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To Operate or Not to Operate: The Dilemma between Surgery versus Conservative Management of Cervical Disc Herniation

Volume 1 - Issue 5

Carlos Perez Gonzalez, MD, Yahira Acevedo-Santiago, MD, Franklin E. Caldera, DO, MBA and *Yejia Zhang,MD, PhD

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    • Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, USA

    *Corresponding author: Yejia Zhang, Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, USA

Received: September 22, 2017;   Published: October 04, 2017

DOI: 10.26717/BJSTR.2017.01.000409

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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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