Cervical Disc Protrusion Research Articles

The significance of cervical discopathy diagnosis in patients with mastalgia.

The primary aim of this study was to explore the involvement of cervical discopathy in the development of non-cyclic mastalgia by employing cervical magnetic resonance imaging (MRI). A total of 407 patients were included in the study. Individualized management plans were developed for each patient. Pathological findings in MRI results were assessed by specialists in physical therapy and neurosurgery, and appropriate treatment was administered. Visual assessments of patients were conducted. The Analog Scale (VAS) scoring system was used at the initial presentation, and patients were evaluated at 1 and 3 months following the treatment. In the MRI examinations of the patients included in the study, simultaneous cervical disc protrusion was observed in 29% (n: 124) of those with annular bulging. Comparing the VAS scores of patients before treatment, at the 1st and at the 3rd month showed a significant decrease in mastalgia pain (p < 0.001). The diagnosis of cervical discopathy holds significant importance in the treatment of mastalgia patients. Therefore, clinicians should keep the cervical spine in mind as a potential contributing factor to mastalgia.

Cervical Multifidus and Longus Colli Ultrasound Differences among Patients with Cervical Disc Bulging, Protrusion and Extrusion and Asymptomatic Controls: A Cross-Sectional Study.

The aim of this study was to analyze the differences in morphological and histological features of the cervical multifidus (CM) and longus colli (LC) muscles among patients with cervical disc bulging, protrusion, or extrusion. Fifteen patients with cervical disc bulging (20% male, mean age: 48.5, standard deviation (SD) 7.5 years), fifteen with cervical disc protrusion (6% male, mean age: 43, SD 7.8 years), and fifteen with cervical disc extrusion (40% male, mean age: 44, SD 8 years) diagnosed via clinical and imaging findings participated in this study. Additionally, fifteen asymptomatic controls (40% male, mean age: 40.4, SD 9.7 years) were also included. The following ultrasound measurements, cross-sectional area (CSA), anterior-posterior distance (APD), lateral dimension (LD), and mean echo-intensity (EI) of the CM and LC at C5-C6 level were examined by an assessor blinded to the subject's condition. The results revealed no group ×side significant differences among the groups (p > 0. 00625). However, group effects were found for APD and MEI of the CM (p = 0.006 and p < 0.001, respectively) and CSA, APD and MEI of the LC (all, p < 0.001). The LD of the LC muscle and the APD and LD of the CM were negatively associated with related disability (p < 0.01; p < 0.05 and p < 0.01, respectively), and pain intensity was negatively associated with LC APD and LD (both p < 0.05). These results suggest that US can be used to detect bilateral morphological changes in deep cervical flexors and extensors to discriminate patients with cervical disc alterations.

Outcomes in Dogs with Multiple Sites of Cervical Intervertebral Disc Disease Treated with Single Ventral Slot Decompression.

In dogs with acute myelopathy but showing multiple sites of spinal compression from intervertebral disc disease (IVDD) on imaging, one approach is surgical decompression of the single acute disc extrusion while ignoring other previously extruded or protruded discs. However, little is known regarding the outcomes of this approach. This study described the outcomes and investigated prognostic factors in 40 dogs with multiple sites of cervical disc extrusion or protrusion on MRI who underwent ventral slot decompression for the single acute disc. The overall recovery rate was 97.5%. The median recovery time was seven days. The number of affected discs (including disc extrusion and protrusion) and the presence and number of the affected discs causing severe spinal compression did not influence the 30-day outcome. Compared with 23 dogs with single disc extrusion treated surgically, the recovery time and outcomes were similar between the two groups. The total number of affected discs was not associated with recovery time or outcomes. In conclusion, if an acute disc could be identified, ventral slot decompression targeting the single acute disc is a viable management approach for dogs with an acute presentation but diagnosed with multiple sites of spinal cord compression from IVDD.

