Characteristics and treatment of traumatic cervical disc herniation

Objective:To explore clinical presentations and the operational opportunity of traumatic cervical disc herniation. Methods:From June 2002 to June 2009,40 patients with traumatic cervical disc herniation were treated. There were 24 males and 16 females,with an average age of 43.2 years old ranging from 30 to 56 years. There were 36 patients with single intervertebral disc herniation and 4 patients with double. The injury level of those patients were at C3,4 in 16 cases,C4,5 in 10 cases,C5,6 in 12 cases and C6,7 in 6 cases. Among them,18 patients showed spinal cord signal changes by MRI,5 patients suffered from nothing but neck and shoulder pain,8 patients with nerve root stimulation;10 patients with spinal cord compression,and 17 patients had both nerve root stimulation and spinal cord compression symptoms. Conservative treatment were applied to 13 patients with neck and shoulder pain and nerve root stimulation,5 cases of which were transferred to operation in case of poor effects,and Odom criteria were used to assess operational effects. Twenty-seven patients with spinal cord compression accepted operation from 1 to 27days after their trauma,16 of which were operated in 5 days (early operational group with an JOA score of 11.3±2.8),other 11 cases were operated from 5 to 27 days (delayed operational group with an JOA score of 11.4±2.9 ),then functional assessment of spinal cord were assessed according to JOA criteria. Results:Three patients who were transferred from conservative treatment recovered excellently according to Odom criteria and the other 2 were good at final followed-up. JOA score of early operational group increased from (11.3±2.8) to (15.3±1.8) one week after operation (P0.01),and (15.9±1.4) at final followed-up (P0.01). JOA score of delayed operational group increased from (11.4±2.9) to (14.0±2.6) one week after operation (P0.01),and (15.3±1.5) at final followed-up (P0.01). The recovery ratio of JOA score of early operational group were(74.6±16.8)% 1 week after operation,and increased to (85.6±13.6)% at final followed-up;while that of delayed operational group were (50.9±17.5)% and (68.2±21.5)%,and there were significant difference between early operational group and delayed operational group both at 1 week postoperation and final followup (P0.05). Conclusion:There are some difference in pathological segment and imaging manifestation between traumatic cervical disc herniation and cervical spondylosis. Early operation is favorable to the recovery of neurological function in patients with spinal cord compression.