Can intensive conservative treatment reverse chronic cervical disc herniation? A preregistered case study with complete MRI-documented resolution

The validity of conservative management in certain type of acute cervical disc herniation based on amelioration of brachialgia has been described previously. But, disappearance of radiculopathy secondary to spontaneous resolution of the disc material being demonstrated in control MRI has been sporadically reported as a case report or small series. Herein we will describe 70 carefully selected patients with acute mono-radiculopathy due to cervical soft disc herniation. These cases were enrolled in a prospective study for the possibility of their spontaneous resolution with time. For the possibility spontaneous resolution of the sequestrated disc material, periodic MRI was used. In parallel, pain intensity at the onset and its intensity at the time of its complete resolution were assessed via Visual Analogue Scale (VAS). Mixed-design repeated measures ANOVA and independent sample T-test were carried out to determine the effects of this kind of treatment on pain intensity and ultimate outcome of the patients. Surprisingly, spontaneous resolution of the sequestrated disc material was observed in control MRI, in all 70 recruited patients, in duration with mean of 5.71 ± 1.49 months. Furthermore, despite severity of the pain at the onset, amelioration of radiculopathy occurred with significant decrease in VAS score with initial intensity from mean of 9.30 ± 0.80 to mean of 0.90 ± 0.76, after disappearance of the offending disc material. The details of the current series which is the first prospective one in the literature might offer a strong clue about the validity of conservative management in certain type of acute cervical disc herniation. The current report may advocate the neurosurgeons to allow the nature to resolve its problem with its own alterations in due time in sequestrated cervical disc herniation’s in the absence of neurological deficit.

Syringomyelia is a neurological condition in which a longitudinal fluid-filled cavity is formed within the spinal cord. It usually occurs in the cervical region and is associated with Chiari malformation, infections, trauma, and tumors of the spinal cord. However, syringomyelia associated with cervical disc disease (SCD) is very rare and only a few cases have been reported so far. This case report presents the clinical and radiological findings of 13 cases of SCD to describe the properties of SCD and explore the nature of the relationship between syringomyelia and cervical disc disease. SCD was diagnosed in 13 using MRI findings, including coexistence of syringomyelia and cervical disc disease, presence of narrowed cervical subarachnoid space secondary to the cervical disc herniation or cervical local kyphosis associated with cervical disc degeneration or herniation, and the cervical disc herniation or segmental kyphosis and syrinx should be located within the same levels. The MRI findings were used to grade the syrinx and determine whether the cervical disc herniation or local kyphosis was located at the proximal or distal end of the syrinx. All patients had single-level disc herniation or kyphosis, the most common level being C5-6 (n = 6), followed by C6-7(n = 4) and C4-5 (n = 3). Eight patients had a distal type (disc disease located in the proximal end of the syrinx) SCD while five had the proximal variety (cervical disc disease located in the distal end of the syrinx). The average length of the syrinx was two vertebral segments. Surgery was performed in five cases and some degree of syrinx resolution was observed in all of them. Discussion - The main cause of syringomyelia is obstruction of cerebrospinal fluid (CSF) pathways; total obstruction could cause distal syrinx, whereas partial obstruction could cause proximal or distal syrinxes. Restoration of CSF pathways may result in some degree of resolution of syringomyelia. A causal association may exist between cervical disc disease and cervical syringomyelia but needs further exploration. SCD is a mild form of syringomyelia with symptoms primarily arising due to disc herniation or local kyphosis. The surgical treatment of the cervical disc disease is sufficient and results in a syringomyelia resolution of some degree.

The effects of disk herniations on the career and performance outcomes of Major League Baseball (MLB) pitchers are unknown. The purpose of this study is to determine the outcomes after a cervical or lumbar disk herniation for MLB pitchers. Forty MLB pitchers from 1984 to 2009 with a cervical disk herniation or lumbar disk herniation were identified using a previously established protocol. Cervical disk herniation was identified in 11 pitchers, 8 of which were treated operatively. The majority of pitchers with cervical disk herniation (8/11) returned to play at an average of 11.6 months. Lumbar disk herniation was identified in 29 pitchers, 20 of which were treated operatively. All pitchers with lumbar disk herniation (29/29) returned to play at an average of 7.3 months after diagnosis.

