Clinical analysis of cervical radiculopathy causing deltoid paralysis

Abstract

In general, deltoid paralysis develops in patients with cervical disc herniation (CDH) or cervical spondylotic radiculopathy (CSR) at the level of C4/5, resulting in compression of the C5 nerve root. Therefore, little attention has been paid to CDH or CSR at other levels as the possible cause of deltoid paralysis. In addition, the surgical outcomes for deltoid paralysis have not been fully described. Fourteen patients with single-level CDH or CSR, who had undergone anterior cervical decompression and fusion for deltoid paralysis, were included in this study. The severity of deltoid paralysis was classified into five grades according to manual motor power test, and the severity of radiculopathy was recorded on a visual analog scale (zero to ten points). The degree of improvement in both the severity of deltoid paralysis and radiculopathy following surgery was evaluated. Of 14 patients, one had C3/4 CDH, four had C4/5 CDH, three had C4/5 CSR, one had C5/6 CDH, and five had C5/6 CSR. Both deltoid paralysis and radiculopathy improved significantly with surgery (2.57+/-0.51 grades vs 4.14+/-0.66, P=0.001, and 7.64+/-1.65 points vs 3.21+/-0.58, P=0.001, respectively). In conclusion, the current study demonstrates that deltoid paralysis can develop due to CDH or CSR not only C4/5, but also at the levels of C3/4 and C5/6, and that surgical decompression significantly improves the degree of deltoid paralysis due to cervical radiculopathy.

Fig. 1.

A 46-year-old male patient with deltoid paralysis due to cervical spondylotic radiculopathy at the C5/6 level. A Lateral radiograph of the cervical spine showing narrowing of intervertebral disc space and posterior osteophytes of the C5/6 level (white arrow). B T2-weighted sagittal magnetic resonance (MR) image showing multiple disc degeneration but no disc herniation at the C5/6 level. C Last follow-up lateral radiograph of cervical spine showing evidence of complete union at the C5/6 level

Fig. 2.

A 51-year-old male patient with deltoid paralysis due to cervical disc herniation of the C3/4 level. A Lateral radiograph of the cervical spine showing no definite abnormal findings, apart from a relatively narrow canal of the cervical spine. B, C T2-weighted sagittal and T1-weighted axial MR images showing spinal cord compression by a large herniated soft disc at the C3/4 level with intramedullary high signal intensity. D Last follow-up lateral radiograph of cervical spine showing evidence of union at the C3/4 level