Sudden nontraumatic tetraplegia associated with cervical disc herniation: Importance of emergent microdiscectomy – Case report.

Abstract

Background: Cervical disc herniation is a rare cause of nontraumatic para- or tetraplegia and as such represents a true emergency. We present a case of acute nontraumatic tetraplegia secondary to cervical disc herniation with no associated previous spinal stenosis or previous signs of mielopathy. The aim of this case report is to discuss the pathophisiology of acute tetraplegia and to highlight the need for urgent surgical decompression.Case report: A 37-year old men presented with sudden onset of muscle weakness in the arms and legs that quickly progressed. He had no history of head and neck trauma. The clinical picture was in accordance with the anterior spinal cord syndrome – he finally developed acute C6 tetraplegia. Magnetic resonance imaging revealed large cervical disc herniation of the C5-C6 cervical discus. The cervical spine was compressed dorsally. Microdiscectomy C5-C6 was performed. His neurological condition improved during few days after the operation. During the six year postoperative observation period he stayed symptom free. Conclusions: Cervical disc herniation should be considered in the differential diagnosis of acute nontraumatic para- or tetraplegia. Cervical herniation can cause diminished blood supply to the anterior spinal artery and anterior spinal cord ischaemia. Immediate magnetic resonance imaging and early decompressive surgery is recommended to avoid irreversible neurologic deficit.

Keywords

• nontraumatic tetraplegia
• intervertebral disc herniation
• microdiscectomy