Background: Different treatments for discogenic axial back/neck pain or radicular pain to limbs are there from conservative therapies and minimally invasive therapies to open spine surgeries with lots of controversial outcomes. Percutaneous laser disc decompression (PLDD) is one of the minimally invasive therapies which is done under local anesthesia and has been successfully performed in many selected patients for their lumbar and cervical disc herniation problems. In PLDD, a part of the nucleus pulposus is vaporized with the help of laser energy to reduce the intradiscal pressure of the diseased discs causing nerve compression. In this case series after a 1-year follow-up, the clinical effectiveness of PLDD with epidural steroid injection is assessed in selected lumbar and cervical disc herniation cases. Materials and Methods: Ninety-six patients underwent the PLDD procedure at the cervical and lumbar disc with epidural steroid injections for their disc herniation causing radicular pain in the upper and lower limbs, respectively. The patients were followed at 8 weeks, 3 months, 6 months, and 1 year. The main outcome measures were done through the visual analog scores (VASs) and the Oswestry Disability Index (ODI) for upper and lower limb pain. Results: The primary outcome showed that there is a significant clinically relevant difference between the two groups at a 1-year follow-up. VAS and mean disability score based on the ODI were significantly lower in cervical disc herniation patients. The reoperation rate in the cervical group is also much less than the lumbar group. Conclusion: Like all other surgical modalities for disc herniation, PLDD has its own advantages and disadvantages. However, compared to lumbar disc herniation, it may give better results in cervical disc herniation. In selected cases, combined PLDD with epidural steroid injection can be chosen as a “first-choice-minimally-invasive-treatment,” when standard conservative therapies do not give satisfactory outcome.

Introduction
 Studies have suggested that radicular pain following disc herniation may be associated with local or systemic inflammatory responses produced in the vicinity of the herniated disc rather than compression of the nerve. Present study assessed the association of serum interleukin-6 (IL-6) levels, high-sensitivity C-reactive protein (hs-CRP) and related risk factors in patients undergoing discectomy following cervical disc herniation (CDH) or lumbar disc herniation (LDH).
 Methods
 Study recruited 77 patients undergoing discectomy for LDH and CDH. An interviewer administered questionnaire was used to obtain sociodemographic, behavioral and occupational data. IL-6 and hs-CRP levels were measured in each individual. IL-6 was analyzed by ELISA method and hs-CRP was determined using auto analyzer. Results were analyzed by using SPSS version 25.0.
 
 Results
 Significant correlation was not found with serum IL-6 and hs-CRP levels (r=0.02, p˃0.05) for acute and chronic CDH and LDH. Patients with chronic neck or back pain showed significantly (p=0.043) higher IL-6 level compared to patients with acute neck or back pain. Serum hs-CRP level was significantly higher (p=0.048) in patients with acute neck or back pain compared to patients with chronic neck or back pain. Significant association was not observed between; level of physically demanding nature of occupation (p=0.542), duration of occupation (p=0.446), type of exercise (p=0.371), type of sports (p=0.339) and CDH or LDH.
 Conclusion
 Though significant correlation was not observed between inflammatory markers IL-6, hs-CRP and CDH or LDH. The mean IL-6 was higher in chronic back pain and neck pain patients with LDH and CDH whereas mean hs-CRP mean was higher in acute back pain and neck pain patients. Significant association was not reported between selected known risk factors (behavioral, occupational) and CDH or LDH.

Cervical and back pains are important clinical problems affecting human populations globally. It is suggested that Propionibacterium acnes (P. acnes) is associated with disc herniation. The aim of this study is to evaluate the distribution of P. acnes infection in the cervical and lumbar disc material obtained from patients with disc herniation. A total of 145 patients with mean age of 45.21±11.24years who underwent micro-discectomy in cervical and lumbar regions were enrolled into the study. The samples were excited during the operation and then cultured in the anaerobic incubations. The cultured P. acnes were detected by 16S rRNA-based polymerase chain reaction. In this study, 145 patients including 25 cases with cervical and 120 cases with lumbar disc herniation were enrolled to the study. There was no significant difference in the age of male and female patients (p=0.123). P. acnes infection was detected in nine patients (36%) with cervical disc herniation and 46 patients (38.3%) with lumbar disc herniation and no significant differences were reported in P. acnes presence according to the disc regions (p=0.508.). Moreover, there was a significant difference in the presence of P. acnes infection according to the level of lumbar disc herniation (p=0.028). According to the results, the presence of P. acnes is equal in patients with cervical and lumbar disc herniation. There was a significant difference in the distribution of P. acnes infection according to level of lumbar disc herniation. II.

