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

lingua: Inglese

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


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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