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Abstract: The patient came to the hospital with self-perceived neck and shoulder pain, neck stiffness, and reduced muscle strength in the upper limbs 1 year prior to the consultation, and the symptoms had gradually worsened in the last 1 week. The cervical spine MRI confirmed a herniated cervical disc compressing the spinal nerve. In order to restore the function of the cervical spine and upper limbs, surgical removal of the herniated disc combined with internal fixation treatment was considered. After surgery, the cervical disc nerve compression was released, and the symptoms of neck and shoulder pain and neck stiffness were relieved.
Basic information】Male, 48 years old
Disease Type】Cervical disc herniation
Hospital】Harbin First Hospital
Date of consultation】January 2022
Treatment plan】Anterior cervical discectomy + intervertebral bone graft fusion titanium plate internal fixation + medication (mannitol injection + dexamethasone injection) + cervical brace external fixation protection + upper limb muscle strength training
Treatment period】7 days of hospitalization and review after six months
Effectiveness of treatment】Discectomy for nerve compression, relief of pain and weakness, recovery of cervical movement
I. Initial consultation
The patient used to have intermittent pain in the neck and shoulder, and the muscle strength of the upper limbs was weakened, and fine movements were not completed well. The nature of the patient’s work required long periods of low head ambulation, which caused degenerative changes in the cervical discs and therefore led to cervical disc herniation. After being admitted to the hospital, the MRI examination showed that the cervical disc herniation was compressing the spinal nerve, and it was considered that surgery was needed as soon as possible to restore the blood supply to the nerve and the nerve conduction function to avoid serious atrophy of the upper limb muscles. The patient had a detailed understanding before admission and agreed to the treatment plan.
II. Treatment process
The patient then underwent surgery, during which the anterior cervical decompression surgery was used to remove the damaged disc, and bone was taken from the iliac region and implanted between the vertebral bodies, while titanium plate screws were used for internal fixation and fusion treatment. The cervical ligament was also tensed and the intervertebral foramen was enlarged to further relieve and prevent compression of the spinal cord and nerve roots.
Care was taken to protect the surrounding blood vessels and the recurrent laryngeal nerve during the surgery to avoid serious injury. After surgery, drainage strips were placed at the cervical spine surgical site to avoid the formation of hematoma, and mannitol injection as well as dexamethasone injection were used for 5-7 days after surgery to reduce nerve edema, while external fixation of a cervical brace was given for protection.
III. Treatment effect
After 7 days of cervical spine surgery, the patient showed significant relief of pain symptoms and was able to actively elevate the joints of the upper limbs, and the numbness and radiating pain of the upper limbs had completely disappeared, suggesting that the nerve conduction function was gradually recovering. However, the upper limb muscles still had mild atrophy, so the patient should insist on upper limb muscle strength training after surgery, and can assist in resistance training with small dumbbells, elastic bands and other devices to gradually enhance the upper limb muscle strength and restore muscle strength. Six months later, the patient came to the hospital for a review, indicating that the symptoms had been completely relieved and the upper limbs had returned to normal levels.
IV. Notes
We are glad that the patient’s cervical disc herniation compressing the spinal nerve was controlled after the surgery, but after the discharge, the patient should be advised to wear the cervical brace external fixation continuously for 3 months for protection and review the cervical spine X-ray regularly to confirm the complete healing of the implant before removing the cervical brace external fixation. If there is a significant increase in body temperature or persistent pain at the cervical spine surgery site, it is necessary to follow up with the orthopedic clinic in time to exclude infection or loosening of the internal fixation. After successful implant fusion, patients should insist on cervical spine muscle exercise, such as cervical spine meter drill training, which not only enhances the strength of cervical spine muscles and improves the stability of cervical spine, but also should improve the flexibility of cervical spine, and avoid long-term low head work or playing with cell phone in life. Otherwise, other segments of the cervical disc can still appear to herniate and cause recurrence of symptoms by compressing the nerves.
V. Personal insight
The reason why cervical disc herniation develops to the surgical stage is usually that the patient does not pay enough attention to the disease in the early stage of the disease and does not pay attention to the maintenance of the cervical spine in life, so that the speed of degenerative changes in the cervical disc is significantly accelerated, such as the patient in this case, so that the symptoms can be improved after treatment. And even if conservative treatment was ever used, it failed to carry out systematic treatment and may rely only on a single conservative treatment, such as oral celecoxib capsules, which did not have the proper effect of conservative treatment. Therefore, in order to prevent the emergence of cervical disc herniation, bad living and working habits should be corrected in daily life, while strengthening neck muscle exercises.