Since Guinto et al. reported a case of spontaneous regression of a herniated lumbar disc in 19841, this phenomenon in lumbar discs has been well documented and discussed2–4. However, there have been fewer reports of spontaneous regression of cervical disc herniation (CDH)5–7, especially ones confirmed by magnetic resonance imaging (MRI)8–10. Recently, a patient with CDH attending our hospital experienced this exceptional condition after 6 months of conservative treatment. In the following report, we will present this case and discuss the condition. A 32-year-old man was admitted to hospital because of weakness, impairment of walking, sensory disturbance in all extremities, and being woken at night by neck pain. The patient had no difficulty with micturition nor trauma history. In addition, there had been no obvious improvement in his condition after taking nonsteroidal drugs. On physical examination, C7 sensory level hypesthesia was demonstrated, his motor power was assessed as grade 4, Hoffmann's sign was present bilaterally, and he had hyperactive patellar tendon reflexes. Ankle and patellar clonus were not observed. Although there were no remarkable findings on plain X-ray films, a computed tomography (CT) scan and MRI showed a large disc herniation at the C6-7 level (1, 2). In addition, the MRI showed obvious compression of the anterior aspect of the spinal cord with changes in its signal intensity. The diagnosis established, we recommended that the patient undergo anterior cervical discectomy and fusion. However, he refused and discharged himself. At a follow-up examination 4 months later, he stated that his condition had improved without any specific care, apart from a hard cervical collar he had obtained from another hospital. His symptoms had begun to show rapid improvement and he had regained his motor strength within 3 weeks, while the numbness in all his extremities had resolved within 3 months. A follow-up MRI 6 months later showed complete regression of the herniated cervical disc (Fig. 3). (a) A lateral X-ray film showing no remarkable findings. (b) CT scan showing large disc herniation at the C6-7 level. (a, b) T2-weighted imaging showing compression of the spinal cord at C6-7 with obvious changes in signal intensity. (a, b) After 6 months of conservative treatment, MRI shows complete regression of the herniated disc. Since the first report of spontaneous regression of a herniated cervical disc by Krieger and Maniker in 19925, several other authors have also reported this rare phenomenon6–10. Usually, patients with myelopathy, a condition which is more severe than radiculopathy, are impatient for their neurological deficits to resolve. Therefore, in the absence of knowledge about the natural history of such patients, doctors are apt to choose surgical treatment. To our knowledge, only 13 cases of spontaneous regression of herniated cervical disc with detailed supportive MRI findings have been reported in the literature. The time between initial presentation and spontaneous regression varied from 2–28 months5–10. These cases of spontaneous regression of CDH in patients without surgical treatment can be regarded as a benign natural course which occurs in some patients with herniated cervical disc. Many factors relating to the resorption process have been recognized, including the age of the patients, dehydration of the expanded nucleus pulposus, resorption of hematoma, revascularization, penetration of herniated cervical disc fragments through the posterior longitudinal ligament (PLL), size of disc herniation, and existence of cartilage and annulus fibrosus tissue in the herniated material. Resorption of a herniated nucleus pulposus is thought to occur via an inflammatory reaction in the outermost layer of the herniation, with macrophages as the major cellular population. In previously reported cases, spontaneous regression of a herniated cervical disc has been found more frequently in extruded than in protruded discs9. Larger type herniations are likely to regress more readily than smaller ones because of their tendency to penetrate the annulus fibrosus and PLL, thereby being exposed to the systemic circulation in the epidural space. Evidence of regression has been seen more frequently in patients who underwent imaging soon after the onset of symptoms than in those in whom imaging was delayed6. Herniated disc regression detected on MRI might represent in part dehydration of the expanded nucleus pulposus and resorption of hematoma, which can occur subsequent to annulus rupture. Rim enhancement around the herniated disc seen in contrast-enhanced MRI is thought to represent a neovascularized zone with macrophage infiltration, macrophages playing an essential role in phagocytosis and herniation regression. An enhanced rim around the outermost areas of a herniated nucleus pulposus (HNP) in a gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA) MRI is thought to be a major determinant of spontaneous resorption of HNP. Thickness of rim with Gd-DTPA enhancement is a more reliable prognostic indicator of spontaneous resorption than is the circumferential extent of rim enhancement11. However, if thickness of rim enhancement cannot be assessed, the Komori classification12 is a useful predictive sign in MRI because herniations with a higher degree of displacement according to the Komori classification have a more rapid resorption rate; especially when the CDH extends more than 67% above or below the height of adjacent vertebrae11. In older patients, the immunologic response and angiogenesis needed for CDH resorption may be weaker. Herniations tend to have less nucleus pulposus and more hardened annulus fibrosus and cartilaginous endplate material6, the latter is able to inhibit neovascularization of the herniated disc13. In younger patients, the inflammatory response may be less pronounced. Indeed, in an experimental dog model, the younger animals had no neovascularization nor inflammatory cell accumulation in sequestered disc fragments14. In shorts, in five of fourteen patients, including the previous thirteen and the present one, surgery was recommended. Of these five cases, three had myelopathy and two radiculopathy. Nonoperative management was pursued for several reasons. One patient refused while the other four cases experienced relief of symptoms with conservative treatment. At the latest follow-up, 11 patients with radiculopathy had achieved almost full recovery according to physical examination5,6,9,10. However, one of the other three cases with myelopathy reported obvious alleviation of symptoms6, another experienced continuous limbs paresthesia7 while the third one complained of no improvement in symptoms in spite of evidence of regression on MRI6. Eventually, this patient underwent anterior cervical discectomy and fusion. In most of the cases alleviation of clinical symptoms occurred concordantly with rapid resorption. Although the generalization that cervical disc herniations can be successfully managed with nonoperative management would be inappropriate from the results of only a few cases, conservative observation for at least two or three months could be considered as an option for patients with cervical disc herniation, especially those with complicated medical conditions. Spontaneous regression of herniated cervical disc is rare. As all previously reported cases have been of the extruded type, nonsurgical management may be considered as an option for the treatment of patients with a cervical extruded disc. MRI is a useful prognostic tool.