Degenerative Cervical Myelopathy: A Case Report of Delayed Diagnosis in a Younger Man

BACKGROUND: Degenerative cervical myelopathy is most caused by degenerative cervical stenosis in an over 55-year age group. However, it may occur in younger ages, most commonly due to large cervical disc protrusions. CASE PRESENTATION: The case report describes a 42-year-old male, who presented with progressive ataxia and upper limb discoordination over a 4-year period. He was initially diagnosed and treated for bilateral carpal tunnel releases. Following his persistent symptoms, cervical magnetic resonance imaging was performed, which confirmed a large cervical C4/5 disc protrusion. OUTCOME AND FOLLOW-UP: Although initially managed with observation, his continuing decline resulted in emergency cervical decompression. Surgery for myelopathy aims to prevent further deterioration, and timely treatment is therefore critical to restoring function. DISCUSSION: This case highlights the difficulties faced by people with degenerative cervical myelopathy to obtain a diagnosis and treatment, and the consequences. Myelopathy is an important differential diagnosis to consider irrespective of age. Where suspected, a cervical spine MRI should be requested. JOSPT Cases 2022;2(4):220–225. Epub: 12 October 2022. doi:10.2519/josptcases.2022.11088

36-YEARS-OLD MALE WITH CERVICAL DISC PROTRUSION AND POSTURAL DEVIATIONS

Structures around the cervical spine are a common source of neck pain and have numerous aetiologies. One of the aetiologies considered here is the sustained abnormal posture; this type of presentation can be seen in the population which works tirelessly in the same position for hours like the patient in our case who works as a technician. Patient’s main concerns were pain in right shoulder radiating till the elbow, the severity of the pain kept the patient awake for nights. Clinical findings include severely restricted extension of neck and reduced lateral flexion and rotation of the affected side; Spurling’s test positive for the affected side and distraction test positive. MRI revealed cervical intervertebral disc protrusion at multiple levels (C3-C4, C4-C5, C5-C6, and C6-C7). This case report concluded that poor cervical posture responsible for overloading on cervical spine leads to disc protrusion in people who work for long hours in abnormal posture.

Microendoscopic Dorsal Laminectomy for Multi-Level Cervical Intervertebral Disc Protrusions in Dogs.

The objective of this study was to evaluate the feasibility and clinical outcomes of microendoscopic dorsal laminectomy for multi-level cervical intervertebral disc protrusions in dogs. Eight client-owned dogs diagnosed with multi-level cervical intervertebral disc protrusions using computed tomography (CT) and magnetic resonance imaging (MRI) were included in this retrospective case series. Microendoscopic dorsal laminectomies (MEL) were performed with an integrated endoscopic system to the cranial and caudal vertebrae of the affected intervertebral joints. Pre- and post-operative neurological status, operation time, intra-operative complications, and postoperative complications were reviewed. Post-operative CT images were obtained to measure the dimensions of laminectomy and compared to those of planned laminectomy. Full endoscopic procedures were feasible in 7 dogs (87.5%) and the laminectomy dimensions were in agreement with pre-operative planning. In all dogs, major intra- and postoperative complications did not occur. Conversion to open surgery was required in one case. Short-term postoperative clinical deterioration was found in two dogs. Long-term clinical outcomes were good and comparable to those reported in previous studies of open dorsal laminectomies. MEL is a promising minimally invasive approach to multi-level cervical dorsal laminectomy for intervertebral disc protrusions. This technique may improve postoperative discomfort compared to the open approach. Further studies are needed to directly compare outcomes between these two approaches.

Complete Resorption of Large Cervical Disc Protrusion Compressing Spinal Cord

In this report, we describe a case of 32-year-old woman who experienced spontaneous resolution of a large herniated disc with cord compression at C5-6. While the need for a surgical procedure is commonly accepted in case of symptomatic myelopathy, the medical management of cases with no or mild symptomatic lesion may be debated [1]. The following manuscript describes a case of spontaneous regression of herniated cervical disc and suggests that, even in patient with acute cervical disc herniation accompanied with cervical myelopathy, non-surgical, conservative treatment could be an option.

