Article
Severe dyspnea due to cervical spinal/foraminal stenosis C3/4 – postoperative regression after anterior decompression – case report
Dyspnoe aufgrund zervikaler Spinalkanal-/Foramenstenose – postoperative Rückbildung nach anteriorer Dekompression – Fallbericht
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Authors
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Martin E. Weidemeier
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Henry W. S. Schroeder
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Steffen K. Fleck
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: A case of a cervical spinal and foraminal stenosis C3/4 is presented which caused a high-grade exertional dyspnea mimicking congestive heart failure.
Methods: Case report and literature review
Results: We report about a 58-year-old man who presented with progression of exertional dyspnea limiting his walking distance to a maximum of 80 meters. Other signs of radiculopathy such as pain or motor weakness were denied. Respiratory symptoms started one-and-a-half year earlier and were investigated extensively but ruled out cardiac pathologies. A left-sided diaphragmatic elevation resulted from a traffic accident twelve years ago.
Neurography showed no compound muscle action potentials of the left N. phrenicus proving decompensation of prior inapparent phrenic dysfunction. Along being asthmatic and obese (BMI 38.2 kg/m2) he is using nCPAP due to a chronic obstructive sleep apnea. MRI revealed cervical spinal stenosis with foraminal stenosis at the level of C3-C4. We performed an anterior cervical discectomy with uncoforaminotomy on both sides. Three months after surgery his dyspnea resolved completely making him able to walk 3 kilometers. Increase of physical activity made him lose 10 % of his body weight (BMI 32.7 kg/m2).
Our case is a rare example of a cervical spinal stenosis leading to a high-grade exertional dyspnea as the only symptom. Radiculopathies of C3-C4 level most commonly cause radiating pain and sensory deficits. Motor impairment often remains inapparent. Progression of dyspnea on exertion may drastically reduce physical activity level leading to fast fatiguability and weight gain. Mimicking symptoms of heart failure a cardiac pathology should be ruled out primarily along other diseases of respiratory dysfunction. However, MR imaging may identify spinal pathologies and be useful for evaluating possible candidates for neurosurgical intervention.
Conclusion: To our knowledge, this is the tenth case worldwide reporting about a cervical spinal stenosis at the C3-C4 level with accompanying foraminal stenosis leading to severe dyspnea. Our intervention led to complete regression of exertional dyspnea after anterior decompression. Affection of the diaphragmatic innervation is thought to be the underlying mechanism and can be investigated via nerve conduction studies along electromyography. The presented case is rare but has to be kept in mind when progression of respiratory complaints seems to be unrelated to any other cardiorespiratory pathology.
