title: Cervical disc herniation in a patient with congenital insensitivity to pain: a case report.
abstract: METHODS
  A case report of a patient with a known diagnosis of congenital insensitivity to pain who developed a herniated cervical disc.
  
  
  OBJECTIVE
  To study the clinical manifestations of cervical radiculopathy in a patient with congenital insensitivity to pain and the long-term outcome after surgical treatment.
  
  
  BACKGROUND
  There have been no reports in the English literature documenting such a patient.
  
  
  METHODS
  Retrospective case report and long-term clinical and radiographic follow-up.
  
  
  RESULTS
  This patient with a known diagnosis of congenital insensitivity to pain had neurologic motor weakness with "neck and shoulder pain." Clear radicular pattern could not be elicited. The patient underwent a successful anterior discectomy and fusion with long-term clinical and radiographic results.
  
  
  CONCLUSIONS
  Patients with congenital insensitivity to pain who develop a cervical disc herniation may present with atypical symptoms not manifesting in the classic radicular pattern. Higher index of suspicion by the clinician must be practiced to make the appropriate diagnosis. Successful surgical outcome may be achieved in these patients.
authors.affiliation: University of Pittsburgh Medical Center, Department of Orthopedic Surgery, Pittsburgh, Pennsylvania, USA. jkang@uoi.upmc.edu
authors.forename: J D
authors.initials: JD
authors.lastname: Kang
authors.forename: H H
authors.initials: HH
authors.lastname: Bohlman
mesh_terms: D000328:Adult; D017586:Diskectomy; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D009408:Nerve Compression Syndromes / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D000699:Pain Insensitivity, Congenital / Q000150:complications*; D011859:Radiography; D013035:Spasm / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery