Skip to main content

Early presentation of traumatic cervical disc herniation with neurologic deficit and without an adjacent bone lesion

International Orthopaedics volume 43, pages 785–790 (2019)Cite this article

Abstract

Aim of the study

The purpose of this study was to explore clinical features and the operational opportunity of traumatic cervical disc herniation.

Method

Patients with cervical spine injury (413) were retrospectively reviewed. Six patients with neurological deficits were identified to have disc herniation without adjacent bone lesion. The diagnosis was confirmed by MRI. The Japanese Orthopedic Association (JOA) score was used to assess the severity of clinical symptoms. Different grading systems have been used in analyzing various stages of herniated cervical discs. All patients underwent anterior cervical decompression, insertion of autologous iliac crest graft, and fixation with cervical plate.

Results

The causes of injury were road traffic accidents in four patients and sport and domestic accidents in one patient each. There were five patients with single intervertebral disc herniation and one patient with double. Pre-operative JOA score was 14 for three patients, the remaining three patients scored 10, 6, and 3 respectively. At final follow-up, the score was 17 for four patients and 14 for two patients.

Discussion

Traumatic cervical disc herniation with neurologic deficit and without adjacent bone lesion is a rare condition. MRI is the golden examination to confirm diagnosis. Early recognition is essential for appropriate therapy and to minimize the extent of neurological deficit.

Conclusion

The MRI is mandatory in diagnosing different types of traumatic herniated cervical disc. Discectomy and anterior cervical interbody fusion using autologous iliac crest graft are the treatment options.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Ammor R, Ajja A (2015) Hernie discale cervicale post-traumatique. Pan Afr Med J 22(295) http://www.panafrican-med-journal.com/content/article/22/295/full

  2. Caetano de Barros A, Caetano de Barros M (1984) Traumatic extradural and intradural herniation of cervical disk treated surgically. Surg Neurol 21(6):577–580. https://doi.org/10.1016/0090-3019(84)90273-8

    Article  CAS  PubMed  Google Scholar 

  3. Quenum K, Coulibaly O, Arkha Y, Derraz S, El Ouahabi A, El Khamlichi A (2011) Atteinte médullaire cervicale post-traumatique sans lésion osseuse du rachis chez l’adulte: analyse de neuf cas consécutifs. Neurochirurgie 57(1):46–50 https://www.ncbi.nlm.nih.gov/pubmed/21353682

    Article  CAS  PubMed  Google Scholar 

  4. Suetsuna F, Okudera Y, Tanaka T, Tamura T (2014) Spinal cord injury due to cervical disc herniation caused by bench pressing. J Spine 3:154

    Google Scholar 

  5. Ecker TM, Kleinschmidt M, Martinolli L, Zimmermann H, Exadaktylos AK (2008) Clinical presentation of a traumatic cervical spine disc rupture in alpine sports: a case report. Scand J Trauma Resusc Emerg Med 16:14 http://www.sjtrem.com/content/16/1/14

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hisato T, Takaki K, Nanae A (2011) MRI findings of traumatic cervical disc herniation. J-STAGE 60(3):424–428

    Google Scholar 

  7. Kumar Y, Hayashi D (2016) Role of magnetic resonance imaging in acute spinal trauma: a pictorial review. BMC Musculoskelet Disord 17:310

    Article  PubMed  PubMed Central  Google Scholar 

  8. Miao JL, Zhang CY, Peng Z (2012) Characteristics and treatment of traumatic cervical disc herniation. Zhongguo Gu Shang 25(10):817–820

    PubMed  Google Scholar 

  9. Kato S, Oshima Y, Oka H, Chikuda H, Takeshita Y, Miyoshi K et al (2015) Comparison of the Japanese Orthopaedic Association (JOA) score and modified JOA (mJOA) score for the assessment of cervical myelopathy: a multicenter observational study. PLOS ONE. https://doi.org/10.1371/journal.pone.0128392

  10. Ryu JS, Chae JW, Cho WJ, Chang H, Moon MS, Kim SS (2010) Cervical myelopathy due to single level prolapsed disc and spondylosis: a comparative study on outcome between two groups. Int Orthop 34:1011–1015

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kotilainen EM, Kärki T, Satomaa OK (1997) Traumatic cervical disc herniation—tetraparesis in a patient kicked by a horse. Acta Orthop Scand 68(2):176–179. https://doi.org/10.3109/17453679709004003

