O Aριστοτέλης Π. Μήτσος, είναι Νευροχειρουργός εξειδικευμένος στις Αγγειακές παθήσεις του Εγκεφάλου και του Νωτιαίου Μυελού (ανευρύσματα, αγγειακές δυσπλασίες, όγκοι). Έχει εξειδικευθεί στο αντικείμενο αυτό στη Μεγ. Βρετανία κατέχοντας  τον τίτλο του Master of Science  του Πανεπιστημίου της Οξφόρδης στην Ενδοαγγειακή Νευροχειρουργική και Επεμβατική Νευροακτινολογία και είναι Διδάκτωρ του Πανεπιστημίου Αθηνών. Περισσότερα...

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Cervical Disc Disease

      The human spine is consisted of:

  • bone structures: the vertebrae 
  • inervertebral discs
  • muscles and ligaments

 

     Pic. 1

 

 

 

All the above structures support the central part of the human body and create the spinal canal, which includes the neural part of the spinal cord (pic.1). In each level of the cervical cord a pair of nerves is exiting innervating the corresponding areas of the upper extremities (pic.2).

 

                      Pic. 2

 

The daily activities put a substantial amount of axial and rotating stress on the intervertebral discs of the cervical segment, which normally is quite mobile, and in some cases may lead to premature  destruction of the disc material, loosing its elasticity and absorption ability during normal movements (pic.3).

 

  Pic. 3

This process may further deteriorate after minor daily trauma (i.e. malposition of the cervical spine during sleep) or major trauma events (i.e. a car accident). The clinical results of such events maybe axial cervical pain and muscle spasm as well as lower threshold of symptoms  in the same activities.

Further destruction will lead in cervical intervertebral disc protrusion, putting pressure on the nearby neural elements i.e. the cervical segment of the spinal cord (Pic. 4).

      

 Pic. 4

A frequently used term «cervical syndrome» is totally unacceptable, as it does not describe any kind of «syndrome» but an eterogenic group of diseases of the cervical part of the spinal cord with a common presentation of signs and symptoms from this body area.

The important role of the involved physcian is the identification of the exact cause of the signs and symptoms and not only the temporary release of the using symptomatic drugs. Cervical disc disease is one of those pathologies deserving early diagnosis and treatment.

The two most important diagnostic tests in the evaluation of the cervical disc disease are the plain x-rays and the MRI of the cervical spine (Pic. 5), which in combination with the clinical signs and symptoms will delinate the pathology and dictate the appropriate treatment.

It is of particular importance to mention that the neural structures in this area - especially the cervical cord and nerves - are particularly vulnerable with serious neurological consequences (Pic. 5).

 

 

             

       Pic. 5: Cervical MRI  showing a lateral and a central (arrow) disc protrusion

 

Conservative Treatment

 

  • cervical collar
  • antinflammatory and muscle relaxation drugs
  • modification of body posture and daily activities

 

    

      Surgical Treatment

The indications of surgical treatment are:

ü  established neurological signs

ü    failure of the conservative treatment

ü    recurrence of symptoms after successful

conservative treatment

ü    extremely huge disc protrusion putting at risk the

           nearby neural structures

 

The commonest surgical procedure for cervical disc disease is discectomy and fusion. Unbder general anaesthesia, a small 4cm superficial incision is made in the lateral neck area (Pic. 6) and using the neurosurgical microscope, we approach the anterior part of the cervical spine, evacuating all the disc material and the osteophytes and opening also the posterior longitudinal ligament to decompress completely the spinal cord and nerves bilaterally (Pic. 7)

      

               

                         Pic. 6                                                        Pic. 7

 

Following this decompression, a specially designed cage with the approprpiate dimensions togethet with bone allograft is positioned in the evacuated intervertebral space to facilitate bone fusion (Pic. 8).

       Pic. 8

              

The above described operation lasts about two hours  and needs two days hospitalization. Postoperatively, the patient is mobilized immediately and return to his daily activities wering a cervical collar for 2-4 weeks.

.

 

 

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