Figure 1.

A 53-year-old right hand dominant male presented with right-sided neck and trapezius pain with paresthesias that were recalcitrant to non-operative modalities. Epidural injections had provided significant but temporary relief. His neurologic exam was normal except for positive Spurling’s sign and decreased sensation in the C4 dermatome, both on the right. Radiographs (a, b) revealed multilevel spondylosis with 8 degrees of C2-7 kyhposis. MRI (c, d) and CT (e, f) showed severe right C3-4 foramenalstenosis, which correlated with his right C4 radicular symptoms. The patient underwent an uncomplicated C3-4 anterior cervical discectomy and fusion with right-sided foraminotomy (g, h). He experienced complete relief of his radicular symptoms, which was maintained at his most recent follow up visit (two years post-surgery). MRI (i, j) performed at that time for workup of neck pain revealed persistent multilevel spondylosis, particularly in the lower cervical spine, but no significant central or foraminal stenosis at C3-4.