Chemonucleolysis represents a minimally invasive percutaneous technique characterized by an intradiskal injection of materials under fluoroscopic or CT guidance. Recently, a substance based on radiopaque gelified ethanol has been introduced. The purpose of this study was to describe the indications, procedure, safety, and efficacy of radiopaque gelified ethanol in the percutaneous treatment of cervical and lumbar disk herniations. Between September 2010 and August 2013, 80 patients (32 women and 48 men; age range, 18-75 years) were treated for 107 lumbar disk herniations (L2-L3, n = 1; L3-L4, n = 15; L4-L5, n = 53; and L5-S1, n = 38) and 9 cervical disk herniations (C4-C5, n = 2; C5-C6, n = 2; C6-C7, n = 3; and C7-D1, n = 2) by percutaneous intradiskal injection of radiopaque gelified ethanol under fluoroscopic guidance. Thirty-six patients underwent a simultaneous treatment of 2 disk herniations. Patient symptoms were resistant to conservative therapy, with little or no pain relief after 4-6 weeks of physical therapy and drugs. All patients were evaluated by the Visual Analog Scale and the Oswestry Disability Index. Sixty-two of 73 (85%) patients with lumbar disk herniations and 6/7 (83%) patients with cervical disk herniations obtained significant symptom improvement, with a Visual Analog Scale reduction of at least 4 points and an Oswestry Disability Index reduction of at least 40%. Leakage of radiopaque gelified ethanol in the surrounding tissues occurred in 19 patients, however without any clinical side effects. In our experience, percutaneous intradiskal injection of radiopaque gelified ethanol is safe and effective in reducing the period of recovery from disabling symptoms.

The proinflammatory mediator (PIM) levels were assessed in surgically removed samples of herniated cervical intervertebral discs. The objective of this study was to investigate if there is a correlation between the levels of PIMs in disc material and myelopathy associated with cervical intervertebral disc herniation and spondylosis. The role of proinflammatory mediators in the degeneration of intervertebral disc and the inflammatory effects of disc herniations on radicular pain has been previously published. However, the possible relationship between PIMs and myelopathy related to cervical disc herniation and spondylosis has not been investigated before. Thirty-two patients undergoing surgery for cervical disc herniation and spondylosis were investigated. Surgically obtained disc materials, stored at 70 degrees C, were classified into two groups: cervical disc herniation alone or with myelopathy. Biochemical preparation and solid phase enzyme amplified sensitivity immunoassay (ELISIA) analysis of the samples were performed to assess the concentration of mediators in the samples. Very similar values of interleukin-6 were found in both groups whereas the concentrations of mediators were significantly higher in myelopathy group. This study has demonstrated that PIMs are involved in cervical intervertebral disc degeneration with higher concentrations in the samples associated with myelopathy.

