Is numbness in the right index finger and thumb with bruising on the palm a normal symptom after a 2-level artificial disc replacement (ADR) surgery in the cervical spine?

Numbness and Bruising After 2-Level Cervical Artificial Disc Replacement

Numbness in the right index finger and thumb with palm bruising after 2-level cervical artificial disc replacement is NOT a normal expected outcome and requires urgent evaluation to rule out new nerve compression, C6/C7 nerve root injury, or vascular complications.

Immediate Clinical Assessment Required

The specific distribution of numbness (thumb and index finger) suggests C6 nerve root involvement, which should have been addressed—not created—by the surgery. This warrants immediate investigation:

• C6 radiculopathy manifests as numbness/paresthesias in the thumb and index finger, which is the exact distribution described 1
• Palm bruising is not a typical postoperative finding and may indicate hematoma formation, vascular injury, or excessive surgical manipulation 1
• The combination of new neurological symptoms with bruising raises concern for postoperative hematoma causing nerve compression, which is a surgical emergency

Expected vs. Abnormal Postoperative Findings

Normal Postoperative Course

• Transient neuropraxia (stinger-type symptoms) that resolves within minutes to hours may occur, but symptoms lasting beyond 5 minutes warrant further evaluation 1
• Mild incisional discomfort and neck stiffness are expected 1
• Gradual improvement in pre-existing radicular symptoms is the goal 2, 3

Abnormal Findings Requiring Investigation

• New-onset numbness in a dermatomal distribution not present preoperatively suggests iatrogenic nerve injury or new compression 1
• Bruising on the palm is not an expected surgical site finding and may indicate:
  • Postoperative hematoma with distal tracking
  • Vascular injury during approach
  • Excessive retraction injury 4

Recommended Diagnostic Algorithm

Immediate steps (within 24 hours):

1. Detailed neurological examination focusing on:

   • C6 motor function (wrist extension, biceps strength)
   • C6 sensory distribution (thumb, index finger, radial forearm)
   • Comparison to preoperative baseline 1

2. MRI cervical spine without contrast to evaluate:

   • Postoperative hematoma at surgical site
   • Adequate neural decompression at operated levels
   • Proper prosthesis positioning without migration 1, 2
   • New disc herniation or compression at adjacent levels

3. If MRI contraindicated or inconclusive, obtain CT cervical spine without contrast to assess:

   • Hardware positioning and alignment
   • Bony foraminal patency
   • Exclude fracture or subsidence 1

Critical Pitfalls to Avoid

• Do not dismiss new postoperative neurological deficits as "normal swelling"—this delays diagnosis of potentially reversible complications 1
• Do not wait for "conservative management" when new nerve deficits appear after surgery—this represents a change from baseline requiring investigation 1
• Avoid attributing symptoms to preoperative pathology without imaging confirmation, as artificial disc replacement should improve, not worsen, radicular symptoms 2, 3, 5

Time-Sensitive Considerations

• Postoperative hematomas causing neurological compromise require urgent surgical evacuation to prevent permanent deficit 1
• Nerve root injury from retraction or direct trauma has better recovery potential if identified and addressed early 4
• Device malposition or migration detected early allows for revision before permanent neurological damage occurs 2, 5

Expected Outcomes After Proper ADR

When artificial disc replacement is performed correctly, patients should experience:

• Maintenance or improvement of preoperative neurological function 2, 3
• Preservation of range of motion at the operated segment (average 8.1° ± 4.6°) 5
• Reduction in arm pain with VAS scores improving from 6.9 ± 1.1 preoperatively to 0.9 ± 0.3 postoperatively 2
• No new neurological deficits in properly selected and executed cases 3, 6

The described symptoms represent a deviation from expected postoperative course and mandate urgent evaluation to prevent permanent neurological injury.