    Article  CAS  PubMed  Google Scholar 

  12. Hakkaku T, Nakazato K, Koyama K, Kouzaki K, Hiranuma K (2017) Cervical intervertebral disc degeneration and low cervical extension independently associated with a history of stinger syndrome. Orthop J Sports Med 5(11):2325967117735830

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A et al (2011) International standards for neurological classification of spinal cord injury. J Spinal Cord Med 34(6):535–546

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wong JJ, Côté P, Quesnele JJ, Stern PJ, Mior SA (2014) The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J 14:1781–1789. https://doi.org/10.1016/j.spinee.2014.02.032

    Article  PubMed  Google Scholar 

  15. Jomin M, Lesoin F, Lozes G, Thomas CE, Rousseaux M, Clarisse J (1986) Herniated cervical discs: analysis of a series of 230 cases. Acta Neurochir 79:107–113

    Article  CAS  PubMed  Google Scholar 

  16. Jacobs LJ, Chen AF, Kang JD, Lee JY (2016) Reliable magnetic resonance imaging based grading system for cervical intervertebral disc degeneration. Asian Spine J 10(1):70–74

    Article  PubMed  PubMed Central  Google Scholar 

  17. Yi JS, Cha JG, Han JK, Kim HJ (2015) Imaging of herniated discs of the cervical spine: inter-modality differences between 64-slice multidetector CT and 1.5-T MRI. Korean J Radiol 16(4):881–888

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kettler A, Rohlmann F, Neidlinger-Wilke C, Werner K, Claes L, Wilke HJ (2006) Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: part II. Cervical spine. Eur Spine J 15:732–741

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hattou L, Morandi X, Lefebvre J, Le Reste PJ, Riffaud L, Hénaux PL (2017) Anterior cervical interbody fusion using polyetheretherketone cage filled with synthetic bone graft in acute cervical spine injury. Orthop Traumatol Surg Res 103:61–66. https://doi.org/10.1016/j.otsr.2016.09.004

    Article  CAS  PubMed  Google Scholar 

  20. Liao JC, Niu CC, Chen WJ, Chen LH (2008) Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion. Int Orthop 32:643–648

    Article  PubMed  Google Scholar 

  21. Suzuki A, Daubs MD, Hayashi T, Ruangchainikom M, Xiong C, Phan K et al (2018) Patterns of cervical disc degeneration: analysis of magnetic resonance imaging of over 1000 symptomatic subjects. Glob Spine J 8(3):254–259

    Article  Google Scholar 

  22. Ruetten S, Komp M, Merk H, Godolias G (2009) Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations. Int Orthop 33:1677–1682

    Article  Google Scholar 

  23. Chu CW, Kung SS, Tsai TH, Huang TY, Hwang SL (2011) Anterior discectomies and interbody cage fusion without plate fixation for 5-level cervical degenerative disc disease: a 5-year follow-up. Kaohsiung J Med Sci 27:524–527. https://doi.org/10.1016/j.kjms.2011.06.017

    Article  PubMed  Google Scholar 

  24. Lied B, Roenning PA, Sundseth J, Helseth E (2010) Anterior cervical discectomy with fusion in patients with cervical disc degeneration: a prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage). BMC Surg 10:10 http://www.biomedcentral.com/1471-2482/10/10

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Tomé-Bermejo F, Piñera AR, Alvarez-Galovich L (2016) Osteoporosis and the management of spinal degenerative diseases. Arch Bone Jt Surg 2017; 5(5): 272–282

Download references

Author information

Affiliations

  1. Fellow West African College of Surgeons (FWACS), Cheikh Anta Diop University of Dakar, P.O. Box: 11551, Dakar, Senegal

    Jean Claude Sane, Jean Marie Vianney Hope, Souleymane Diao, Joseph Davy Diouf, Amadou Ndiassé Kasse & Mouhamadou Habib Sy

Authors
  1. Jean Claude Sane
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean Marie Vianney Hope
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Souleymane Diao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joseph Davy Diouf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amadou Ndiassé Kasse
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mouhamadou Habib Sy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean Marie Vianney Hope.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sane, J.C., Hope, J.M.V., Diao, S. et al. Early presentation of traumatic cervical disc herniation with neurologic deficit and without an adjacent bone lesion. International Orthopaedics (SICOT) 43, 785–790 (2019). https://doi.org/10.1007/s00264-018-4117-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-018-4117-2

Keywords

  • Traumatic cervical disc herniation
  • Neurological deficit
  • MRI
  • Discectomy