Intractable hiccups and neck pain due to left C4 radiculopathy decreased with posterior foraminotomy
- Department of Neurosurgery, Hikone Chuo Hospital, Hikone, Japan.
- Department of Neurosurgery, Otsu City Hospital, Otsu, Japan.
Yoshinori Maki, Department of Neurosurgery, Hikone Chuo Hospital, Hikone, Japan.
DOI:10.25259/SNI_119_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Yoshinori Maki1, Toshinari Kawasaki2, Motohiro Takayama2. Intractable hiccups and neck pain due to left C4 radiculopathy decreased with posterior foraminotomy. 25-Feb-2022;13:74
How to cite this URL: Yoshinori Maki1, Toshinari Kawasaki2, Motohiro Takayama2. Intractable hiccups and neck pain due to left C4 radiculopathy decreased with posterior foraminotomy. 25-Feb-2022;13:74. Available from: https://surgicalneurologyint.com/surgicalint-articles/11407/
Background: Intractable hiccups can last for more than 1–2 months and can occur, as shown in this case study, due to cervical nerve root compression.
Case Description: A 76-year-old male presented with intractable hiccups and neck pain of 7 months’ duration. The patient underwent magnetic resonance imaging studies of the entire neuraxis. The only abnormality found was on the cervical magnetic resonance images that demonstrated left C4 nerve root compression due to the C3– C4 lateral/foraminal osteophyte. Following a left-sided C3–C4 laminoforaminotomy, the hiccups and the neck pain improved.
Conclusion: A 76-year-old male presented with intractable hiccups and neck pain attributed to a left C3/C4 lateral/foraminal spondylotic ridge. Following a left C3–C4 laminoforaminotomy, the frequency of hiccup attacks remained the same, but their duration was markedly shortened to 30 s, while the neck pain improved.
Keywords: C4 nerve root, Intractable hiccups, Laminoforaminotomy, Neck pain, Radiculopathy
Persistent hiccups and intractable hiccups are, respectively, defined based on their duration: more than 24–48 h and more than 1-2 months.[
A 76-year-old male presented neurologically intact, but with neck pain of 9 months duration, and 7 months of intractable hiccups. Notably, the hiccup attacks occurred 20–80 times/day, each lasting approximately 15 min. Upper endoscopy and abdominal computed tomography studies were negative. The patient underwent magnetic resonance imaging (MRI) studies of the entire neuraxis. When the cervical MRI revealed left C4 foraminal nerve root-osteophytic compression, left C3–C4 laminoforaminotomy was performed [
(a) Preoperative sagittal magnetic resonance image (MRI). Apparent cervical spinal cord stenosis is not observed. (b) An axial MRI at the level of the bilateral C4 nerve roots. Left foramen stenosis of the C4 nerve root is visible (white arrow heads). (c) A computed tomography image showing osteophytes causing left foramen stenosis of the C4 nerve root. The ventral and dorsal roots of C4 are compressed (black arrow heads). (d) The left C4 nerve root is posteriorly decompressed (triple arrows). (e) A postoperative computed tomography image showing release of the left C4 nerve root (black arrow heads).
Lesions that continuously irritate the afferent, central, and efferent pathways of the hiccup reflex may result in intractable hiccups [
A 76-year-old male with intractable hiccups/neck pain attributed to a left C4 root compression/C3–C4 osteophyte formation, experienced marked improvement in his hiccups (i.e., attacks markedly shortened to 30 s), and radiculopathy following a left C3–C4 laminoforaminotomy.
The authors certify that they have obtained all appropriate patient consent.
There are no conflicts of interest.
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