Myelopathy Caused by Soft Cervical Disc Herniation : Surgical Results and Prognostic Factors

  • Kim, Young-Jin (Department of Neurosurgery Dankook University College of Medicine) ;
  • Oh, Seong-Hoon (Department of Neurosurgery Hanyang University Medical Center) ;
  • Yi, Hyeong-Joong (Department of Neurosurgery Hanyang University Medical Center) ;
  • Kim, Young-Soo (Department of Neurosurgery Hanyang University Medical Center) ;
  • Ko, Yong (Department of Neurosurgery Hanyang University Medical Center) ;
  • Oh, Suck-Jun (Department of Neurosurgery Hanyang University Medical Center)
  • Published : 2007.12.28

Abstract

Objective : The purpose of this study was to investigate the surgical results and prognostic factors for patients with soft cervical disc herniation with myelopathy. Methods : During the last 7 years, 26 patients with cervical discogenic myelopathy were undertaken anterior discectomy and fusion. Clinical and radiographic features were reviewed to evaluate the surgical results and prognostic factors. The clinical outcome was judged using two grading systems (Herkowitz's scale and Nurick's grade). Results : Male were predominant (4:1), and C5-6 was the most frequently involved level. Gait disturbance, variable degree of spasticity, discomfort in chest and abdomen, hand numbness were the most obvious signs. Magnetic resonance(MR) images showed that central disc herniation was revealed in 16 cases, and accompanying cord signal changes in 4. Postoperatively, 23 patients showed favorable results (excellent, good and fair) according to Herkowitz's scale. Conclusion : Anterior cervical discectomy and fusion effectively reduced myelopathic symptoms due to soft cervical disc herniation. The authors assured that the shorter duration of clinical attention, the lesser the degree of myelopathy and better outcome in discogenic myelopathy.

