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cervical_disc_herniation

Cervical disc herniation

Cervical disc herniation (CDH) is the most common cause of cervical radiculopathy and could overlap with fibromyalgia (FM).The prevalences of FM and widespread pain in patients with CDH were found as 11.5% and 78.8% respectively 1).

Slow-onset disc herniation can directly compress and/or chemically irritate cervical nerve roots, and this type of root injury elicit pain in animal models of radiculopathy.

Types

High cervical disc herniation.

Traumatic cervical disc herniation

Cervical intradural disc herniation (IDH) is a rare condition with very few case reports in the literature.

All patients with a cervical IDH reported in the literature have a traumatic etiology.

Only one patient with a spontaneous cervical IDH has been reported 2).

Clinical features

Diagnosis

Treatment

Outcome

The surgical outcomes of CDH have been reported to be successful in terms of clinical and radiological measures 3) 4).

Decreased disk height, percentage of herniated nucleus pulposus HNP in the spinal canal, or presence of signal intensity change in the spinal cord seem to be the important risk factors for motor weakness in patients with cervical disk herniation. Moreover, the presence of signal intensity change in the spinal cord seems to be an important risk factor for delayed recovery 5).

The better long-term results with the posterior operation might be due to the more complete opening of the foramen for neural decompression at the time of the operation and thereafter 6).

Case series

Four patients (mean age 39.5 years) presented to a tertiary care academic medical center from September 2012 to September 2013 with severe progressive neurologic deficits due to cervical disk herniation and were included in the series. Patients' surgical, medical, and imaging records were retrospectively reviewed under an Institutional Review Board waiver of informed consent. Results  Patients in the series presented with acute neurologic deterioration, including paraparesis, Brown-Séquard syndrome, or quadriparesis deteriorating to quadriplegia. Emergent magnetic resonance imaging (MRI) scans and emergent decompression and fusion for acute soft disk herniation were performed in all cases. All patients recovered to excellent functional status with Frankel score improvement from B (one patient)/C (three patients) to E (three patients)/D (one patient).

Acute cervical disk herniation with acute neurologic deterioration is a medical emergency necessitating emergent MRI and surgical decompression. Clinical presentation varies. In patients with rapid-onset neurologic deterioration, a high level of suspicion for this rare entity is indicated 7).

1)
Demir SE, Aytekin E, Karacan I, Aydin T, Kavadar GD. The prevalence of fibromyalgia among patients with cervical radiculopathy due to cervical disc herniation: A pilot study. J Back Musculoskelet Rehabil. 2013 Nov 13. [Epub ahead of print] PubMed PMID: 24225311.
2)
Warade AG, Misra BK. Spontaneous cervical intradural disc herniation. J Clin Neurosci. 2013 Aug 23. pii: S0967-5868(13)00448-7. doi: 10.1016/j.jocn.2013.06.011. [Epub ahead of print] PubMed PMID: 24210799.
3)
Decker RC. Surgical treatment and outcomes of cervical radiculopathy. Phys Med Rehabil Clin N Am. 2011;22:179–191.
4)
Smith JS, Helgeson MD, Albert TJ. The argument for anterior cervical discectomy and fusion over total disk replacement. Semin Spine Surg. 2012;24:2–7.
5)
Nam TW, Lee HS, Goh TS, Lee JS. Predictors of Motor Weakness and Delayed Recovery in Cervical Disk Herniation. J Spinal Disord Tech. 2015 Aug;28(7):E405-9. doi: 10.1097/BSD.0b013e31829f5a1f. PubMed PMID: 26213841.
6)
Dohrmann GJ, Hsieh JC. Long-Term Results of Anterior versus Posterior Operations for Herniated Cervical Discs: Analysis of 6,000 Patients. Med Princ Pract. 2014;23(1):70-3. doi: 10.1159/000351887. Epub 2013 Sep 27. PubMed PMID: 24080595.
7)
Harel R, Knoller N. Acute Cervical Disk Herniation Resulting in Sudden and Severe Neurologic Deterioration: A Case Series. Surg J (N Y). 2016 Sep 17;2(3):e96-e101. doi: 10.1055/s-0036-1593357. eCollection 2016 Jul. PubMed PMID: 28824999; PubMed Central PMCID: PMC5553475.
cervical_disc_herniation.txt · Last modified: 2018/08/18 20:59 by administrador