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Abstract
This work included 30 patients with clinically and radiologically confirmed degenerative cervical disc disease and received surgical treatment. The aim of this work was directed at evaluations of surgical treatment in management of patients with degenerative cervical disc disease.
The results were as follow:
I- The age incidence ranged from 26-69 years.
II- Pathology: patients of cervical disc disease have been
categorized into 4 groups according to pathology.
A) Unilateral soft disc protrusion with nerve root
compression.
B) Foraminal spur, or hard disc, with nerve root compression.
C) Medial soft disc protrusion with spinal cord compression.
D) Transverse ridge or cervical spondylosis with spinal cord compression - soft disc herniations usually affect one level whears hard disc can be multiple.
III- Clinical picture: According to clinical presentation patients were classified in to 2 groups.
1) Group (A) with radiculopathy (21cases).
2) Group (B) with myelopathy (9cases).
(A) Radicolopathic group (21 patients):
1- Onset: 8 patients had acute onset, 11 patients had insidious
onset and 2 patients had acute on top of chronic onset.
2- Radicular pain was the initial symptom in all cases.
3- Radicular numbness was present in all cases.
4- Neck pain was present in all cases.
5- The patients were classified according to the clinical course in
to 3 groups.
Progressive - radicular pain (66.7 %).
Stationary - radicular pain with recurrent exacerbation(14,3 %).
Intermittent - radicular pain with progressive neurological
deficit (19 %).
6- The duration of symptoms ranged from 4 week to 49 weeks.
(B) Myelopathic group (9 patients):
1- Onset: 2 patients had acute onset, 5 patients had insidious
onset, 2 patients had acute on top of chronic onset
2- Course: One patient had stationary course, two patients had
intermittent course, six patients had progressive course.
3- Duration of symptom: raged from 3 week to 19 week with
mean duration was (11).
4- Severity of the disease: according to Nurick’s grading
system of myelopathy (44.4%) were present in grade (I)
(22.2 %) were present in grade (II) (22.2 %) were present in
grade (III) and (11.1%) were present in grade IV
5- Sphincteric dysfunction: (55.6 %) were present In grade (III)
(22.2 %) were present in grade (II) (22.2%) were present in
grade (I) No patient was present in grade (0).
IV- Radiological evaluation: roentgen x ray & M.R.I were the
routine investigation in evaluation in cases of degenerative
cervical disc disease for:
a) Detection of ostephyte formation
b) Confirmation of disc herniation
c) Determination of the level of disc herniation
C4-5 6< C5-6 15< C6-7 9
V- Surgical treatment:
A) Anterior cervical disectomy was performed in (96.97%) of
cases: single level (83.33%), double level (16.67%).
B) Disectomy with bone graft and fixation using plate and
screws in (3.33%) of cases. Posterior longitudinal ligament was intact in 86.66% of cases posterior longitudinal
ligament was incised in 13.33% of cases.
VI- Complication:
- Seven cases had transient dysphagia
- One patient had superficial wound infection
- One patient had urinary tract infection.
VII- Outcomes:
A) In Radiclopathic group: excellent, outcome was noted in
(19%) of cases and good outcome was present in (61.9%)
of cases.
B) In Myelopathic group: no patient was present in the excellent, group and (44.4%) had good outcome.