Cervical Discopathy in Idiopathic Trigeminal Neuralgia: More than Coincidence?

Abstract

Background Data: The most common cause of trigeminal neuralgia is neurovascular compression. However, several patients present with unknown etiology. Purpose: This study aims to investigate the relationship between trigeminal neuralgia and cervical pathology in patients previously diagnosed with idiopathic trigeminal neuralgia. Study Design: We designed an observational case-control study in our tertiary center. Patients and Methods: A study group consisting of patients previously diagnosed with idiopathic trigeminal neuralgia and a control group consisting of patients with tension-type headaches were included in the study. A blinded neuroradiologist reevaluated cranial MRIs of trigeminal neuralgia patients. Once it was confirmed that no signs of neurovascular compression or any secondary causes were present, a cervical MRI was performed to evaluate cervical pathologies. Cranial and cervical MRIs of the controls were evaluated by the same neuroradiologist. Results: Twenty patients who had prior diagnoses of idiopathic trigeminal neuralgia and 20 controls were investigated. The mean age of trigeminal neuralgia patients was 64.9 ± 12.6, and the mean age of the control group was 61.3 ± 9.1 (p = 0.305). The male/female ratio in trigeminal neuralgia patients was 2.3 and 1.8 in the control group (p = 0.736). While indentation on the trigeminal spinal tract above the C4 spinal level was observed in 12 out of 20 patients, none of the controls had any involvement in the same region (p < 0.001).

Association between trigeminal neuralgia and degenerative cervical myelopathy: A cross‐sectional study using US data

“…Given the uncertainties regarding the source of TN, there has been an increasing focus on pathology of the spinal trigeminal nucleus, also called the trigeminal tract, as a potential etiology 5,6 . Several recent case reports have highlighted a potential link between degenerative conditions affecting the cervical spine and development of TN 7–11 .…”

“…To our knowledge, the potential association between TN and DCM has only been explored by one study larger than a case report or series 5 . This recent case–control study, which included 20 individuals, found a significant association between cervical disc displacement causing indentation on the cervical spinal cord superior to the C4 vertebra and symptoms of TN 5 .…”

“…To our knowledge, the potential association between TN and DCM has only been explored by one study larger than a case report or series 5 . This recent case–control study, which included 20 individuals, found a significant association between cervical disc displacement causing indentation on the cervical spinal cord superior to the C4 vertebra and symptoms of TN 5 . While this preliminary finding from a relatively small sample remains unconfirmed, neuroanatomical evidence suggests that a link between cervical cord compression and TN is plausible.…”

“…5 This recent case-control study, which included 20 individuals, found a significant association between cervical disc displacement causing indentation on the cervical spinal cord superior to the C4 vertebra and symptoms of TN. 5 While this preliminary finding from a relatively small sample remains unconfirmed, neuroanatomical evidence suggests that a link between cervical cord compression and TN is plausible. The spinal trigeminal tract, which contributes to the sensory components of the trigeminal nerve, extends as far caudal as the fourth cervical segment with the cervical component termed the pars caudalis.…”

“…Given the uncertainties regarding the source of TN, there has been an increasing focus on pathology of the spinal trigeminal nucleus, also called the trigeminal tract, as a potential etiology. 5,6 Several recent case reports have highlighted a potential link between degenerative conditions affecting the cervical spine and development of TN. [7][8][9][10][11] Some of these cases reported that patients undergoing cervical spine surgery for degenerative cervical myelopathy (DCM), a relatively common condition involving spinal cord compression, experienced remission of TN postoperatively.…”