Spinal Cord Injury by Ruptured Disc Particles in Cervical Spinal Trauma

ABSTRACT

The incidence and definite criteria of posttraumatic cervical disc herniation is still uncertain. Not infrequently, ruptured posttraumatic cervical disc particles play important role on the cervical cord injury. In a prospective study, 23 patients of cervical spinal cord injury were evaluated preoperatively by magnetic resonance imaging(MRI) to reveal the incidence, developing mechanism, and radiographic results of posttraumatic cervical disc herniation, and severity of spinal cord damage by ruptured disc particles and usefulness of preoperative cervical MRI. All of the patients, who showed abnormal neurological signs consistent in cervical spinal cord inury, were evaluated preoperatively by cervical MRI within 24 hours after trauma. MRI was also taken after reduction in patients with cervical dislocation. The criteria for identifying posttraumatic disc herniation was limited to ruptured disc. Diffuse buldging disc or degenerated cervical stenosis was not considered as posttraumatic disc herniation. MRI demonstrated 7 patients(30%) with spinal cord compression by ruptured disc particles. Compressed spinal cord showed intramedullary swelling and localized high signal intensity by T2-weighted images. All of the patients with ruptured disc particles were operated by anterior approach and intervertebral fusion as soon as possible. Preoperatively, 6 patients showed incomplete spinal cord injury(Frankel's grade B-D); 5 patients showed one Frankel's grade improvement postoperatively. No patients worsened after reduction of cervical dislocation. These results suggest that ruptured disc particle is one of the main causes of cervical spinal cord injury which can be easily identified by MR imaging. It is author's opinion that early removal of ruptured particle compressing the spinal cord can be important factor to improve the neurologic status. The aurthor recommends prompt preoperative MR imaging study for the patient with suspected acute cervical spinal cord injury.