Case study: Cervical hernia with radicular pain
A 41-year-old woman presented with cervical pain radiating to the left upper limb. Her medical history reveals no prior comorbidities, but she engages in frequent and vigorous exercise, notably CrossFit. The pain she experiences is persistent, exacerbated by physical exertion and exercise, and characterized by sensations of shock, pins and needles, and burning. On the Numeric Rating Scale (NRS), her baseline pain level is 4, spiking to 8 at its peak.
The pain was distributed along the C7 dermatome.
Physical examination
- Left neck pain, aggravated with the Spurling maneuver with a radicular pattern in the left C7 nerve root
- Pain described as shock, pins and needles, and burning sensations (DN4 7/10)
- No motor weakness in the left forearm or hand
MRI
- C6-7 posterior disc protrusion with a wide base
- Slight left uncarthrosis, moderately reducing the amplitude of the foramen
MRI of the cervical spine revealing a protruding C6-C7 disc.
Diagnosis
The patient was diagnosed with brachial plexus root pain, characterized by compression, irritation, or damage to the cervical roots, usually radiating to the neck and/or upper limb. The most common cause of cervical root pain is a herniated cervical disc.
Imaging, such as cervical spine MRI, is essential not only for the diagnosis but also for procedural planning, as it allows the identification of anatomic variations (namely of the vertebral arteries).
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