Keywords

References

  1. An HS : Degenerative disc disease of the cervical spine in An HS, Simson JM (eds) : Surgery of the cervical spine, ed 1. London : Martin Dunitz Ltd, 1994, pp181-194
  2. Aronson N, Bagan M, Filtzer DL : Results of using the smith-Robinson approach for herniated and extruded cervical discs. Technical note. J Neurosurg 32 : 721-722, 1970 https://doi.org/10.3171/jns.1970.32.6.0721
  3. Boni M, Cherubino P, Denaro V, Benazzo F : Multiple subtotal somatectomy. Technique and evaluation of a series of 39 cases. Spine 9 : 358-362, 1984 https://doi.org/10.1097/00007632-198405000-00005
  4. Bucciero A, Visioli L, Cerillo A : Soft cervical disc herniation. An analysis of 187 cases. J Neurosurg Sci 42 : 125-130, 1998 https://doi.org/10.1097/00006123-199801000-00025
  5. Chiles BW, Leonard MA, Choudhri HF, Cooper PR : Cervical spondylotic myelopathy : patterns of neurological deficits and recovery after anterior cervical decompression. Neurosurgery 44 : 762-770, 1999 https://doi.org/10.1097/00006123-199904000-00041
  6. Collias JC, Roberts MP : Posterior operations for cervical disc herniation and spondylotic myelopathy in Schmidek HH, Sweet WH(eds) : Operative neurosurgical techniques. Indication, methods, and results, Phladelphia : W.B. Saunders Company, 1988, Vol 2, pp1347-1358
  7. Cooper PR : Cervical spondylotic myelopathy. Contemp Neurosurg 19 : 1-8, 1997
  8. Crandall PH, Batzdorf U : Cervical spondylotic myelopathy. J Neurosurg 25 : 57-66, 1966 https://doi.org/10.3171/jns.1966.25.1.0057
  9. Czervionke LF, Haughton VM : Degenerative disease of the spine in Atlas AW(ed) : Magnetic resonance imaging of the brain and spine, ed 1. New York : Raven Press, 1996, pp1093-1160
  10. Dillin WH, Wartkins RG : Cervical disc disease in Herkowitz HN, Grafin SR, Balderstone RA, Eismont FJ, Bell GR, Wiesel SW(eds) : The Spine, ed 3. Philadelphia : W.B. Saunders Company, 1992, Vol 1, pp560-570
  11. Dubuisson A, Lenelle J, Stevenaert A : Soft cervical disc herniation : a retrospective study of 100 cases. Acta Neurochir (Wien) 125 : 115-119, 1993 https://doi.org/10.1007/BF01401837
  12. Enzmann DR : Degenerative disc disease in Enzmann DR, DeLapaz RL, Rubin JB(eds) : Magnetic resonance of the spine, ed 1. St. Louis : The CV Mosby Company, 1990, Vol 1, pp437-509
  13. Epstein JA, Marc JA, Hyman RA, Khan A, Mardayat M : Today myelography in the evaluation of lumbar discs. With the presentation of three cases of thoracic neoplasms simulating nerve root lesions. Spine 4 : 121-128, 1979 https://doi.org/10.1097/00007632-197903000-00005
  14. Fergerson RJ, Kaplan LR : Cervical spondylitic myelopathy. Neurol Clin 3 : 373-382, 1985 https://doi.org/10.1016/S0733-8619(18)31042-9
  15. Flanders AE, Schaefer DM, Doan HT, Mishkin MM, Gonzales CF, Northrup BE : Acute cervical spine spine trauma : correlation of MR imaging findings with degree of neurologic deficit. Radiology 177 : 25-33, 1990 https://doi.org/10.1148/radiology.177.1.2399326
  16. Grisoli F, Graziani N, Fabrizi AP, Peragut JC, Vincentelli F, Diaz- Vasquez P : Anterior discectomy without fusion for treatment of cervical lateral soft disc extrusion : a follow-up 120 cases. Neurosurgery 24 : 853-859, 1989 https://doi.org/10.1227/00006123-198906000-00010
  17. Herkowitz HN, Kurz LT, Overholt DP : Surgical management of cervical soft disc herniation. A comparison between the anterior and posterior approach. Spine 15 : 1026-1030, 1990 https://doi.org/10.1097/00007632-199015100-00009
  18. Houser OW, Onofrio BM, Miller GM, Fdger WN, Smith PL : Cervical spondylotic stenosis and myelopathy : evaluation with computed tomographic myelography. Mayo Clin Proc 69 : 557-563, 1994
  19. Jackson RJ, Gokaslan ZY : Treatment of disc and ligamentous disease of the cervical spine in Winn HR(ed) : Youmans Neurological Surgery, ed 5. Philadelphia : Saunders, 2004, Vol 4, pp4395-4407
  20. Lee SJ, Oh SH, Lee KS, Cheong JH : Cervical myelopathy due to calcification of ligamentum flavum at the atlantoaxial junction. J Korean Neurosurg Soc 33 : 517-520, 2003
  21. Lestini WF, Wiesel SW : The pathogenesis of cervical spondylosis. Clin Orthop Relat Res 239 : 69-93, 1989
  22. Lunsford LD, Bissonette DJ, Zorub DS : Anterior surgery for cervical disc disease. Part 2. Treatment of cervical spondylotic myelopathy in 32 cases. J Neurosurg 53 : 12-19, 1980 https://doi.org/10.3171/jns.1980.53.1.0012
  23. Murphy MG, Gado M : Anterior cervical discectomy without interbody bone graft. J Neurosurg 37 : 71-74, 1972 https://doi.org/10.3171/jns.1972.37.1.0071
  24. Nurick S : The natural history and the results of surgical treatment of the spinal cord disorder associated with cervical spondylosis. Brain 95 : 101-108, 1972 https://doi.org/10.1093/brain/95.1.101
  25. Parke WW : Correlative anatomy of cervical spondylotic myelopathy. Spine 13 : 831-837, 1988 https://doi.org/10.1097/00007632-198807000-00023
  26. Rovira M, Torrent O, Ruscalleda J : Some aspects of the spinal cord circulation in cervical myelopathy. Neuroradiology 9 : 209-214, 1975 https://doi.org/10.1007/BF00346149
  27. Saunders RL, Bernini PM, Shirreffs TG, Reeves AG : Central corpectomy for cervical spondylotic myelopathy : a consecutive series with long-term follow up evaluation. J Neurosurg 74 : 163-170, 1991 https://doi.org/10.3171/jns.1991.74.2.0163
  28. Seifert V, Stolke D : Multisegmental cervical spondylosis : treatment by spondylectomy, microsurgical decompression, and osteosynthesis. Neurosurgery 29 : 498-503, 1991 https://doi.org/10.1227/00006123-199110000-00002
  29. Yamashita Y, Takahashi M, Matsuno Y, Sakanamo Y, Oguni T, Sakae T, et al : Chronic injury of the spinal cord : assessment with MR imaging. Radiology 175 : 849-854, 1990 https://doi.org/10.1148/radiology.175.3.2343135
  30. Yu YL, de Boulay GH, Stevens JM, Kendall BE : Computed tomography in cervical spondylotic myelopathy and radiculopathy : visualization of structures, myelographic comparison, cord measurements and clinical utility. Neuroradiology 28 : 221-236, 1986 https://doi.org/10.1007/BF00548196