Percutaneous laser disc decompression (PLDD) has been regarded as an effective alternative for the treatment of cervical soft disc herniations. Repeated X-Ray scanning is essential when performing this technique. Technical note. We present a new method for the treatment of cervical disc herniation using ultrasound to guide the needle entry to the cervical disc, to avoid excess of radiation exposure during the surgical procedure. We evaluated the efficacy of this cervical approach. We retrospectively reviewed the clinical data of 14 cases who underwent a PLDD under ultrasound guidance for the treatment of contained cervical disc herniation using a 1,470 Nm diode laser. The lower cervical discs (C5-C6 and C6-C7) were the most affected sites, accounting for 78.6% of surgical discs. A significant NRS reduction between baseline and 1 month (P = .0002) and between baseline and 12 months (P = .0007) was observed. Our results support the conclusion that ultrasound guided PLDD with fluoroscopic validation is a minimally invasive technique for patients affected by herniated cervical discs, but proper choice of patients is critical. This approach should not be performed except after adequate training under close supervision of surgeons experienced in this procedure and in interventional US.

Aim. To evaluate the association of COL11A1 gene C4603T polymorphism with the risk of cervical and lumbar disc herniation among Ukrainian people. Materials and methods. In total, 97 patients (48 women and 49 men with a mean age of 34.49 ± 6.75 years) with lumbar and cervical disc herniation and 60 (30 women and 30 men with a mean of 35.00 ± 6.51 years) control subjects were included in the study. All participants underwent T2-weighted magnetic resonance imaging (MRI). Single nucleotide polymorphism С4603Т (rs1676486) of COL11A1 gene was detected by real-time polymerase chain reaction using Tag Man Universal PCR Master Mix (Applied Biosystems, USA) and Tag Man SNP Genotyping Assays (Applied Biosystems, USA). Results. The study revealed the association of the COL11A1 gene C4603T polymorphism with a risk of lumbar L5-S1 herniation in the dominant (OR = 3.20; 95 % CI (1.34–7.50); P < 0.008) and multiplicative models (OR = 2.82; 95 % CI (1.34–5.93); P < 0.006). A statistical association of the polymorphism with lumbar L4-L5 herniation was not found. Carriers of the 4603Т allele had a four-fold higher risk of cervical herniation in the dominant model (OR =4.00; 95 % CI (1.37–11.79); P < 0.01), and three-fold higher – in the multiplicative model (OR = 3.12; 95 % CI (1.26–7.69); P < 0.05). Conclusions. The study has shown the statistically significant association of the COL11A1 C4603T polymorphism with cervical and lumbar disc herniation among Ukrainian people. The 4603T allele presence should be considered when a sports career planning or occupational choice related to a heavy load on the cervical or lumbar spine.

Purpose: This study aimed to evaluate the efficacy of cervical discectomy with bladed peek cage and differences in clinical outcomes, complication rates, and radiological findings of patients with multiple-level cervical degenerative disc herniation in terms of age, sex, and number of levels.Materials and Methods: The following data were assessed: demographic data, patient complaints, symptoms, neurologic examination and radiologic findings, postoperative outcomes, and complications of surgery. We assessed 156 patients who had level 2, 3, and 4 cervical degenerative disc herniation detected between 2012 and 2018 via radiological examination.Results: Of the patients, 41.6% (n = 65) were men and 58.4% (n = 91) women. The patients were aged 32–76 years, with an average age of 50.68 years. Moreover, 85.2% (n = 133), 13.5% (n = 21), and 1.3% (n = 2) of patients presented with level 2, 3, and 4 cervical degenerative disc herniation, respectively. All patients received medications as a conservative treatment during the preoperative period, and 79.5% (n = 124) underwent physiotherapy. In terms of complications, five patients developed neurological deficit and one developed superficial wound infection during the early postoperative period.Conclusion: The fusion rate may be similar to the stabilization, and cervical region movements may be achieved after performing anterior cervical plaque surgery with cage as well as anterior cervical discectomy and bladed peek cage surgery in patients with level 2 or higher cervical degenerative disc herniation and/or cervical spondylosis.

