Resolution of Right Hemidiaphragm Paralysis following Cervical Foraminotomies

Our plain-English summary of Resolution of Right Hemidiaphragm Paralysis following Cervical Foraminotomies, by N. Singleton, M. Bowman, D. Bartle (Case Reports in Orthopedics, 2018).

The study

• Authors: N. Singleton, M. Bowman, D. Bartle
• Journal: Case Reports in Orthopedics
• Published: 2018;2018:6195179
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Hemidiaphragm paralysis secondary to phrenic nerve palsy is a well-recognised medical condition. There are few case reports in the literature documenting resolution of hemidiaphragm paralysis following cervical spine surgery. This case report documents our experience with one such case.

Case Presentation: A 64-year-old man was referred to the orthopaedic service with right hemidiaphragm paralysis. He had a previous history of asbestos exposure and polio and was initially seen and investigated by the respiratory physicians. He also reported intermittent neck pain and an MRI scan showed right-sided cervical foraminal stenosis. He underwent posterior right C3/4 and C4/5 foraminotomies, and by three months postoperatively, his hemidiaphragm paralysis had resolved and his shortness of breath had also improved.

Conclusion: This report documents a unique case of resolution of hemidiaphragm paralysis following posterior unilateral cervical foraminotomies.

In plain English

This was a case report by authors from the orthopaedic department of Tauranga Hospital, New Zealand, describing one patient: a 64-year-old man referred with paralysis of the right half of his diaphragm (the main breathing muscle). His past history included asbestos exposure and polio. The article gave no details of the asbestos exposure and did not link it to his paralysis. A chest CT scan showed no abnormality inside the chest. An MRI of the neck showed right-sided narrowing of the openings where nerve roots leave the spine, at C3/4 and C4/5. The authors wrote that it could not be determined whether the paralysis came from this narrowing or from his post-polio syndrome. He had surgery to widen those openings (foraminotomies). By three months after surgery the paralysis had resolved and his shortness of breath had improved. Breathing test results also rose, for example forced vital capacity from 3.88L to 4.86L. The authors concluded that compressed neck nerve roots should be considered as a cause of this kind of paralysis, since surgery can resolve it.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (a single patient)
• Who was studied: One 64-year-old man with right hemidiaphragm paralysis, referred to the orthopaedic service. The authors were based at the Orthopaedic Department, Tauranga Hospital, New Zealand.
• Exposure: The treatment studied was posterior right C3/4 and C4/5 cervical foraminotomies. Asbestos exposure is mentioned only as part of the patient's past history, alongside polio. No fiber type, job or dose is given, and the article does not connect it to his condition.
• Main results:
  • A chest CT scan showed no abnormality inside the chest.
  • MRI showed right-sided cervical foraminal stenosis with bony (osteophytic) changes at C3/4 and C4/5.
  • Before surgery, the underlying cause of the paralysis could not be determined: either the cervical foraminal stenosis or the post-polio syndrome.
  • By three months after surgery, the hemidiaphragm paralysis had resolved and the patient's shortness of breath had improved.
  • Breathing tests in this patient, before versus after surgery: FVC rose from 3.88L to 4.86L, FEV1 from 2.44L to 3.13L and TLC from 5.11L to 7.65L.
  • Further breathing tests in this patient, before versus after surgery: FRCpl rose from 2.61 to 3.63 and RV from 1.23L to 2.58L.
• The authors' conclusion: The authors concluded that, although rare, cervical nerve root compression should be considered as a cause of phrenic nerve palsy in patients with hemidiaphragm paralysis and breathing symptoms, because surgery can result in resolution of the paralysis and potential improvement in symptoms.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure.

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