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Journal of Neurosurgical Sciences 1998 December;42(4):203-11

Copyright © 1998 EDIZIONI MINERVA MEDICA

language: English

Myeloradicular damage in traumatic cervical disc herniation

Bucchiero A., Carangelo B., Cerillo A., Gammone V., Panagiotopoulos K., Vizioli L.

Department of Neurosurgery, School of Medicine University of Naples “Federico II”, Naples, Italy


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Background. The lit­er­a­ture on ­pure trau­mat­ic ­disc her­ni­a­tion is ­now volu­mi­nous ­but diver­sity of opin­ion ­exists regard­ing fre­quen­cy, path­o­gen­e­sis ­and man­age­ment of ­this ­type of ­lesion. As a fur­ther con­tri­bu­tion to ­the solu­tion of ­the ques­tion it is ­thus jus­ti­fied to ­report ­our ­series of cer­vi­cal trau­mat­ic ­disc her­ni­a­tion.
Methods. During ­the peri­od ­from January 1986 to December 1994, 41 ­patients (25 ­males ­and 16 ­females, ­between ­the ­ages of 24 ­and 51 ­years) ­with trau­mat­ic cer­vi­cal ­disc her­ni­a­tions ­were oper­at­ed on by ante­ri­or ­approach. Twenty-­six (63.4%) ­patients pre­sent­ed ­with radic­u­lar syn­drome, 3 (7.3%) ­with medul­lary symp­toms ­and ­signs, ­and 12 (29.3%) ­with mye­lor­a­dic­u­lop­a­thy. Disc her­ni­a­tion ­was at ­the C3/4 lev­el in 4 (9.7%) cas­es, at ­the C4/5 lev­el in 7 (17.1%) cas­es, at ­the C5/6 lev­el in 24 (58.5%) cas­es, ­and at ­the C6/7 lev­el in 8 (19.5%) cas­es. In 6 (40%) ­patients suf­fer­ing ­from mye­lop­a­thy (­with or with­out radic­u­lop­a­thy) an ­area of ­high MR sig­nal inten­sity ­was ­observed with­in ­the cer­vi­cal ­cord on T2-weight­ed imag­es; ­such ­area cor­re­spond­ed at ­the lev­el of ­cord com­pres­sion by ­disc ­and ­was ­not dem­on­strat­ed on T1-weight­ed imag­es. All ­patients under­went dis­cec­to­my with­out ­bone graft­ing.
Results. Among ­patients ­with radic­u­lop­a­thy, 27 (71%) expe­ri­enced com­plete ­relief of pre­op­er­a­tive symp­tom­a­tol­o­gy, ­and 11 (29%) ­minor ­pain ­and/or neu­ro­log­i­cal def­i­cits with­out inter­fer­ence ­with ­work activ­ies. The mye­lop­a­thy com­plete­ly dis­ap­peared in 11 (73.3%) cas­es where­as ­remained ­unchanged in 3 (20%); 1 ­patient ­with mye­lop­a­thy expe­ri­enced ame­li­o­ra­tion of pre­op­er­a­tive spe­cif­ic symp­toms ­and ­signs.
Conclusions. The ­results of sur­gery ­for cer­vi­cal radic­u­lop­a­thy ­due to trau­mat­ic ­disc her­ni­a­tion ­are sat­is­fac­to­ry ­since 92 to 100% of ­the ­patients post­op­er­a­tive­ly ­regain ­prior activ­ities, an obser­va­tion we ­have con­firmed ­with ­our ­own ­series. The ­results in cas­es of mye­lop­a­thy ­are ­less sat­is­fac­to­ry: ­although approx­i­mate­ly 73% of ­our ­patients ­with mye­lop­a­thy report­ed ­total ­relief of pre­op­er­a­tive symp­tom­a­tol­o­gy, pub­lished ­reports indi­cate ­that a sig­nif­i­cant post­op­er­a­tive improve­ment is ­seen in 33 to 56% of ­patients.

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