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Abstract: The patient had been suffocating in the back of the neck for more than 10 years, and in the past 1 month, he had pain and numbness in the right plantar area. He went to a Chinese medicine hospital for conservative treatment, massage and traction as in the past, but his symptoms were not significantly relieved, so he consulted our hospital. Cervical spine MRI showed: multi-segment cervical disc herniation. After the posterior cervical spine single-opening spinal canal enlargement and internal fixation with bone graft fusion, the symptoms of suffocation in the back of the neck and right plantar discomfort were significantly relieved.
Basic information】Female, 56 years old
Disease Type】Cervical disc herniation
Hospital】Shanxi Provincial People’s Hospital
Date of Consultation】October 2021
Treatment plan】Surgical treatment (cervical posterior single-opening spinal canal enlargement and internal fixation with bone graft fusion) + medication (parecoxib sodium for injection, sodium chloride injection, glucose injection, cefuroxime sodium for injection, eperisone hydrochloride tablets)
[Treatment period] 15 days of hospitalization and regular review
【Treatment effect】Patients can walk properly on the ground 3 days after surgery
I. Initial consultation
The patient was accompanied by his family to the hospital and reported that he had been suffering from suffocation at the back of the neck for more than 10 years, and in the last month he had pain and numbness in the right sole of the foot, without the feeling of lumbar girdling or stepping on cotton. In the Chinese hospital rehabilitation physiotherapy for nearly 20 days, the symptoms were not significantly relieved. The muscle strength of the extremities was normal, muscle tone was not high, the Hoffmann sign of both upper extremities was positive, and the Babinskin sign of both lower extremities was negative. The patient was considered more likely to have cervical spine disease, but the possibility of lumbar spine disorders could not be ruled out, so the patient was advised to undergo cervical spine MRI + lumbar spine MRI, and the MRI results showed cervical spine multi-segmental disc protrusion and compression of the posterior spinal cord; the lumbar spine results were not significantly abnormal. At this point, the patient was diagnosed with “cervical disc herniation”. The patient was asked to go through the admission procedure.
(Preoperative MRI film)
II. Treatment process
After the diagnosis was clear, the patient and his family were informed of his condition: the patient’s cervical discs were herniated in multiple segments and were compressing the spinal cord and nerve roots backward, which was the reason why the patient felt trapped in the back of the neck. The location of the cervical spinal cord is relatively high, and sensory transmission from the lower extremities to the cerebral cortex must pass through the cervical spinal cord. Part of the spinal cord is compressed, resulting in partial obstruction of sensory afferents, and thus the patient has abnormal sensation in the right plantar area and pain and numbness. Bed rest, traction, infusion, and massage cannot bring the disc back into place. At most, the muscles at the back of the neck are loosened to temporarily relieve the symptoms, but the symptoms will soon reappear. In addition, the shorter the nerve compression in the spinal cord, the easier it is to recover the nerve after lifting the compression, and the longer the compression, the longer the nerve recovery time will be, or even cannot be, even after lifting the disc as an oppressor. Therefore, the patient was advised to undergo surgery. The patient and his family decided to have early surgery after repeated consideration.
After completing the relevant tests, the patient underwent posterior cervical single-opening spinal canal enlargement and internal fixation with bone graft fusion on the fifth day of admission (to enlarge the spinal canal and give enough space for the spinal cord). After the cervical spine surgery, medications such as pain relief (parecoxib sodium for injection), rehydration (sodium chloride injection, glucose injection) and infection prevention (cefuroxime sodium for injection) were given. On the second day, the patient complained of neck pain, and an additional muscle relaxation-cum-pain relief drug (ethylprednisolone hydrochloride tablets) was added.
(Postoperative X-ray)
III. Treatment effect
On the 3rd postoperative day, the patient complained of significant reduction of suffocation in the posterior cervical region, and the caudal end of the percussion hammer crossed the bilateral plantar, and the patient felt that the plantar pain and numbness were also reduced. The cervical spine positive and lateral radiographs showed that the position of internal cervical spine fixation was satisfactory, after which the patient put on a cervical brace and walked on the ground with the assistance of his family, and during walking, the patient felt that the right plantar was much easier than before the operation. After 15 days of hospitalization, the patient’s wound was dry, with no signs of infection such as redness, swelling and exudation, and the blood test infection index was normal.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but we need to pay attention to the following matters in daily life.
1, the first 3 months after cervical spine surgery should be mainly bed rest, and you can get down to the ground appropriately. However, due to the posterior cervical single-opening surgery, the strength of the neck muscles is weaker than before surgery, and the hinge side of the vertebral plate needs fusion time, so it is necessary to wear a neck brace for downward activities. Wearing time is generally 6 weeks, and after 6 weeks, find your own primary surgeon to review to see if the position of the internal fixation has shifted after cervical spine surgery.
2. Frequent movement of the extremities is required during bed rest, especially flexion and extension of both lower extremities to prevent blood clots and bed rest complications. Bed turning, it is recommended that axial turning, i.e. head, neck, trunk and lower limbs are turned in a straight line as a whole.
3. During the discharge period, focus on whether the alleviated symptoms are aggravated again or new uncomfortable symptoms appear, such as numbness and weakening of muscle strength, if any of the above, you need to come to the hospital promptly.
V. Personal insight
Cervical disc herniation is a common disease in today’s society, and it is a common occurrence, and working with low head, studying and looking down at the cell phone are all triggering factors. For mild cervical disc herniation, patients can often improve through rehabilitation physiotherapy and lifestyle changes (avoiding long-term head down). However, for people with severe cervical disc herniation, who already have symptoms such as numbness, inflexibility, and radiating pain in the upper limbs, such as this patient, they should come to the hospital promptly.