Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon
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Peripheral / Spine Case

Ulnar nerve decompression after cervical laminectomy

68 year-old man with progressive right hand pain, sensation loss, and weakness after successful cervical spine decompression

Description

68 year old man initially presented to ER with cervical myelopathy
Reported 8 years of hand numbness & tingling, 4 months of progressive difficulty walking. Legs weak and loss of balance, Right arm more than left arm weakness and loss of dexterity.
Fall at home prompted presentation to ER.
Neurological exam with weakness of all extremities- most in hands and proximal legs, loss of sensation most in the hands, hyper-reflexia
Underwent Urgent cervical surgery C2-7 laminectomy
After 6 months, Strength and gait return, but has worsening right hand numbness and weakness
Loss of sensation in ring & small digits
Nerve testing (EMG & NCS) confirmed severe ulnar neuropathy
Failed conservative care

Educational Notes

Patients may have multiple compressive pathologies affecting their nerves that can be targets for neurosurgical intervention.

Gallery

Images

Figure 1CT C-spine performed in ER showing diffuse degeneration
Figure 2Preoperative MRI showing severe cervical spinal stenosis with spinal cord compression extending from C2-C7.
Figure 3Postoperative CT of the neck reconstructed to evaluate the cervical spine. Shows removal of the C2-C7 lamina with satisfactory spinal canal decompression
Figure 46 months after cervical surgery patient returns to OR for right ulnar nerve decompression. Intraoperative photo shows undersurface of the right arm with the surgical incision marked out.
Figure 5Operative photo showing the proximal ulnar nerve emerging from the upper arm but then disappearing into scar tissue.
Figure 6Illustration showing the course of the ulnar nerve in the right arm and the site of compression as also demonstrated in the operative photos.
Figure 7Final operative photo showing the decompressed ulnar nerve crossing the elbow into the into forearm

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