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International Orthopaedics

, Volume 9, Issue 1, pp 19–27 | Cite as

Soft disc herniation of the cervical spine

  • Yoshiki Yamano
Article

Summary

The definition of soft disc hernia of the cervical spine is not always clear, so we have studied 34 cases where soft disc material was extruded or had migrated outside the intervertebral space. There were 22 cases of the paracentral-central type and 12 cases of the posterolateral type. The diagnosis was made by discography using anteroposterior, lateral and both oblique radiographs.

All the patients complained of pain or discomfort in the neck or the interscapular region which was increased by the neck compression test and reproduced during discography. Severe pain in the area was present in all the cases of the posterolateral type and in about half of the paracentral-central type. Cord signs, such as increased reflexes in the lower limbs, were found in 15 cases of the paracentral-central type and in 5 cases of the posterolateral type. These signs correlated with the width of the spinal canal and the amount of prolapsed disc material.

Discography and reproduction of pain were most useful for the diagnosis of this type of hernia. It has now become possible to differentiate the paracentral type from the central type by performing computerised tomography scanning after discography.

We treated 12 cases conservatively and 22 cases surgically, and obtained good results in both groups.

Key words

Cervical spine Soft disc hernia Discography Radicular pain 

Résumé

La définition de la hernie discale cervicale n'est pas toujours claire, aussi avons-nous étudié 34 malades chez qui les éléments discaux avaient été expulsé ou avaient migré en dehors de l'espace intervertébral. Il y avait 22 cas de type central ou paracentral et 12 cas de type postéro-latéral. Le diagnostic a été obtenu grâce à la discographie, en utilisant des clichés de face, de profil, ainsi que deux clichés obliques.

Tous les malades se plaignaient de douleurs ou de gêne au niveau du cou ou de la région inter-scapulaire, exagérées par le test de compression du cou et retrouvées lors de la discographie. Les douleurs étaient importantes dans tous les cas de type postéro-latéral et dans la moitié environ de ceux de type central ou paracentral. Il existait des signes médullaires, tels qu'une augmentation des réflexes au niveau des membres inférieurs, dans 15 hernies centrales ou paracentrales et dans 5 hernies postéro-latérales. Ces signes étaient proportionnels à la largeur du canal rachidien et au volume de la hernie.

La discographie et la reproduction des douleurs sont les principaux éléments du diagnostic de ce type de hernies. Il est maintenant possible de distinguer les variétés centrales et paracentrales grâce à l'utilisation du scanner après discographie.

12 malades ont bénéficié d'un traitement conservateur et 22 ont été opérés; de bons résultats ont été obtenus dans les deux groupes.

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Copyright information

© Springer Verlag 1985

Authors and Affiliations

  • Yoshiki Yamano
    • 1
  1. 1.Department of Orthopaedic SurgeryKawasaki Medical SchoolKurashiki, OkayamaJapan

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