45 year old active woman with 3 years of neck and right arm pain. MRI scan shows disc abnormalities at C3-4 and C6-7 (Image A). The C6-7 level shows (Images A & B) a right sided disc herniation impinging upon the exiting nerve root. This finding corresponds to the patient’s pain in her middle finger and the weakness of her wrist flexion and triceps.
The patient had a significant amount of mechanical neck pain, at times worse than the arm pain. A discogram was therefore performed to rule out other causes of her neck pain.
This procedure involved placing a needle inside the disc and injecting dye. If the familiar pain is reproduced, the discogram is noted as positive at that disc. A positive discogram indicates that there is a high chance that the disc is the cause of the patient’s pain.
This patients discogram revealed dye extravasation at C3-4 (Image C), but no reproduction of familiar neck pain.
At C5-6 (Image D), she had reproduction of familiar neck pain. The C4-5 disc was negative for reproduction of pain or extravasation of dye.
A two-level anterior decompression, fusion, and instrumentation was performed resulting in immediate improvement of arm symptoms and gradual improvement of neck pain (Image E).