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Intractable hiccups and neck pain due to left C4 radiculopathy decreased with posterior foraminotomy
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How to cite this article: Maki Y, Kawasaki T, Takayama M. Intractable hiccups and neck pain due to left C4 radiculopathy decreased with posterior foraminotomy. Surg Neurol Int 2022;13:74.
Abstract
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
INTRODUCTION
Persistent hiccups and intractable hiccups are, respectively, defined based on their duration: more than 24–48 h and more than 1-2 months.[2,3,5,9] The etiology of intractable hiccups includes: psychogenetic disorders, infection, trauma, medications, congenital anomalies, stroke, vascular malformations, demyelinating diseases, familial background, and iatrogenic conditions.[1-5,8] Additional causative lesions for intractable hiccups involve the thoracic spine, mediastinum, abdomen, or neural tracts extending from the cerebral cortex to the lumbar spine.[2-4,8] Here, a 76-year-old male with intractable hiccups and neck pain underwent a left-sided C3–C4 laminoforaminotomy to remove an osteophyte resulting in focal C4 root compression.
CASE PRESENTATION
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 [Figure 1a-e]. Postoperatively, the frequency of the hiccups remained the same, but the attacks were shortened to 30 s at most, and the neck pain improved.
DISCUSSION
Lesions that continuously irritate the afferent, central, and efferent pathways of the hiccup reflex may result in intractable hiccups [Table 1].[1-5,8,9] The afferent root receives ascending visceral and somatic sensory stimuli through the vagus nerve, phrenic nerve, and sympathetic neural branches of the T6-T12 nerve roots. Central modulation involves the cervical C3-C5 nerve roots, and the dorsolateral medulla. Descending hiccup modulation is regulated by the hypothalamus, reticular activating system, subthalamic nuclei, and the temporal lobe. Further, the phrenic nerve, the major efferent pathway of the hiccup reflex, is primarily composed of the ventral root of the C4 nerve.[6,7] Here, a 76-year-old male’s intractable hiccups and posterior neck pain were attributed to a left C3–C4 osteophyte/C4 radiculopathy, and markedly improved following a C3–C4 laminoforaminotomy.
CONCLUSION
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.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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