Disc herniation in cervical fracture subluxation

Abstract

Previous reports of computed tomographic scan with contrast myelography in cervical spinal cord injury have shown a rate of disc herniation of less than 5%. We hypothesized that injuries associated with forces adequate to cause bone or ligamentous injury in the region of the disc space could be associated with higher and more significant rates of disc herniation. Thirty-seven consecutive traumatic midcervical fracture subluxations were reviewed. Fracture subluxation was defined by fracture of the facet joints, pedicles, or vertebral bodies or more than 3.5 mm subluxation from C2-C3 to C7-T1. Reduction was achieved in 97% and was not associated with neurological deterioration. On the basis of plain films, tomograms, and plain computed tomographic scans, the injuries were classified as flexion dislocation, flexion compression, compression burst, or extension injuries. Twenty-five computed tomographic scans with contrast myelograms and one magnetic resonance imaging scan were obtained. All patients with partial neurological deficits were studied. A herniated disc was defined as that which deformed the thecal sac and/or nerve roots. Retrospectively, a neuroradiologist reviewed the studies for the presence of herniated disc. Disc herniation was seen at the level of injury in 9 (35%) patients and not seen in other patients. Forty-seven percent of the patients with partial deficits had herniated discs. Herniated disc was seen most frequently in flexion dislocation and flexion compression injuries. Three patients (20%) with partial deficits underwent discectomy. Patients with partial spinal cord injury and discectomy, on average, improved more than other patients with partial spinal cord injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Fracture dislocations of the cervical spine: a review of 106 conservatively and operatively treated patients

“…The type of surgery, anterior or posterior, not only depends on the direction of instability and type of fracture, but is also influenced by spinal canal compromise with bone fragments, epidural hematoma or herniated disc material. Traumatically herniated disc material causing medullary compression [7,14], either before or after reduction, is a probable confounding factor in a retrospective study setting of this kind. Most of the cases in this series were treated before the era of MRI.…”

Posterior approach for cervical fracture–dislocations with traumatic disc herniation

“…Even though computed tomography (CT) myelography was still the principal neuroimaging study before MRI, the reported prevalence of disc herniation with cervical spine injuries was \5% [3,7]. However, with the use of MRI, the reported incidence of traumatic disc herniation increased to about 40% [11,12,24].…”

“…Disc extrusion can occur because these injuries may cause the rupture of the posterior longitudinal ligament and posterior annulus. Previous reports have suggested that up to 40% of all fracture-dislocations of the cervical spine are associated with intervertebral disc herniation [12,22,24]. Traumatic cervical disc herniation is thought to cause further compression of the spinal cord and increase the risk of neurological deterioration during closed or open reduction [10,20,25].…”

Traumatic cervical disc herniation—tetraparesis in a patient kicked by a horse

“…Harrington et al (1991) have shown that cervical disc herniations are common in patients with cervical fracture subluxations. In their series of 37 consecutive patients with cervical fracture subluxation, disc hemiation was demonstrated at the level of the injury in one third of the cases.…”