Guan Qing, Xing Fei, Long Ye, Xiang Zhou
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, PR China; Department of Orthopedics, The First people's Hospital of Yibin, Yibin City, Sichuan Province, PR China.
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, PR China.
J Clin Neurosci. 2018 Feb;48:1-6. doi: 10.1016/j.jocn.2017.10.024. Epub 2017 Nov 20.
Cervical intradural disc herniation (CIDH) is rare, and diagnosis and treatment are challenging. We conducted a systematic review and meta-analysis of the literature on the diagnosis and treatment of CIDH.
The presentation, imaging manifestations, diagnosis, management, prognosis and possible pathogenesis were reviewed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English-language studies and case reports published from inception to 2017 were retrieved. Data on presentation, imaging characteristics, diagnosis, management, outcomes and pathogenesis were extracted.
Twenty articles involving 23 patients were selected. The most common involved level was C5-6 (43.5%), followed by C6-7 (30.4%), C4-5 (13%), and C3-4 (13%). Spontaneous IDH occurred in 61% of the patients, and relevant cervical trauma was present in 39%. Brown-Sequard's syndrome (56.5%), quadriparesis (34.8%), and radiculopathy (8.7%) were the main presentations. Magnetic resonance imaging (MRI) was the most commonly used diagnostic technique, and the "halo" and "Y-sign" were strong indicators of CIDH. Three (13%) patients were diagnosed as having CIDH preoperatively, and 87% were confirmed intraoperatively. All patients underwent surgical intervention primarily (73.9%) through an anterior approach. Neurological function improved postoperatively in all patients but one. Dural and arachnoid mater tears were managed by direct suture or covering with a substitute, and only one patient sustained cerebrospinal fluid (CSF) leakage after surgery.
IDH mostly involves the lower cervical spine. More than half of the patients had spontaneous CIDH, and some had a relevant cervical trauma history. BSS was the main presentation. It is difficult to diagnose CIDH depending on clinical presentations and radiographic findings. Surgery was an effective treatment for CIDH and can provide a definitive diagnosis. With meticulous management of dural and arachnoid tears, the postoperative incidence of CSF leakage was found to be low.
颈椎硬膜内椎间盘突出症（CIDH）较为罕见，其诊断和治疗颇具挑战性。我们对CIDH诊断与治疗的相关文献进行了系统综述和荟萃分析。
按照系统综述和荟萃分析的首选报告项目指南，对其临床表现、影像学表现、诊断、治疗、预后及可能的发病机制进行综述。检索自起始至2017年发表的英文研究和病例报告。提取有关临床表现、影像学特征、诊断、治疗、结局及发病机制的数据。
选取了20篇涉及23例患者的文章。最常受累节段为C5 - 6（43.5%），其次是C6 - 7（30.4%）、C4 - 5（13%）和C3 - 4（13%）。61%的患者发生自发性椎间盘突出症，39%存在相关颈部创伤史。布朗 - 色夸综合征（56.5%）、四肢瘫（34.8%）和神经根病（8.7%）为主要临床表现。磁共振成像（MRI）是最常用的诊断技术，“晕征”和“Y征”是CIDH的有力指标。3例（13%）患者术前被诊断为CIDH，87%在术中得以确诊。所有患者主要接受手术干预（73.9%），采用前路手术。除1例患者外，所有患者术后神经功能均有改善。硬脑膜和蛛网膜撕裂通过直接缝合或用替代物覆盖进行处理，术后仅1例患者发生脑脊液（CSF）漏。
椎间盘突出症多累及下颈椎。半数以上患者为自发性CIDH，部分患者有相关颈部创伤史。布朗 - 色夸综合征为主要临床表现。依靠临床表现和影像学检查结果难以诊断CIDH。手术是CIDH的有效治疗方法，且能提供明确诊断。通过对硬脑膜和蛛网膜撕裂的精细处理，发现术后脑脊液漏发生率较低。
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