Song Joshua, Oh Jacob Yoong Leong
Department of Orthopaedic Surgery, Spine Division, Tan Tock Seng Hospital, Singapore.
J Spine Surg. 2022 Mar;8(1):76-83. doi: 10.21037/jss-21-106.
We report a unique case of a patient who sustained an intradural disc herniation from a left C5-6 unilateral facet dislocation after a fall. This was not easily identified on pre-operative imaging. We explain the details of our surgical approach in this case report. A 65-year-old male fell into a 2 m drain and sustained a left C5/6 unilateral facet dislocation. He then sustained an American Spinal Injury Association (ASIA) B cord injury. His power was 0/5 from C8 downwards bilaterally but sensation was intact throughout. Magnetic resonance imaging (MRI) showed severe compression at C5/6 but no overt intradural disc herniation. This patient subsequently underwent a closed reduction in the operating theatre followed by a combined anterior and posterior approach for the disc herniation. Cerebral spinal fluid (CSF) leakage was noted upon completion of the C5/6 discectomy and it was discovered that there was a traumatic dural tear from the traumatic disc herniation. The decision was made not to repair the dural tear due to the friable nature of the dura and the potential for adhesive glue to propagate through the spinal cord. An anterior drain was placed for 3 days and then removed, he subsequently underwent rehabilitation and was able to regain power in the affected myotomes. Intradural disc herniations can be easily missed on MRI in the setting of cervical spinal trauma. Hence, the anterior approach is an increasingly acceptable approach to tackle disc herniations in unilateral cervical facet dislocations (CFD) surgery.
我们报告了一例独特的病例，一名患者在跌倒后因左侧C5-6单侧小关节脱位导致硬膜内椎间盘突出。术前影像学检查不易发现此情况。我们在本病例报告中解释了手术方法的细节。一名65岁男性跌入2米深的下水道，导致左侧C5/6单侧小关节脱位。随后他遭受了美国脊髓损伤协会（ASIA）B级脊髓损伤。双侧从C8以下肌力为0/5，但感觉始终完好。磁共振成像（MRI）显示C5/6处严重受压，但无明显硬膜内椎间盘突出。该患者随后在手术室进行了闭合复位，然后采用前后联合入路治疗椎间盘突出。在完成C5/6椎间盘切除术后发现脑脊液（CSF）漏出，并且发现因外伤性椎间盘突出导致了硬脑膜撕裂。由于硬脑膜质地脆弱以及黏合剂可能会扩散至脊髓，因此决定不修复硬脑膜撕裂。放置前路引流管3天后拔除，随后他接受了康复治疗，并能够恢复受影响肌节的肌力。在颈椎创伤的情况下，硬膜内椎间盘突出在MRI上很容易被漏诊。因此，前路入路是在单侧颈椎小关节脱位（CFD）手术中处理椎间盘突出越来越被接受的方法。
