Analysis Of 37 Cases Of Epidural Cervical Disc Herniation

Objective:To summarize the clinical features of 37 Epidural cervical disc herniation(ECDH) out of 271 cases of Cervical Disc Herniation treated in our department from 2002.10to 2008.2 retrospectively,and to explore the incidence, clinical features,diagnosis and treatment of ECDH.Methods:37 cases in this group,there were 22 males and 15 females;the average age was 42.5 years old(rang,45～71);mean course was 11 months(rang, 5d～36months).Of these patients,20 were of CSM,while 13 were ACDH,3 with radiculopathy and 1 underwent a revision surgery.To evaluate the symptoms,and signs in preoperation,postoperation,the Japanese Orthopedic Association(JOA) scoring system was used.Then the data of two groups were compared at last.All patients had X-ray,CT,MRI examination.Of these patients,35 had been carried out anterior cervical decompressin,1 underwent Simultaneous anterior and posterior vertebral canal decompression,and 1 subtotal vertebral resection.All patients had posterior longitudinal ligament(PLL) open or resection.Results:The incidence of ECDH was 13.7%in all the cervical disc herniation patients.In MRI,the extrusion occupied 45.3%—78.4%(70.7±7.8%) of the vertebral canal.31 cases were found focal interruption of the black line of posterior longitudinal ligament(PLL) in MRI.The courses of herniations:18 had a median penetration,15 had a paramedian one,4 had a lateral penetration,and 4 shift to inferior part,1 shift to upper side。Operation time:50—315(78.7±25.1) minutes, blood loss:10—20038±27.4) ml.All the cases were followed up.Followed up from 4—61(17±4.6)months.JOA score:pre-operationg 3-16(9±2.7)12 months after operation 9-17(14±2.1)The spinal cord neurologic function recovery rate of posterior longitudinal ligament resection group was 53.3%—100%(78.5±14.7%) Conclusion:ECDH has a significant incidence in the cervical disc herniation, so we should treat it seriously.If in MRI,the extrusion occupied more than 50%of the vertebral canal,the black line of posterior longitudinal ligament was found focal interruption,and in operation PLL had been found penetrated,we can make a diagnosis of Extruded cervical disc herniation.The satisfying result can be obtained by undergoing anterior cervical decompressin,incising the posterior longitudinal ligament and removing the extruded nucleus pulposus...