Differential Diagnosis for Progressive Left Arm Weakness after Anterior Cervical Discectomy Decompression and Fusion

• Single Most Likely Diagnosis
  • Postoperative hematoma or seroma causing spinal cord compression: This is a common complication after spinal surgery, which can lead to neurological deficits such as arm weakness due to compression of the spinal cord or nerve roots.
• Other Likely Diagnoses
  • Pseudomeningocele: A collection of cerebrospinal fluid (CSF) that can occur after spinal surgery, potentially causing nerve compression or irritation leading to arm weakness.
  • Hardware failure or malposition: Incorrect placement or failure of the surgical hardware (e.g., plates, screws) can lead to instability, compression, or irritation of the spinal cord or nerve roots, resulting in arm weakness.
  • Infection (e.g., epidural abscess, osteomyelitis): Postoperative infections can cause inflammation, abscess formation, or bone infection, leading to compression or destruction of the spinal cord or nerve roots.
• Do Not Miss Diagnoses
  • Spinal epidural hematoma: A potentially life-threatening condition that requires immediate intervention. Even though it may not be the most likely diagnosis, missing it could have severe consequences, including permanent neurological damage or death.
  • Cervical spine instability: Instability of the cervical spine can lead to further injury or compression of the spinal cord, necessitating prompt recognition and treatment to prevent long-term damage.
• Rare Diagnoses
  • Dural tear with CSF leak: Although less common, a dural tear can lead to CSF leakage, potentially causing headaches, nerve root irritation, or meningitis.
  • Nerve root avulsion or injury: Direct injury to the nerve roots during surgery can result in arm weakness, although this is relatively rare with modern surgical techniques.
  • Vertebral artery injury or thrombosis: Injury to the vertebral artery during surgery can lead to thrombosis, embolism, or vertebral-basilar insufficiency, resulting in neurological deficits, including arm weakness.