Diagnosis and treatment of traumatic cervical intervertebral disc tear

English Keywords:Cervical spine  Spinal cord injury  Cervical intervertebral disc  Tear  No fracture and dislocation

English Abstract:

  【Abstract】 Objectives: To investigate the characteristics of traumatic cervical intervertebral disc tear, the diagnostic features of MRI and the treatment strategy. Methods: From June 2015 to June 2018, 46 patients with traumatic cervical intervertebral disc tear and spinal cord injury, 34 males and 12 females, with an average age of 51.0±12.3 years ranging from 21 to 74 years, were retrospectively analyzed. Among them, 27 were injured in traffic accidents, 11 were injured by falling and 8 were injured by tumbling. Of all patients, 40 had facial abrasion. ASIA scale, X-ray, CT and MRI examination were performed before operation in all patients, and fat suppression sequence was required in MRI examination. Disc tear was diagnosed according to MRI, and the MRI imaging characteristics was recorded. ACDF was chosen in anterior segment injury. After general anesthesia in anterior approach, the upper vertebral body would show posterior displacement in partial disc tear segments in X-ray under cervical hyperextension position. Subdiscography would be given for the case with high preoperative suspicion of disc tear but found no tear in operation. The MRI characteristics were recorded after compared with intraoperative exploration. The VAS score and Oswestry dysfunction index (ODI) of neck pain before operation, 1 week after operation, 1 month after operation and at the last follow-up were compared. Results： Of the 46 patients, there were 2 cases of grade B, 7 cases of grade C, 26 cases of grade D and 11 cases of grade E. At final follow-up, there were one case of grade D and 45 cases of grade E, with mild nerve injury and good recovery after operation. According to preoperative MRI characteristics and actual disc injury during operation, the MRI characteristics of disc tear could be divided into two types: typical and atypical. Posterior X-ray under cervical hyperextension position and intraoperative discography under general anesthesia were helpful for judging disc injury. A total of 74 disc tear were found in the 46 patients, including 12 patients with two segmental disc tear, and 3 patients with three segmental disc tear. Anterior ACDF was effective in the treatment of intervertebral disc tear. All patients improved gradually during the follow-up of 6.0±1.3 months(4-8 months). VAS score and ODI were significantly improved at 1 week, 1 month after operation and the last follow-up(P<0.05). Conclusions： Traumatic cervical intervertebral disc tear accompany with mild spinal cord injury, and can be diagnosed according to MRI characteristic findings. Anterior cervical ACDF surgery is targeted at the etiology, which can achieve good nerve recovery and satisfactory outcomes.