Bucciero A, Carangelo B, Cerillo A, Gammone V, Panagiotopoulos K, Vizioli L
Department of Neurosurgery, School of Medicine University of Naples Federico II, Italy.
J Neurosurg Sci. 1998 Dec;42(4):203-11.
The literature on pure traumatic disc herniation is now voluminous but diversity of opinion exists regarding frequency, pathogenesis and management of this type of lesion. As a further contribution to the solution of the question it is thus justified to report our series of cervical traumatic disc herniation.
During the period from January 1986 to December 1994, 41 patients (25 males and 16 females, between the ages of 24 and 51 years) with traumatic cervical disc herniations were operated on by anterior approach. Twenty-six (63.4%) patients presented with radicular syndrome, 3 (7.3%) with medullary symptoms and signs, and 12 (29.3%) with myeloradiculopathy. Disc herniation was at the C3/4 level in 4 (9.7%) cases, at the C4/5 level in 7 (17.1%) cases, at the C5/6 level in 24 (58.5%) cases, and at the C6/7 level in 8 (19.5%) cases. In 6 (40%) patients suffering from myelopathy (with or without radiculopathy) an area of high MR signal intensity was observed within the cervical cord on T2-weighted images; such area corresponded at the level of cord compression by disc and was not demonstrated on T1-weighted images. All patients underwent discectomy without bone grafting.
Among patients with radiculopathy, 27 (71%) experienced complete relief of preoperative symptomatology, and 11 (29%) minor pain and/or neurological deficits without interference with work activities. The myelopathy completely disappeared in 11 (73.3%) cases whereas remained unchanged in 3 (20%); 1 patient with myelopathy experienced amelioration of preoperative specific symptoms and signs.
The results of surgery for cervical radiculopathy due to traumatic disc herniation are satisfactory since 92 to 100% of the patients postoperatively regain prior activities, an observation we have confirmed with our own series. The results in cases of myelopathy are less satisfactory: although approximately 73% of our patients with myelopathy reported total relief of preoperative symptomatology, published reports indicate that a significant postoperative improvement is seen in 33 to 56% of patients.
关于单纯创伤性椎间盘突出症的文献现已大量存在，但对于此类病变的发生率、发病机制及治疗方法，仍存在不同观点。因此，为解决这一问题做出进一步贡献，报告我们的颈椎创伤性椎间盘突出症系列病例是合理的。
在1986年1月至1994年12月期间，41例（25例男性和16例女性，年龄在24至51岁之间）颈椎创伤性椎间盘突出症患者接受了前路手术。26例（63.4%）患者表现为神经根综合征，3例（7.3%）有脊髓症状和体征，12例（29.3%）有脊髓神经根病。椎间盘突出位于C3/4节段4例（9.7%），C4/5节段7例（17.1%），C5/6节段24例（58.5%），C6/7节段8例（19.5%）。6例（40%）患有脊髓病（伴或不伴神经根病）的患者在T2加权图像上颈髓内观察到高MR信号强度区域；该区域对应于椎间盘压迫脊髓的节段，在T1加权图像上未显示。所有患者均接受了椎间盘切除术，未进行植骨。
在患有神经根病的患者中，27例（71%）术前症状完全缓解，11例（29%）仍有轻微疼痛和/或神经功能缺损，但不影响工作活动。脊髓病在11例（73.3%）患者中完全消失，3例（20%）无变化；1例脊髓病患者术前特定症状和体征有所改善。
创伤性椎间盘突出症导致颈椎神经根病的手术效果令人满意，因为92%至100%的患者术后恢复了术前活动，我们自己的系列病例也证实了这一观察结果。脊髓病病例的结果不太令人满意：尽管我们约73%的脊髓病患者报告术前症状完全缓解，但已发表的报告表明，33%至56%的患者术后有显著改善。
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