Case of the week: Updating a cervical MR scan avoided unnecessary cervical surgery

Abstract

Background: As spinal surgeons, we have all likely seen cases in which lumbar disc herniations regressed/resolved on successive MR studies. Here, we present a patient whose original cervical MR showed a large C4-C5 cervical disc herniation that completely resolved on the follow-up MR obtained 9 months later, thus avoiding cervical surgery. Case Description: A young patient (e.g. <30 years old) sustained multiple prior traumatic events over the past 3 years. The last episode 9 months ago resulted in the performance of an MR scan that demonstrated a significant central C4-C5 disc herniation with cord/root compression. Despite pain and mild radiculopathy, the patient had no focal neurological deficit, and did not undergo surgery. When the patient recently consulted multiple spinal orthopedists and neurosurgeons, the uniform recommendation was for a C4-C5 anterior cervical discectomy/ fusion (ACDF). However, a telemedicine consultation with a spinal neurosurgeon resulted in a follow-up cervical MR scan that demonstrated cervical disc resorption, and, therefore, no need for cervical surgical intervention. When the new study showed full resolution of the C4-C5 disc, the telemedicine and local neurosurgeon agreed that cervical surgery was unnecessary. Conclusion: The spinal literature shows that predominantly lumbar disc herniations (LDH) spontaneously regress on MR studies 34.7–95% of the time over 6–17 month intervals, with full resolution being seen in 43–75% of cases. As cervical disc herniations likely demonstrate similar resorption/resolution on successive MR studies, old cervical MR examinations should probably be updated/repeated in patients who are being considered for cervical surgical intervention. If/when cervical discs have resorbed, cervical surgery may be avoided.