Association of Chiari Type 1 malformation and cervical spine curve changes

Introduction: In this study, we aimed to examine the association of cervical spine curve abnormalities (loss of cervical lordosis or reversal of cervical curve) with Chiari Type 1 malformation (CM1). Further, a possible relation of syrinx formation in the cervical spinal cord and disc protrusion with CM1 was analyzed. Material and Methods: Cervical spinal magnetic resonance imagings of 998 patients were retrospectively screened for the presence of CM1. The frequency rates of syrinx formation within the spinal cord, cervical spinal curve changes, and cervical disc herniation among CM1+ and CM1− patients were compared. Results: Patients with CM1 have significantly higher rate of loss of cervical lordosis when compared with those who have not CM1. The syrinx formation rate was also found lower in the CM1+ patients with loss of cervical lordosis than in CM1+ patients with either normal cervical lordosis or reversed cervical curve. No significant difference was detected between CM1+ and CM1− patients regarding cervical disc herniation rate. Discussion and Conclusion: As the loss of cervical lordosis rate is higher in CM1, the patients with lateral X-ray findings of cervical lordosis flattening may be evaluated regarding typical neurological symptoms of syringomyelia.

ACDF vs TDR for patients with cervical spondylosis \u2013 an 8\xa0year follow up study

BackgroundACDF has been considered as the gold standard in the treatment of single level cervical disk protrusion. However, it may cause adjacent level degeneration due to regional biomechanical changes. TDR has been applied with satisfactory results for over a decade, but there is no consensus if TDR is safer and more efficient than ACDF. The current study was carried out to compare the efficiency and safety of TDR and ACDF in the treatment of patients with single level cervical disk protrusion.MethodsOne hundred forty-five consecutive patients who underwent either TDR or ACDF in our center were included in the current study. Time of surgery, intraoperative blood loss, VAS arm and neck pain scores, ROM, ODI, SF36 and Patient satisfaction were compared before the surgery, after the surgery, and during follow up 1, 3, 5, 8 years after the surgery.ResultsThe time of surgery was 64.6 ± 20.7 min in the ACDF group and 69.4 ± 19.3 min in the TDR group; intraoperative hemorrhage was 67.2 ± 14.3 ml in ACDF group and 70.7 ± 18.6 ml in TDR group. There were no significant differences between two groups concerning time of surgery and intraoperative blood loss. No differences were found concerning patient satisfaction between the two groups during the follow up (P > 0.05). Significant differences were found between the groups concerning VAS arm and neck pain scores, ROM, ODI and SF36 after the surgery and during the 8 year follow up.ConclusionTDR may be a more effective approach than ACDF for treating patients with single level cervical disk protrusion.KeywordsCervical disk herniation, ACDF, TDR, Retrospective study

Posterior Percutaneous Endoscopic Cervical Foraminotomy and Diskectomy With Unilateral Biportal Endoscopy.

This report describes a new, minimally invasive procedure, posterior percutaneous endoscopic cervical diskectomy, performed with a unilateral biportal endoscopic approach. The procedure is used to treat cervical foraminal soft disk protrusion. This report also describes the short-term results with this procedure. In 2015, 14 patients underwent this new, minimally invasive procedure. The technique was applied with a standard arthroscopy device and conventional spine instruments. The Neck Disability Index and visual analog scale scores for the neck and upper arm were evaluated, and 13 consecutive patients were included in the analysis. Mean follow-up was 14.8 months (range, 12-18 months). The Neck Disability Index decreased from 27.0±2.5 to 6.8±1.4 at the last follow-up (P<.05). Visual analog scale scores for the neck and upper arm also decreased significantly (neck, 6.2±0.8 to 2.4±0.9; upper arm, 7.0±1.1 to 2.2±0.6). Posterior percutaneous endoscopic cervical diskectomy with a uniportal endoscope provides a clear operative field because of continuous endoscopic saline irrigation and requires only a short hospitalization and no postoperative rehabilitation. Posterior percutaneous endoscopic cervical diskectomy with a unilateral biportal endoscopic approach also can be performed efficiently because of the wide field of visualization and familiar surgical field. Thus, posterior percutaneous endoscopic cervical diskectomy with the unilateral biportal endoscopic approach may be an alternative procedure for cervical foraminal soft disk protrusion. [Orthopedics. 2017; 40(5):e779-e783.].

Cement plug technique for the management of disc-associated cervical spondylopathy in 52 Dobermann Pinscher dogs.

