Successful Rectification of Cervical Nerve Root Irritation with Sequential Surgical Maneuvers during Posterior Cervical Instrumentation

Abstract

Posterior cervical instrumentation is used to treat a variety of cervical pathologies, including cervical spondylotic myelopathy, severe canal stenosis, and degenerative diseases. A 55-year-old man with severe cervical canal stenosis underwent a C3–C6 laminectomy and lateral mass screw fixation under general anesthesia. After lateral mass screw fixation and rod placement on the right side, raw electromyography (EMG) revealed irritative discharges in the right biceps brachii muscle. Following a suspicion of irritation/mechanical stretching of the C5–C6 nerve root, a posterior foraminotomy was performed on the right side as a rescue measure. The amplitude of raw EMG irritative discharges in the right biceps brachii muscle decreased significantly after posterior foraminotomy. Following rod reapplication with decreased rod lordosis, the irritative EMG discharges were eliminated. Before implementing further measures, posterior foraminotomy can be a crucial initial intervention for minimizing nerve root irritation due to mechanical factors after cervical lateral mass screw fixation.