Diagnosis And Treatment Of Traumatic Cervical Intervertebral Disc Tear

Objectives:To investigate the characteristics of traumatic cervical intervertebral disc tear,the diagnostic features of MRI and the treatment strategy.Methods:From June 2015 to June 2018,46 patients with traumatic cervical intervertebral disc tear and spinal cord injury,34 males and 12 females,aged 21-74 years,with an average age of(51.0 +12.3)years,were retrospectively analyzed.Among them,27 were injured in traffic accidents,11 were injured by falling from high places and 8were injured by falling.Of the 46 patients,40 had facial abrasion.ASIA grading was performed before operation.X-ray,CT and MRI were performed before operation in all patients,and fat suppression sequence was required for MRI examination.According to the results of preoperative MRI images,the possibility of disc tear was judged,and the characteristics of MRI imaging signals that could judge the disc tear were recorded.ACDF was used in the operation of anterior segment injury.After general anesthesia in all patients undergoing anterior surgery,cervical hyperextension,fluoroscopy,and partial disc tear segments will show posterior displacement of the upper vertebral body.If no cervical intervertebral disc injury is found in the preoperative examination,it shall be explored during the operation;If there is high suspicion of disc tear before operation and no tear during operation,subdiscography will be given during operation.The imaging manifestations of preoperative MRI features were compared with those of intraoperative exploration,and the characteristic imaging manifestations of MRI were summarized.The VAS score and Oswestry dysfunction index(ODI)of neck pain before operation,1 week after operation,1 month after operation and the last follow-up were compared.Results:According to the preoperative ASIA classification,there were 2 cases of grade B,7cases of grade C,26 cases of grade D and 11 cases of grade E in 46 patients.One caseof grade D and 45 cases of grade E were followed up for the last time after operation.The characteristics of the cases were mild nerve injury and good recovery after operation.According to the analysis of preoperative MRI features and the actual results of disc injury during operation,the MRI features of disc tear can be divided into two types: typical and atypical.Posterior cervical extension fluoroscopy and intraoperative discography under general anesthesia were helpful for judging disc injury.It was found that not all 46 patients had one segmental disc tear,12 patients had two segmental disc tear,3 patients had three segmental disc tear,a total of 74 disc tear.Anterior ACDF is effective in the treatment of intervertebral disc tear.The follow-up time of 46 patients was 6.0 +1.3 months(4-8 months).All patients improved gradually during the follow-up.VAS score and ODI were significantly improved at 1 week,1 month and the last follow-up(P < 0.05).Conclusions:Traumatic cervical intervertebral disc tear patients have mild spinal cord injury and good nerve recovery after operation.The characteristic imaging findings of MRI can clearly diagnose traumatic cervical intervertebral disc tear.Anterior cervical ACDF surgery is targeted at the etiology,with satisfactory results.