Case 1 Cervical disc prolapse

Figure 1: MRI brain of the patient sagittal T2 sequence and axial T2.

Clinical presentation

• Female pt. 53 years old with 9 months history of bilateral brachialgia more on the right side with diffuse distribution.
• The condition started after significant head trauma.
• 3 months ago, the patient developed quadriparesis, difficulty walking associated with urine incontinence.
• MRI shown in figure 1-1.

• Q1: What are the main categories of presentation for cervical disc prolapse CDP? Into which of these categories could this patient be classified?”
• The main categories of presentation of CDP are:

1. Radiculopathy
2. Myelopathy
3. Radiculomyelopathy
4. Axial neck pain only
5. Symptoms appears in clusters: Cord syndromes.

• Based on the above categories, this patient falls into the radiculomyelopathy category.

• Q2: Based on the shown MRI, which nerve root is expected to be compressed?
• The C7 nerve root is the one expected to be affected.

• Q3: What is the difference between prefixed and postfixed brachial plexus? How can this difference influence the patient’s brachialgia?
• The brachial plexus roots range from C5 to T1 nerve roots. Sometimes, it can be prefixed, meaning it includes roots from C4 to C8, or postfixed, including roots from C6 to T2. This anatomical variation can influence the patient’s brachialgia due to shifts and aberrations in the spinal cord segments. In a prefixed configuration, a C6-C7 disc prolapse can cause brachialgia in C8 instead of the C7 nerve root. In a postfixed configuration, the same disc prolapse can cause C6 brachialgia instead of affecting the C7 nerve root directly.