To report the radiographic and clinical outcome of an intervertebral bone cement plug technique for the management of disc-associated cervical spondylopathy in Dobermann Pinscher dogs. Retrospective study of 52 Dobermann Pinscher dogs. A variable degree of cement plug subsidence with loss of vertebral distraction was evident in all dogs (n = 40) that were radiographed >6 weeks postoperatively. In no case was there definitive evidence of vertebral body fusion. Eight dogs had a sudden deterioration in neurological status, cervical hyperaesthesia, or both between three days and 12 weeks following surgery that was considered to be implant-associated; six of these dogs were euthanatized. Following surgery, 43/52 dogs were considered to be neurologically normal or to have improved, however, nine of 43 subsequently deteriorated due to adjacent segment disease. At the long-term follow-up, 34 dogs were considered to be neurologically normal or to have improved. Twenty-nine dogs were dead by the end of the study period. Intervertebral bone cement plug surgery results in an initial improvement in clinical signs in the majority of Dobermann Pinschers with disc-associated cervical spondylopathy. However, it fails to maintain vertebral distraction or achieve vertebral body fusion, and is associated with acute implant complications, additional cervical disc protrusions or mortality in a significant proportion of cases.

Mastalgia Due to Degenerative Changes of the Spine.

Mastalgia is a common and enigmatic condition; the cause and optimal treatment are still inadequately defined. Cervical radiculopathy, which is the result of cervical nerve root pathology often caused by spaceoccupying lesions such as cervical disc herniation, spondylosis, or osteophytosis, is frequently encountered in physical therapy. The aim of the study was to evaluate the incidence of vertebral pathologies in patients with non-cyclic mastalgia and the efficacy of conservative treatment of these pathologies on relieving breast pain. One hundred patients were included in the study, all with breast pain continuing throughout the day and lasting at least three months. Breast and axillary physical examinations, mammographic and/or ultrasonographic evaluations were normal in all the patients. The patients' pain levels were scored using a visual analog scale (VAS). Cervical and thoracic spine magnetic resonance imaging (MRI) was performed on all the participants. Among 96 patients that had pathological findings on magnetic resonance imaging (96%), 49 women had diffuse annular bulging of the cervical spine, and 47 had cervical disc protrusion. Additionally, 12 patients had thoracic disc protrusion. At the end of the three-month period, the patients who were given only conservative treatment returned for follow-up evaluations. According to the VAS scores, five patients had mild to moderate improvement, 55 showed significant improvement, and 29 achieved complete remission. The authors concluded that if none of the known causes of breast pain are found in a patient, the patient should be evaluated for vertebral pathologies.

Cervical Disc Protrusion Correlates with the Severity of Cervical Disc Degeneration

Cervical Disc Protrusion Correlates with the Severity of Cervical Disc Degeneration

Surgical treatment of cervical disc protrusion causing intracranial hypotension following chiropractic manipulation

We describe a woman with intracranial hypotension provoked by a combination of calcified disc protrusion and chiropractic manipulation who required surgical intervention for definitive treatment. Intracranial hypotension is a rare but increasingly well recognized cause of orthostatic headache that arises due to spinal cerebrospinal fluid leakage from meningeal diverticula or dural perforations.

Postoperative transient tetraplegia in two patients caused by cervical spondylotic myelopathy

We report two patients with cervical spondylotic myelopathy following non-cervical spine surgery. These cases revealed postoperative transient tetraplegia with respiratory insufficiency despite optimal anaesthetic management. Both patients showed no limitation of their neck movement at pre-operative airway examination. In addition, their necks had never been overextended during anaesthesia including tracheal intubation. However, postoperative magnetic resonance imaging showed cervical spondylotic myelopathy. Cervical disc herniation and protrusion of a hypertrophic ligamentum flavum caused spinal canal cord compression, and, these may lead to tetraplegia and phrenic nerve impairment. Their muscle weakness gradually improved and completely recovered the following morning. We should consider the existence of cervical spondylosis in the elderly patients over the age of 60 years.

Complex Regional Pain Syndrome Associated with Cervical Disc Protrusion and Foraminotomy

Case report. To report a previously undescribed association between complex regional pain syndrome (CRPS) and surgery for cervical disc protrusion. Although CRPS has been associated with disc protrusion and lumbar spine surgery, there is no record in the literature of a similar association with cervical disc protrusion. Description of a clinical case. A patient with radicular pain due to cervical disc protrusions underwent posterior foraminotomy, which did not relieve his pain. Within 3-4 weeks, he developed features of CRPS. Review at 16, 22, and 34 months revealed some, but limited, improvement. This case provides circumstantial evidence of a hitherto undescribed association between CRPS and cervical disc protrusion. The mechanism is elusive, but may involve damage to small nerves in or near the intervertebral foramina.

