gms | German Medical Science

Objective: Painless paresis/atrophy of the upper limbs are usually treated by neurologists and diagnosed e.g. as motoneuron-disease or neuralgic shoulder amyotrophy. We examined the rare clinical manifestation of compression-induced cervical radiculopathy with predominant motor deficit and muscular atrophy without pain and only minor disturbance of sensitivity. Aim of the study was to determine the incidence of the syndrome and the long-term outcome after surgical decompression.

Methods: Medical records of 788 patients undergoing decompression due to degenerative cervical radiculopathy/myelopathy were analyzed. Among those, 31 pat. (3.9%, m/f=4/1) presented with painless compressive cervical motor radiculopathy; long-term FU was available in 23 pat. with 49 symptomatic foraminal stenoses. Clinical, imaging and operative findings were retrospectively analyzed. Outcome parameters included course of MRC paresis grade and a questionnaire evaluation of QoL at the end of FU. Patients’ informed consent and approval by the local ethical review board was obtained.

Results: Preop. symptoms (mean duration 13.3mos) included – besides a defining painless paresis (median grade 3/5) – atrophy (78%) and sensory changes (39%) with smoking history in 83% and diabetes in 17% of the pat. Mean age at 1st operation was 59.9yrs, mean FU 4.8yrs. Preop. imaging revealed a predominant nerve root compression from anterior at the neuroforaminal entrance (mostly due to uncarthrosis) in 98% of the stenoses; most stenoses were located in C4-5 (33%) and C5-6 (31%). 30 stenoses in 11 pat. were initially decompressed via ACDF and 19 stenoses in 12 pat. via Posterior Cervical Foraminotomy (PCF). 2/11 pat. with ACDF and 3/12 with PCF needed 2nd surgery for 5 new and 3 recurrent stenoses with time to reoperation being sign. shorter in smokers (p=0.033) Long-term FU revealed a stable or improved status acc. to paresis in 87% of the pat. and Odom’s Grade in 91%, independent from the surgical procedure chosen. The severity of paresis was sign. improved compared to the preop. status (p=0.046) with a median grade of 4/5 at the end of FU. Long-term general performance was excellent with 87% having a WHO/ECOG PSS ≤ 1, 100% a KPS ≥ 80, and 87% a Barthel Index of 100%.

Conclusion: Painless cervical motor radiculopathy predominantly occurs in males with focal compression of the anterior nerve root and disturbance of microperfusion. After differentiation from neurological disorders, surgical decompression can provide improvement of motor function and a favourable long-term outcome.