Objective To evaluate the clinical outcome of artificial cervical disc replacement and cage fusion in the treatment of multi-segmental cervical disc herniation. Methods A total of 39 patients with multi-level cervical disc herniation were treated with disc replacement and adjacent segment cage fusion at one stage. There were 29 patients with two level cervical disc herniation, nine with three level cervical disc herniation and one with four level cervical disc herniation. Of the patients, there were 17 male and 22 female, aged between 35 and 63 years ( mean age 47 years). The herniated disc was located at C3-4 and C4-5 in two patients, C4-5 and C5-6 in 15, C5-6 and C6-7 in nine, C4-5 and C6-7 in three, C3-4,C4-5 and C5-6 in four, C4-5, C5-6 and C6-7 in five and C3-4, C4-8 , C5-6 and C6-7 in one. There were 18 patients with myelopathy and 21 with radieulopathy. The stabilization and the range of motion of implanted disc,the fusion of cage and the displacement of cage were observed on dynamic radiograph postoperatively. The clinical symptom and the neurological function were evaluated according to JOA score and odom' s criteria. Postoperative clinical symptoms and daily function were evaluated by using neck disability index (NDI) scale. Results Twenty-nine patients with bi-level cervical disc herniation underwent single level disc replacement and cage fusion on adjacent segment. Nine patients with three level disc herniation underwent single level disc replacement in seven and level cage fusion on adjacent segment in two. Twopatients underwent two level disc replacement and one level cage fusion. One patient with four level disc herniation was treated with two level disc replacement and two level cage fusion. The patients were followed up for from 6 moths to 3 years, which showed that definite stabilization was achieved for all disc with average range of motion for 9.3 degrees postoperatively. Solid fusion was achieved in all cage, with no subsidence or displacement of cage. The JOA score was increased from 9.1 to 13.2 at final follow up and the NDI (neck disability index) score decreased from 41.8 reduced to 29.5 at final follow up. The clinical success rate (excellent/good/fair) according to Odom' s Criteria was 85%. Conclusion Cervical disc replacement and cage fusion can attain definite stabilization and satisfactory mobility and provide a new effective treatment for cervical disc herniation. The long-term outcome needs further clinical followup. Key words: Intervertebral disk displacemant; Cervical vertebrae; Cervical disc prosthesis

A retrospective follow-up study of conservatively treated patients with mild cervical myelopathy caused by cervical soft disc herniation. To investigate the outcome of conservative treatment for patients with mild myelopathy caused by cervical soft disc herniation and to evaluate usefulness of magnetic resonance findings in the prediction of the outcomes. Recent studies on conservative treatment for cervical soft disc herniation have focused mainly on radiculopathy, and not on myelopathy. Twenty-seven patients with mild cervical myelopathy secondary to cervical soft disc herniation were treated conservatively for more than 6 months by cervical bracing and restriction of daily activities. Of the 27 patients, 17 patients (Group A) underwent conservative treatment only and it was associated with improvement in their neurologic deficits, while the other 10 patients (Group B) ultimately underwent decompression surgery because of neurologic deterioration. Comparisons between the two groups were made in regard to JOA scores, patient satisfaction, and magnetic resonance findings, including location of the disc herniation (focal or diffuse in the sagittal plane, median or paramedian in the axial plane). The JOA scores were 13.6 +/- 1.6 in Group A and 14.1 +/- 1.6 in Group B before treatment, 14.9 +/- 1.0 and 12.9 +/- 2.1, respectively, at 3 months, and 16.2 +/- 0.8 and 16.0 +/- 1.2, respectively, at the final follow-up. The JOA scores at 3 months were significantly lower in Group B than in Group A. Satisfaction with the results of treatment at the final follow-up was reported by 77% of the patients in Group A and 90% in Group B. Focal-type herniation was present in 47% of the patients in Group A and 70% in Group B, while median-type herniation was diagnosed in 77% in Group A and 30% in Group B. Follow-up magnetic resonance imaging of the patients in Group A showed spontaneous regression of a herniated mass in 10 patients (59%). Diffuse-type herniations were more likely to regress spontaneously than focal-type herniations (78% vs. 37%). Conservative treatment is an effective treatment option for mild cervical myelopathy caused by cervical soft disc herniation. A good outcome can be expected in patients with a median-type and/or diffuse-type herniation on magnetic resonance imaging.

Assessment of the Radiation Exposure of Surgeons and Patients During a Lumbar Microdiskectomy and a Cervical Microdiskectomy: A French Prospective Multicenter Study