title: Diagnosis and Treatment of C4 Radiculopathy.
abstract: METHODS
  Clinical case series.
  
  
  OBJECTIVE
  This study sought to clarify symptoms, diagnostic criteria, and treatment of C4 radiculopathy, and the role of diagnostic C4 root block in this entity.
  
  
  BACKGROUND
  Although well understood cervical dermatomal/myotomal syndromes have been described for symptoms originating from impingement on the C2, C3, C5, C6, C7, and C8 roots, less has been written about the syndrome(s) associated with the C4 root.
  
  
  METHODS
  The senior author reviewed surgical records and describes his personal experience with the diagnosis and treatment of C4 radiculopathy.
  
  
  RESULTS
  A total of 712 procedures for cervical radiculopathy without myelopathy were reviewed. Among that cohort, 13 procedures involved the C4 root only and five procedures involved two level procedures including the C4 root. Patients described pain as involving the axial cervical region, paraspinal muscles, trapezius muscle, and interscapular region. No patient described pain over the anterior chest wall or radiating distal to the shoulder, one described pain over the medial clavicle. All patients who were offered surgery had a positive response to a diagnostic C4 transforaminal single nerve root block. Thirteen patients underwent posterior foraminotomy (five at two levels) and five patients underwent an anterior discectomy and fusion at C3-4. Mean Oswestry Disability Index score significantly declined; preoperative score 24.3 (range 14-29), postoperative score 9.7 (range 2-18; P = 0.003) at ≥3 months. Mean Short Form-36v2 score significantly increased; preoperative score 34.2 (range 20-40.2), postoperative score 73.7 (range 40.5-88.3, P = 0.001) at ≥3 months.
  
  
  CONCLUSIONS
  C4 root symptoms overlap those of the C3 and C5 roots and are very similar to facet mediated pain. Asymptomatic C4 foraminal stenosis may be a common imaging finding, it can be difficult to diagnose C4 radiculopathy clinically. Diagnostic C4 root block can make an accurate diagnosis and lead to successful surgical outcomes.
  
  
  METHODS
  4.
authors.affiliation: Department of Neurological Surgery, Oregon Health & Science University, Portland, OR.|Section of Neurological Surgery, Operative Care Division, Portland Veterans Administration Medical Center, Portland, OR.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Ross
authors.affiliation: New York Medical College, Valhalla, New York, NY.
authors.forename: Miner N
authors.initials: MN
authors.lastname: Ross
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D059526:Foraminotomy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D010146:Pain; D011843:Radiculopathy / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome