Hemidiaphragm paralysis from cervical spondylosis

05 November 2004 

Pathophysiology

1.Direct contact of spondylitic bars upon spinal cord

2. Direct contact of spondylitic bars upon nerve roots

3.Secondary ischemia of spinal artery

Degenerative changes in order of frequency

C5-6

C6-7

C4-5

C7-T1

C3-4

Nerve root entrapment

C5-6

C6-7

C3-4 (uncommon)

Cervical spine flex/ext

Total range is 109⁰

18.4% at C5-6

14.7% at C3-4

Case 1

67 yo left hander

worsening shortness of breath, left arm weakness

clonus & extensor plantars in LL

paralysed L diaphragm on fluoroscopy

CT myelogram

Treated with decompressive laminectomy C2-6 and foraminotomy of C3-4 & C4-5 bilaterally

Regained L diaphragm & L arm weakness, improvement in LL

Case 2

47 yo female opera singer trained by Luigi Ricci

4 rear end motor car accidents in preceding 6 years

failing voice over 1 year

2 yr history of neck pain

paralysed L diaphragm

L arm weakness (biceps, wrist extensors) with dynamometer of 0

Xray & discography: acute unilat disc protrusion at C4-5

3 level ant discectomy & interbody fusion C4-5, 5-6, 6-7 and removal of loose disc fragments at C4-5.