Intervertebral disc calcification with neurological symptoms in children: report of conservative treatment in two cases

Intervertebral calcifications are rare in the paediatric population. Two cases of children with symptomatic intervertebral calcifications responsible for spinal cord compression and neurological compromise are presented. The data of two children treated conservatively for a symptomatic intervertebral calcification responsible for spinal cord compression and neurological compromise were retrospectively reviewed. Frontal and lateral radiographs are usually sufficient to determine the presence and extent of the calcified cervical disc protrusion. Conservative treatment with antalgics and bracing was applied in both cases. The two patients were completely free of symptoms 4 weeks after initial treatment. Magnetic resonance imaging screening showed a complete vertebral canal clearance at final follow-up. Despite the lack of significance due to the small number of patients, conservative treatment should be considered in children with moderate neurological symptoms due to calcified disc protrusion.

Judgment notwithstanding the verdict: the anesthesiologist's duty to monitor head position in the perioperative period

In early 2000, Dr F, a neurosurgeon, was treating patient SB, an obese woman, for pain from cervical disc protrusions. Dr F suggested that a cervical hemilaminotomy and foraminotomy at C3-4 and C4-5 would be an effective strategy to address SB's pain. SB agreed to the surgery, and SB was admitted to Hospital at 8 am. The surgery began at 10:15 am, with Dr L as the anesthesiologist and nurse anesthetist JS assisting. Dr L, with the assistance of JS, attached several monitors. After these monitors were attached, JS placed an oxygen mask on SB's face and began administering oxygen. General anesthesia was induced and an endotracheal tube was inserted and fixed into place. After Dr L and JS completed this initial work, Dr F and his surgical nurse placed SB on the operating room (OR) table in a seated position, with SB's head flexed toward her chest. They then taped her head to a horseshoe-shaped headrest to prevent movement during surgery. After positioning SB and taping her head in place, Dr F left the OR to prepare for surgery. During Dr F's absence, the anesthesia team padded various pressure points to prevent

Axillary brachial plexus block complicated by cervical disc protrusion and radial nerve injury

Axillary brachial plexus block complicated by cervical disc protrusion and radial nerve injury

Percutaneous cervical disc decompression

Cervical disc nucleoplasty is a significant and clinically demonstrated innovation in percutaneous disc decompression in case of non-herniated disc protrusions or prolpase. It allows a percutaneous decompression via a 19-gauge needle under utilization of the Coblation technique and under C-arm control. Until now the patients suffering of a cervicobrachialgia in cause of a disc prolapse had only the therapeutical solution between conservative treatment and monosegmental spondylodesis or disc prosthesis of the mentioned motion segment. We wanted to demonstrate a new and practicable anatomical pathway for reaching the cervical disc prolapse comparable to the technique for discography of the cervical spine. The introducer needle is advanced into the disc under fluoroscopic guidance using a standard anterior-lateral approach. The controller delivers radiofrequency energy to quickly ablate tissue at temperatures between 50 degrees and 60 degrees C. The decompression will be done in ablation mode by rotating the device through 180 degrees for 5 s in the posterior, medial and ventral third of the cervical disc. After failed conservative treatment over an average time period of 3 months we treated 26 patients with a contained herniated prolapse or protrusion with radicular arm pain by percutaneous decompression under utilization of the Coblation technique with a controlled energy plasma-mediated field. A randomized control group of 30 patients was treated alone conservatively with medical and physical therapy in the same period. The average preoperative VAS was 8.8. With a follow-up time of 2-years we found an average pain reduction with the visual pain score (VAS) of 2.3 who had a further check-up. The VAS was checked 24 h, 1 week, 3, 6, 12 and 24 months postoperatively. No complications with this method were seen. Comparable to the surgically treated group the conservative patients have had a VAS of 8.4. Under using conservative treatment with physical therapy, physiotherapy, analgetics and perineural injections we have had a diminution of the VAS to 5.1 after 2 years. The percutaneous decompression of the cervical disc protrusion with the Perc DC-Spine Wand by using the Coblation mode is a quick and safe procedure. Furthermore, one may state a persistent pain relief in the follow-up time up to 2 years after the percutaneous decompression of the disc.