Gunasekaran Arunprasad, de Los Reyes Nova Kristine M, Walters Jerry, Kazemi Noojan
Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
World Neurosurg. 2018 Jan;109:275-284. doi: 10.1016/j.wneu.2017.09.209. Epub 2017 Oct 7.
Spontaneous cervical intradural disc herniation (IDH) is a rare occurrence with limited and disparate information available regarding its presentation, diagnosis, and treatment. However, its accurate detection is vital for planning surgical treatment. In this review of the literature, we collected data from all cervical IDHs described to date. Particular attention was paid to diagnostic findings, surgical approach, and causation for cervical IDH, especially at the cervicothoracic junction.
A review for cases of cervical IDH was performed via the following search criteria: ("neck"[MeSH Terms] OR "neck"[All Fields] OR "cervical"[All Fields]) AND intradural[All Fields] AND disc[All Fields]. Thirty-seven cases of cervical disc herniation were identified. Demographic variables identified included age, sex, cervical level of herniation, history of associated cervical trauma, presence of Brown-Séquard syndrome, Horner syndrome, and other neurologic findings, radiographic findings, direction of surgical approach, and postoperative outcomes.
A total of 37 cases of cervical IDH were identified. Most of the cases occurred at the lower levels of the cervical spine, with 35.1% at the C5-C6 level, followed by 24.3% at C6-C7, and lower still at other levels. Of the patients reviewed, 44.4% had a previous history of trauma before manifestation of symptom, with the majority being spontaneous IDH with no previous history of trauma or spine surgery. Brown-Séquard syndrome was present in 43.2% of the patients, whereas 10.8% of patients experienced Horner syndrome. The most common presentations of IDH included quadriplegia, finger/gait ataxia, radiculopathy, and nuchal pain. The degree of neurologic recovery was not associated with patient age. Most of the cervical IDHs in the literature were treated surgically via an anterior approach, but a larger portion of patients who underwent a posterior approach had improved recovery.
Cervical IDH is a rare event, with this review of the literature outlining the clinical and radiographic parameters of its presentation as well as comparing common surgical strategies for treatment. We outline theories underlying the development of cervical IDH and argue for a posterior surgical approach in which the disc herniation is sequestrated with migration.
自发性颈椎硬膜内椎间盘突出症（IDH）较为罕见，关于其临床表现、诊断和治疗的信息有限且存在差异。然而，准确检测对于规划手术治疗至关重要。在本次文献综述中，我们收集了迄今为止所有已描述的颈椎IDH的数据。特别关注了颈椎IDH的诊断结果、手术方法和病因，尤其是在颈胸交界处。
通过以下检索标准对颈椎IDH病例进行综述：（“颈部”[医学主题词]或“颈部”[所有字段]或“颈椎”[所有字段]）且硬膜内[所有字段]且椎间盘[所有字段]。共识别出37例颈椎间盘突出症病例。确定的人口统计学变量包括年龄、性别、椎间盘突出的颈椎节段、相关颈椎创伤史、布朗 - 塞卡尔综合征、霍纳综合征及其他神经系统表现、影像学表现、手术入路方向和术后结果。
共识别出37例颈椎IDH病例。大多数病例发生在颈椎较低节段，C5-C6节段占35.1%，其次C6-C7节段占24.3%，其他节段更低。在接受综述的患者中，44.4%在出现症状前有创伤史，大多数为无创伤史或脊柱手术史的自发性IDH。43.2%的患者出现布朗 - 塞卡尔综合征，而10.8%的患者出现霍纳综合征。IDH最常见的表现包括四肢瘫、手指/步态共济失调、神经根病和颈部疼痛。神经恢复程度与患者年龄无关。文献中大多数颈椎IDH通过前路手术治疗，但接受后路手术的患者中较大比例恢复较好。
颈椎IDH是一种罕见事件，本次文献综述概述了其临床表现和影像学参数，并比较了常见的手术治疗策略。我们概述了颈椎IDH发生发展的潜在理论，并主张采用后路手术方法，在该方法中椎间盘突出物被隔离并移位。
