To Operate or Not to Operate: The Dilemma between Surgery versus Conservative Management of Cervical Disc Herniation by Yejia Zhang in BJSTR
Abstract
A 49 year old male commercial airline pilot presented to the
PM&R spine clinic for an “epidural steroid injection”. The patient
complained of neck pain radiating tohis left posterolateral arm,
and to the 4th and 5th digits occasionally. Symptoms began 28 days
earlier, and involved waking up in pain, without any history of injury.
He described his neck and radiating arm painas sharp and constant,
with an intensity range of 2-8/10. Symptoms were exacerbated by
neck movement, while cervical traction and tramadol alleviated
the pain temporarily. He also had occasional numbness/tingling
of the left 4th and 5th digits. The patient was otherwise healthy.
The patient was employed as a commercial airline pilot but was on
medical leave due to the severity of his symptoms. Due to the nature
of his profession and the concern for the safety of passengers, he
was not allowed to go back to work until his condition improved.
Physical examination was significant for left deltoid atrophy and
subtle shoulder abduction weakness. Spurling’s maneuver caused
radiating pain to the left posterolateral arm at the elbow level. Neck
range of motion was decreased due to pain.
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