Robin Babadjouni, MD: No financial relationships to disclose
Introduction: Phrenic nerve palsy arises from multiple causes such as iatrogenic, viral, traumatic or idiopathic. In our practice, a rising number of patients with cervical radiculopathy are presenting with diaphragm paralysis. The purpose of this abstract is to investigate the relationship between cervical foraminal stenosis and phrenic nerve palsy.
Methods: A retrospective review of all patients presenting with phrenic nerve palsy to a single surgeon at a tertiary medical center from 2020 to 2022 was conducted. Data was collected on demographics, symptoms, mechanism, comorbidities, MRI findings and electromyography results. Patients with cervical spondylosis without viral or traumatic presentation met inclusion criteria.
Results: A total of 8 patients met inclusion criteria (53% of presenting patients), with an average age of 67 years. One patient had history of rheumatological disease and one patient carried a history of multiple sclerosis, both conditions medication-controlled. All presented to a peripheral nerve specialist with referred shoulder pain, neck pain and shortness of breath an average of 12.75 months after onset of symptoms. All patients had hemi-diaphragm elevation on chest radiography and 87.5% had a positive SNIFF test. All but one patient had C3-5 multilevel foraminal stenosis in the following patterns: ipsilateral C3 stenosis (50%), C4 stenosis (87%), C5 stenosis (87.5%), and spinal stenosis (62.5%). 25% had a history of cervical spine surgery. 25% exhibited weakness in the C5 myotome and 2/5 patients with EMGs showed C4 or C5 myotome acute or chronic denervation.
Conclusion : Phrenic nerve palsy may be a sequela of cervical foraminal stenosis. It should be considered and investigated in a timely fashion in patients presenting with referred shoulder pain and respiratory symptoms in the context of cervical spine disease.
