acute cervical disc herniation
Introduction
Introduction to acute cervical disc herniation Acute cervical disc herniation refers to the history of neck trauma with varying degrees of severity. Imaging examination confirmed disc rupture or protrusion without cervical fracture, dislocation, and corresponding clinical manifestations. Before the 1980s, due to the limitations of detection technology, the diagnosis of this disease was insufficient, and the diagnosis was difficult. Since the advent of magnetic resonance imaging, the discovery rate of this disease has increased day by day, and its basic and clinical research has been deepened. basic knowledge The proportion of sickness: 1.7% Susceptible people: no specific population Mode of infection: non-infectious Complications:
Cause
Causes of acute cervical disc herniation
Acute cervical disc herniation is caused by neck trauma. The main cause of injury is accelerated limb violence, which causes the neck to sprain. It is more common in traffic accidents or sports. It can be injured by front, rear and side impacts. The disc injury caused by the extension-acceleration injury caused by the rear-end collision is the most serious. It is generally believed that acute cervical disc herniation is the basis of a certain degree of degeneration in the intervertebral disc. On the other hand, it is affected by a certain external force, but it can also be seen in the intervertebral disc without obvious degeneration.
Prevention
Acute cervical disc herniation prevention
1. Do not doze off while driving, so as to avoid the driver's sudden braking and cause the disease.
2. When doing sports, keep the correct posture and do not stretch your neck.
Complication
Acute cervical disc herniation complications Complications
If the disease is severely pressed against the cervical spinal cord or nerve roots, it is easy to cause paralysis.
Symptom
Symptoms of acute cervical disc herniation Common symptoms Spinal nerve root damage Shoulder involvement of cervical spinal cord demyelinating lesions Spinal cord compression of the neck of the trapezius muscle and ... Cervical vertebral curvature changes straight neck sprained spinal cord compression reflection into the neck Pain
1. History of head and neck trauma, even a slight neck sprain, acute onset, asymptomatic before onset, symptoms and signs of cervical spinal cord or nerve root compression after onset.
2. The disease is acute, most cases have obvious history of head and neck trauma, and some may be caused by minor injury, or even stretched, and the clinical manifestations vary greatly depending on the location and degree of compression, according to the intervertebral disc. Different from the protruding parts and the compressed tissue, the disease can be divided into three types: lateral type, central type, and side central type.
1 lateral cervical disc herniation: the protruding part is outside the posterior longitudinal ligament and the inside of the hook joint, and the protruding intervertebral disc compresses the cervical spinal nerve root passing through it to produce root compression symptoms.
Symptoms: neck pain, stiffness, limited mobility, like a "slall pillow"; severe pain in the neck overextension, and can be radiated to the shoulder or occiput; one side of the upper limb has pain or numbness, but rarely both sides occur.
Signs: the neck is in a stiff position; the paravertebral tenderness, pain in the segment of the lesion, tenderness in the spinous process of the lower cervical spine and the medial aspect of the scapula; cervical spinal nerve root tension test and Spuring test positive; affected nerve root dominating zone feeling, movement and reflex Changes, dominating muscles can have atrophy and muscle weakness.
2 Central cervical disc herniation: the prominent part is in the center of the spinal canal, directly in front of the spinal cord, which can compress the bilateral front of the spinal cord and produce bilateral compression symptoms.
Symptoms: The limbs are weak in different degrees, the lower limbs tend to be heavier than the upper limbs, and the behavior is unstable. In severe cases, there are incomplete or complete paralysis of the limbs; large and urinary dysfunction, which is characterized by urinary retention and difficulty in defecation.
Signs: different degrees of muscle strength decline in the limbs; paresthesia, deep and shallow sensation can be affected, depending on the level of different sensory abnormalities of the disc herniation; the muscle tension of the limbs is increased; the sputum reflexes can occur, and the sputum and sputum can occur. positive, pathological signs such as Hoffmann, Openheim sign positive.
3 side central cervical disc herniation: the protruding part is on one side and between the cervical spinal nerve root and the spinal cord, compressing the unilateral nerve root and spinal cord, in addition to the side symptoms, signs, there are different degrees of single Symptoms of lateral spinal cord compression, manifested as atypical Brown-Sequard syndrome, this type of spinal cord compression is often concealed by severe root pain, and once the spinal cord compression is manifested, the condition is more serious.
Examine
Examination of acute cervical disc herniation
1. Cervical X-ray film: Observable:
(1) The cervical curvature is reduced or disappeared.
(2) Young or acute traumatic prominence, there may be no obvious abnormalities in the intervertebral space, but in older patients, the intervertebral space may have different degrees of degenerative changes.
(3) The soft tissue shadow of the anterior vertebra can be seen to be widened in the disc herniation caused by acute hyperextension injury.
(4) The cervical segmental power picture can sometimes show the instability of the affected segment.
2. CT scan:
Although it is helpful for the diagnosis of this disease, it often cannot be diagnosed by conventional CT scan. CTM (myelography + CT scan) can clearly show the image of spinal cord and nerve root compression by intervertebral disc. In recent years, some scholars have advocated this method. To diagnose cervical disc herniation, and its value in the diagnosis of lateral cervical disc herniation is significantly greater than MRI.
3. Magnetic resonance imaging (MRI):
It can directly display the extent of cervical disc herniation, the type and the degree of damage of the spinal cord and nerve roots, and provide a reliable basis for the diagnosis of cervical disc herniation, treatment options and prognosis. The accuracy of MRI diagnosis of cervical disc herniation is much greater than that of CT. And CTM, showing clear images in central and paracentral cervical disc herniation:
(1) Central type: The intervertebral disc protrudes from the affected intervertebral space at the level of the affected intervertebral space, and compresses the central part of the cervical spinal cord. The compressed spinal cord can be partially bent, flattened or concavely displaced to the rear, and has abnormal signal performance. Among them, signal enhancement is the main feature, and sometimes there is a hollow image in the spinal cord.
(2) Paracentral type: the intervertebral disc protrudes from the posterior lateral part in a block or fragment shape, compressing the lateral side of the cervical spinal cord and one side of the nerve root. The anterior and posterior aspect of the cervical spinal cord are compressed and deformed, and are displaced to the rear or the healthy side, and the local signal is enhanced. The nerve roots are displaced to the posterolateral side or the image disappears. Lateral cervical disc herniation often requires CTM for diagnosis.
4. Electromyography: used to determine nerve root damage, has a certain significance for the positioning of nerve roots, normal electromyography indicates that nerve root function is acceptable, and the prognosis is good.
Diagnosis
Diagnosis and diagnosis of acute cervical disc herniation
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1. Cervical spondylosis: no clear history of trauma, or symptoms of cervical spondylosis before trauma, slow onset, symptoms, signs can be similar to cervical disc herniation, imaging shows that the epiphysis and intervertebral disc together constitute a pressure body, and Often the former is the main one.
2. Cervical spinal canal tumor: no history of trauma, the onset is generally slow, imaging can provide an important basis for identification, intramedullary tumors are easier to distinguish, extramedullary tumors and intervertebral discs have clear boundaries.
3. Periarthritis of the shoulder: thoracic outlet syndrome: mainly differentiated from lateral cervical disc herniation, shoulder pain only shoulder pain and limited mobility, no neurological abnormalities, clinical manifestations of thoracic outlet syndrome Lateral cervical disc herniation, but cervical MRI did not see disc herniation and nerve root compression, chest X-ray can show stenosis or neck ribs.
