Cervical disc herniation

Introduction Cervical disc herniation is one of the more common spinal diseases in the clinic, and the incidence is second only to lumbar disc herniation. Mainly due to the cervical disc nucleus, the annulus fibrosus, the cartilage plate, especially the nucleus pulposus, after different degrees of degenerative lesions, under the action of external factors, the intervertebral disc annulus ruptures, the nucleus pulposus tissue protrudes from the rupture or Peel out of the spinal canal, causing adjacent tissues, such as spinal nerve roots and spinal cord, to cause headache, dizziness; palpitations, chest tightness, neck soreness, limited mobility, shoulder and back pain, upper limb numbness, gait loss Symptoms and signs such as weakness and weakness of the limbs. In severe cases, high paraplegia is life-threatening.

Cause

Cervical disc herniation is caused by factors such as neck trauma and degeneration. The main cause of injury is accelerated violent head movement causing neck sprain, which is more common in traffic accidents or sports. It can be injured by front, rear and side impacts, and the neck caused by Rear-end collision. Disc damage caused by the extension-acceleration injury is the most serious. It is generally believed that acute cervical disc herniation is caused by a certain degree of external force on the basis of a certain degree of degenerative change of the intervertebral disc, but it can also be seen in the intervertebral disc without obvious degeneration.

an examination

Related inspection

Cervical CT examination of spinal MRI

Clinical manifestations of cervical disc herniation

According to the position of the cervical disc to the intraspinal protrusion, there are different clinical manifestations:

1 lateral protrusion type: due to stimulation or compression of the cervical spinal nerve root, it manifests as a unilateral root symptom. In the light, the numbness of the cervical spinal nerve innervation area (ie, the upper limb of the affected side) may occur. In severe cases, severe pain may occur in the affected area of the affected nerve segment, such as knife cutting or burning, accompanied by acupuncture or over-energy. Hemp, pain symptoms can be aggravated by cough. In addition, there are still painful torticollis, muscle spasm and restricted neck activity, and there may be symptoms such as upper limbs sinking, weakness, grip strength, and falling objects. Physical examination can find that the passive active neck or the pressure from the head to the vertical axis can cause pain, the affected nerve segments have changes in movement, sensation and reflex, and the innervation region has corresponding muscle weakness and muscle atrophy. Performance.

2 central protruding type: there are symptoms of unilateral nerve root and unilateral spinal cord compression. In addition to the performance of lateral prominence, there may be different degrees of symptoms of unilateral spinal cord compression, which is characterized by increased muscle tension of the ipsilateral limb below the level of the lesion, weakened muscle strength, hyperreflexia, and shallow reflexes. Pathological reflex, tactile and deep sensory disturbances may occur; the contralateral side is mainly sensory disturbance, that is, temperature and pain disorder, and the distribution of sensory disturbance is not consistent with the lesion level, and the motor function of the contralateral lower limb is good.

3 central protruding type: this type of symptoms without cervical spinal nerve involvement, manifested as bilateral spinal cord compression. Early symptoms are mainly sensory disturbances or dyskinesias. In the advanced stage, there are incomplete sputum sputum of different degrees of upper motor neurons or nerve bundle damage, such as awkward gait, inactivity, unstable walking, often Braids on the chest and waist, heavy ones can be bedridden, even breathing difficulties, incontinence. Examination showed increased muscle tension in the extremities, weakened muscles, hyperreflexia, shallow reflexes or disappearance, positive pathological reflexes, positive sputum and sputum.

Imaging examination of cervical disc herniation

Cervical X-ray films can be observed:

(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 widened in the disc herniation caused by acute hyperextension injury; (4) The instability of the affected segment can sometimes be shown on the cervical power picture.

Although CT scan 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 the intervertebral disc. In recent years, some scholars have advocated the use of this method to diagnose cervical disc herniation, and believe that it is in the diagnosis of lateral cervical disc herniation. The value of the disease is significantly greater than the MRI.

Magnetic resonance imaging (MRI) can directly display the extent and type of cervical disc herniation and the degree of damage to the spinal cord and nerve roots, providing a reliable basis for the diagnosis, treatment options and prognosis of cervical disc herniation. The accuracy of MRI in the diagnosis of cervical disc herniation is much greater than CT and CTM. Clear images can be displayed in central and paracentral cervical disc herniation.

Differential diagnosis

Cervical disc degeneration: Cervical spondylosis, also known as cervical vertebra syndrome, is a general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome, and cervical disc herniation. It is a disease based on degenerative pathological changes. Mainly due to long-term cervical vertebrae strain, bone hyperplasia, or disc herniation, ligament thickening, resulting in cervical spinal cord, nerve root or vertebral artery compression, a series of clinical syndromes of dysfunction. The manifestations of cervical disc degeneration and its secondary pathological changes, such as vertebral instability, loosening; nucleus protruding or prolapse; spur formation; ligament hypertrophy and secondary spinal stenosis, etc., stimulated or oppressed Adjacent nerve roots, spinal cord, vertebral artery, and cervical sympathetic nerves, and cause a variety of symptoms and signs of the syndrome.

Abnormal cervical segmentation: cervical segmental malformation, also known as cervical fusion deformity, is a fusion of two or more cervical vertebrae, which is characterized by a decrease in the number of cervical vertebrae, a shortened neck, limited head and neck movement, and often accompanied by other parts. Malformation, a small number of patients may be associated with neurological disorders.

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