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Acute Cervical Disk Herniation Resulting in Sudden and Severe Neurologic Deterioration: A Case Series.

ABSTRACT: Objective Nontraumatic acute cervical disk herniation resulting in acute severe neurologic deficit is a rare entity described in a limited number of case reports. We describe the management and outcome in patients presenting with severe neurologic deterioration caused by acutely herniated cervical disks. Methods Four patients (mean age 39.5 years) presented to our tertiary care academic medical center from September 2012 to September 2013 with severe progressive neurologic deficits due to cervical disk herniation and were included in the series. Patients' surgical, medical, and imaging records were retrospectively reviewed under an Institutional Review Board waiver of informed consent. Results Patients in the series presented with acute neurologic deterioration, including paraparesis, Brown-Séquard syndrome, or quadriparesis deteriorating to quadriplegia. Emergent magnetic resonance imaging (MRI) scans and emergent decompression and fusion for acute soft disk herniation were performed in all cases. All patients recovered to excellent functional status with Frankel score improvement from B (one patient)/C (three patients) to E (three patients)/D (one patient). Conclusions Acute cervical disk herniation with acute neurologic deterioration is a medical emergency necessitating emergent MRI and surgical decompression. Clinical presentation varies. In patients with rapid-onset neurologic deterioration, a high level of suspicion for this rare entity is indicated.

SUBMITTER: Harel R

PROVIDER: S-EPMC5553475 | biostudies-other | 2016 Jul

REPOSITORIES: biostudies-other

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Project description:Study Design Retrospective study. Objective We previously reported that the long-term neurologic outcomes of C3-C6 laminoplasty for cervical spondylotic myelopathy (CSM) are satisfactory, with reduced frequencies of postoperative axial neck pain and kyphotic deformity. However, only 20 patients were included, which is a limitation in that study. The present study investigated the incidence of late neurologic deterioration (LND) of myelopathic symptoms after C3-C6 laminoplasty for CSM and attempted to identify significant risk factors for LND in a larger patient population. Methods Subjects comprised 137 consecutive patients with CSM who underwent C3-C6 laminoplasty (bilateral open-door laminoplasty, n = 85; unilateral open-door laminoplasty, n = 52) and were followed for >24 months (mean follow-up, 70 months; range, 25 to 124 months). The patients' medical records were examined for evidence of LND due to cervical myelopathy. The age at time of surgery, sex, surgical procedures, anteroposterior spinal canal diameter at the C7 level, type of C6 spinous process, pre- and postoperative C2-C7 angle, C3-C6 range of motion (ROM), and disk height at the C6-C7 level were analyzed to identify risk factors for LND. Results Three patients (2.2%) developed LND of myelopathic symptoms due to caudal segment pathology adjacent to the C3-C6 laminoplasty (LND group). In these three patients, mean Japanese Orthopaedic Association (JOA) score improved from 10.2 before surgery to 12.2 at the time of maximum recovery, and declined to 9.7 just before additional surgery. On the other hand, in 134 patients without LND (non-LND group), the mean JOA score significantly improved from 10.2 before surgery to 13.4 at the time of maximum recovery and was maintained by the final follow-up (13.2). Compared with the non-LND group, the LND group showed significantly smaller anteroposterior spinal canal diameter at C7, more restricted postoperative C3-C6 ROM, and greater postoperative decrease in disk height at C6-C7, although a logistic regression analysis showed no significant differences. Conclusions In patients with CSM with more severe developmental spinal canal stenosis at C7, accelerated degeneration at the caudal segment resulting from restricted C3-C6 ROM after C3-C6 laminoplasty might lead to LND.

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Acute Cervical Disk Herniation Resulting in Sudden and Severe Neurologic Deterioration: A Case Series.

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