A rare complication after minimally invasive posterior cervical laminoforaminotomy

A 29-year-old male was referred to our orthopedic department with progressive severe pain in the neck and weakness of the left upper extremity. The onset of the symptoms began 4 months prior to referral including numbness of the upper left extremity accompanied with pain a few days later. On clinical examination, muscle weakness on the upper extremity was observed. More specifically, muscle weakness (MMT) 3/5 on all the muscle groups of the upper extremity with sensory disorders was noticed. The pain was exacerbated with arm movement and the patient had loss of fine movement ipsilateraly. Prior to admission, the patient had received two rounds of non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics followed by physiotherapy. Due to the poor response to the conservative treatment the patient underwent epidural steroid injection with mild and transient improvement of the symptoms. Subsequently, patient’s admission was decided in order to receive surgical treatment. The patient’s medical history was free. Imaging assessment with X-ray and magnetic resonance imaging (MRI), showed a left foraminal soft disc herniation C5-6. Due to patient’s clinical evaluation and the gradual deterioration of his clinical semiology, it was decided to be treated with minimally invasive posterior cervical “key-hole” laminoforaminotomy and discectomy. After surgery the patient’s neck and radicular pain was alleviated and even from the first post-surgical day the muscle strength of his arm was rehabilated. However, the patient developed a bilateral loss of motor strength in the deltoids with sensory deficit at the second post-operative day. He was initiated corticosteroids and further imaging with MRI was scheduled to exclude any development of hematoma or myelopathy in the cervical spine. According to the MRI results, there was a satisfactory decompression of the herniated level and no lesion of myelopathy or hematoma was found to explain the neurological deterioration of the patient.