preserve the height of the posterior disc space.•In the short term, stable vertebral slippage without nerve compression does not necessitate inclusion in the fusion construct.

Although indirect decompression on the asymptomatic side has demonstrated favorable therapeutic outcomes in previous surgical cases, this particular patient exhibited postoperative symptom exacerbation on the initially asymptomatic side.

For patients with cervical foraminal stenosis, restoring posterior disc height is critical for enlarging the foramen. In contrast, increasing the lordotic angle of the fused segment does not significantly improve foraminal dimensions.

It is not necessary to excessively focus on the restoration of cervical lordosis，maintaining the height and width of the intervertebral foramen is more critical.

When distracting the intervertebral space, placing the cage in a relatively posterior position helps to preserve the height of the posterior disc space.

In the short term, stable vertebral slippage without nerve compression does not necessitate inclusion in the fusion construct.

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