Study Design. A retrospective study on 24 patients with acute central cervical cord injury caused by traumatic disc herniation.
Objectives. To determine the correlation of disc herniation with central cord injury and to evaluate the role of anterior cervical decompression and interbody fusion in management of this injury.
Summary of Background Data. Acute cervical disc herniation has been documented as a causative factor in spinal cord injury but has been infrequently reported with central cord syndrome.
Methods. Between 1989 and 1994, 24 patients with acute cervical disc herniation and central cord syndrome were studied. These patients underwent anterior decompression and fusion, and were followed for 2 to 7 years, with an average follow-up period of 3 years and 8 months. The degree of disc herniation and neurologic scores were rated.
Results. During follow-up period, the American Spinal Injury Association motor score in 24 patients was increased to 86.46 ± 10.22 from 47.79 ± 19.66. The age of the patients was very negatively correlated with recovery rate (P < 0.01), but no correlation was observed between severity of cord compression and neurologic scores (P > 0.05). Postoperative neurologic improvement in patients with fracture or dislocation was very significantly slower (P < 0.01) than in those without these injuries.
Conclusions. Far more common than previously expected, acute disc herniation in cervical spine injury is the one of principal cause for central cord syndrome. Magnetic resonance imaging assessment and surgical intervention are required.
Intervertebral disc herniation often is complicated in acute cervical spine injuries, with or without evidences of fractures or fracture dislocations of the cervical spine. However, although a herniated disc has been mentioned frequently as a causative factor in spinal cord dysfunction after cervical spine injuries, 6,7,9,14,23 it rarely has been identified by traditionally used imaging techniques, and the exact incidence has remained uncertain.
With the advent and application of magnetic resonance imaging (MRI), more comprehensive analyses of the morphologic features in patients with spinal injuries have been possible. The potential of MRI in assessing disc pathology and in providing unique information about changes in intervertebral disc has been emphasized, 1,2,10,12,15,20,27-29 especially when the patients with spinal cord injuries do not show radiographic evidence of fracture or fracture dislocation.
Acute central cord syndrome, characterized by disproportionately greater upper than lower extremity motor impairment, bladder dysfunction, and varying degrees of sensory loss below the level of injury, is the most common of the incomplete injuries to the cervical cord. In the original description, Schneider et al 25 presented nine cases of their own in detail and six additional cases selected from the literature. They concluded that the symptoms in acute central cervical spinal cord injury are caused by a compression of the spinal cord simultaneously both from an arthritic spur or a herniated disc from the anterior direction and from the buckled ligamentum flavum from the posterior. However, in their reported nine cases, no disc herniation was demonstrated as evidence of compression. Since then, in a number of studies, no patients with acute disc herniation have been revealed. 5,17,24,26
In 1977, Raynor 20 performed myelography on 20 patients with cervical spinal injury and concomitant neurologic deficit, evidencing disc herniation in 8 patients. All these patients had a clinical manifestation of central cord syndrome. In 55 patients with cervical spine fractures, Rizzolo et al 21 reported 23 (42%) patients with acute disc herniation. Of these 23 patients, 8 presented with the central cord syndrome. Quencer et al 19 found that in 3 of 11 patients, central cord injuries had resulted from herniated cervical discs.
The purpose of this study was to review retrospectively 24 patients with central cervical cord injury caused by acute cervical disc herniation and to evaluate the role of anterior cervical decompression and interbody fusion in the management of this injury.