Unveiling the Silent Threat of Upper Cervical Disc Herniation: A Case Report

Traumatic herniations of the upper cervical spine are rare, with a higher likelihood of occurrence in older individuals. Their associated neurological symptoms can vary widely, often leading to delays in clinical diagnosis. We report the case of an 86-year-old man who developed neurological symptoms after a fall. Initially, intracranial pathology was suspected, and a head magnetic resonance imaging (MRI) revealed small chronic subdural hematomas, which were managed conservatively. However, as his paralysis progressed over the following days, a repeat brain CT showed no significant changes. Suspecting cervical spine involvement, further imaging identified a C2/3 disc herniation. The patient underwent emergency cervical laminoplasty, but postoperative subluxation required additional surgery, including C1-3 posterior fusion and C2/3 anterior fusion. Post-surgery, the patient exhibited improvement in paralysis affecting both the upper and lower extremities and a reduction in sensory deficits. Early diagnosis and treatment are crucial to improve neuropathic outcomes. A thorough understanding of the symptoms and characteristics of neurological damage to the upper cervical spine can significantly contribute to favorable results. Clinicians should be well-acquainted with this pathological condition.