Acute nontraumatic cervical disk herniation with incomplete tetraplegia. A case report and review of literature

Siam, Ahmed Ezzat; Gouda-Mohamed, Gouda-Mohamed; Werle, Stephan; Boehm, Heinrich

doi:10.1007/s12570-013-0182-6

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…Kato et al reported a case of acute paraplegia during an MRI examination, in a patient with pre-existing spondylosis 13. Siam et al reported a case in which pre-existing cervical spondylosis together with the rapid and momentary rise of the intradiscal pressure secondary to excessive neck movement on bending forward lead to disk rupture at C5–6 that caused immediate severe compression of the spinal cord 8. This mechanism was observed to be identical to the case reported by Liu et al , although symptoms like weakness were apparent after 2 hours in their case 14.…”

Section: Discussionmentioning

confidence: 99%

Delayed spinal cord infarction following anterior cervical surgical decompression

Khan¹,

Jooma

Hashmi

et al. 2017

BMJ Case Reports

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Anterior cervical discectomy and fusion (ACDF) for cord compression is a safe and effective procedure with good outcomes. However, worsening of myelopathy is the most feared adverse event of the surgery. We report the case of a 36-year-old male patient who presented with an acute non-traumatic C5-6 cervical disc herniation causing incomplete quadriparesis. He underwent an uncomplicated ACDF at C5-6, and after an initial period of improvement, he developed a delayed onset of an anterior cord syndrome on day 3, without any discerning cause. We have reviewed similar cases reported in the literature and believe that our patient's postsurgical course is consistent with a delayed ischaemic/reperfusion injury to the cord following surgical decompression and restoration of blood flow through the anterior spinal artery and we make suggestions for management of such clinical events.

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Section: Discussionmentioning

confidence: 99%

Delayed spinal cord infarction following anterior cervical surgical decompression

Khan¹,

Jooma

Hashmi

et al. 2017

BMJ Case Reports

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“…Siam described a 48-year-old woman suffering from incomplete quadriparesis following a C5-C6 disk herniation. 2 The patient was operated within 6 hours following MRI scan and had good functional recovery.…”

Section: Discussionmentioning

confidence: 97%

Acute Cervical Disk Herniation Resulting in Sudden and Severe Neurologic Deterioration: A Case Series

Harel

Knoller

2016

Surg J

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Cervical disk disease usually causes cervical myelopathy or radiculopathy with a gradual stepwise neurologic deterioration. 1 Acute cervical disk herniation resulting in rapid onset neurologic deficit, unrelated to trauma or a neoplastic process, is rare. Acute cervical disk herniation as a cause for quadriparesis was described in seven case reports, 2-6 and additional two cases described in the Japanese literature were cited by Suzuki et al. 7 In addition, three cases of paraplegia caused by nontraumatic disk herniation 7-10 and five cases of Brown-Séquard syndrome were described. 11,12 We hypothesized that rapid diagnosis and treatment could improve the neurologic outcome of these patients. Raising the awareness of this diagnosis and enhancing the importance of magnetic resonance imaging (MRI) availability in emergent settings was our main objective.We report presenting symptoms, treatment, and outcomes of patients with acute cervical disk herniation causing acute neurologic deteriorations treated in our medical center. Keywords► acute cervical herniated disk ► acute neurologic deterioration ► Brown-Séquard syndrome ► cervical myelopathy ► anterior cervical approach AbstractObjective Nontraumatic acute cervical disk herniation resulting in acute severe neurologic deficit is a rare entity described in a limited number of case reports. We describe the management and outcome in patients presenting with severe neurologic deterioration caused by acutely herniated cervical disks. Methods Four patients (mean age 39.5 years) presented to our tertiary care academic medical center from September 2012 to September 2013 with severe progressive neurologic deficits due to cervical disk herniation and were included in the series. Patients' surgical, medical, and imaging records were retrospectively reviewed under an Institutional Review Board waiver of informed consent.Results Patients in the series presented with acute neurologic deterioration, including paraparesis, Brown-Séquard syndrome, or quadriparesis deteriorating to quadriplegia. Emergent magnetic resonance imaging (MRI) scans and emergent decompression and fusion for acute soft disk herniation were performed in all cases. All patients recovered to excellent functional status with Frankel score improvement from B (one patient)/C (three patients) to E (three patients)/D (one patient).Conclusions Acute cervical disk herniation with acute neurologic deterioration is a medical emergency necessitating emergent MRI and surgical decompression. Clinical presentation varies. In patients with rapid-onset neurologic deterioration, a high level of suspicion for this rare entity is indicated.

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Transient monoparesis due to acute cervical radiculopathy after lumbar spine surgery: a case report and review of literature

Siam

Boehm

Saghir

et al. 2013

Eur Orthop Traumatol

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Acute nontraumatic cervical disk herniation with incomplete tetraplegia. A case report and review of literature

Cited by 4 publications

References 19 publications

Delayed spinal cord infarction following anterior cervical surgical decompression

Delayed spinal cord infarction following anterior cervical surgical decompression

Acute Cervical Disk Herniation Resulting in Sudden and Severe Neurologic Deterioration: A Case Series

Transient monoparesis due to acute cervical radiculopathy after lumbar spine surgery: a case report and review of literature

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