Although disc herniation disc at C2-C3 level (C2-3) is very rare, it resultS in severe neurological symptoms. The exact diagnosis for upper cervical disc level is difficult to clarify depending on clinical examination and presentations. Until now, there is no report about non-operative treatment of C2-3 despite the fact is nonoperative treatment for the herniation disc is one of the best option. We report successfully management on a patient with C2-3 and also shown serial imaging study.
Case report: A 68-year old male visited emergent clinics due to severe dizziness and headache for one day. After 7 days at headache clinic, he had complained intractable pain of numbness and dysesthesia on right upper face and at the occipital area. Post-onset 12 days he referred to our department to control his pain. Physical examination disclosed positive spurling sign and the pain was provoked on the usual sites, mainly C2 and C3 dermatomes, The patient’s sensation was decreased on C2, C3 and C4 dermatomes. At neck extension the pain became worse. But there is no abnormal of upper motor neuron signs like increased on deep tendon areas, Hoffman’s and Babinski’ signs. His past medical history included a hypertension, chronic obstructive lung disease and left nephrectomy due to renal stone. Sagittal and axial Magnetic resonance (MR) images showed that 5 X5 X 4 mm, soft disc materials was close to the right of para-median site on C2-3 level [Figure 1. A and B].
We did not perform operation due to his medical condition and expected the spontaneous regression of the soft disc. Therefore, we treated him with 8mg of methylprednisolone twice daily for five days, amitriptyline 5mg and pregabalin 75mg, once daily, 5mg buprenorphine patch weekly. Eight day after medications, his pain was improved by 80%. Two months later, he said that replied to pain survey that he is rare discomfort; pain intensity, VAS 3, 3-4 times during 10-15 sec at day. He only is taking amitriptyline 5mg and aceclofenac 100mg daily. Serial MR images three months after initial MR showed absorption of disc particle on C2-3 level [Figure 1. C and D].
Conclusion: Nonoperative treatment with steroid may be a very useful method for upper cervical disc herniation, which is high possibility of spontaneous regression overtime.
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