(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: Cervical disc herniation is a common clinical type of disc herniation. The patient of this film case is a female, 51 years old, with right-sided limb weakness for 1 year. After six months of conservative treatment, her symptoms worsened and she developed unsteadiness in walking, so she came to our hospital and was clearly diagnosed with cervical disc herniation after examination, suggesting spinal cord compression. She was treated with posterior decompression surgery and took ibuprofen extended-release capsules, diclofenac sodium extended-release tablets and methylcobalamin tablets for 2 weeks after the surgery, and returned to the hospital for a review after 1 month.
Basic information】Female, 51 years old
Disease Type】Intervertebral disc herniation (cervical disc herniation)
Hospital】The First Hospital of China Medical University
Date of consultation】August 2020
Treatment plan】Surgery (posterior decompression surgery) + medication (ibuprofen extended-release capsules, diclofenac sodium extended-release tablets, methylcobalamin tablets)
Treatment period】Inpatient treatment for 2 weeks, return to hospital for review after 1 month
Treatment effect] Symptoms improved, limb muscle strength returned to normal
I. Initial consultation
One year ago, the patient developed right-sided limb weakness without any obvious cause, and was seen in an outside hospital. Recently, the conservative treatment was not effective, and the weakness of the right limb worsened and unstable walking occurred. The specialist examination showed that the limbs were movable, the muscle strength of the limbs was reduced by about 4 levels, the sensation was mildly decreased, the hoffman sign was positive bilaterally, the tendon reflex was hyperactive, the meningeal stimulation sign was negative, and the Babinski sign was positive. MRI scan of the cervical spine showed cervical degeneration; C3/4, C4/5, C5/6, C6/7 disc herniation and spinal stenosis at C5/6 and C6/7 levels; abnormal signal in the spinal cord at C5/6 level, consistent with degenerative MRI; abnormal signal in the spinal canal at the posterior edge of C7 vertebrae in the scan field; slight hypertrophy of the yellow ligament at C5/6 and C6/7 levels; abnormal signal in the bone of T3 vertebrae in the scan field. The preliminary diagnosis was: cervical disc herniation, and the patient was admitted to hospital for treatment.
II. Treatment history
The patient’s MRI scan of the cervical spine showed posterior protrusion of the discs at C3/4, C4/5, C5/6, and C6/7, and compression of the dural sac; patchy long T2 abnormal signal was seen in the spinal cord at C5/6 level, and STIR showed high signal, suggesting that the patient’s spinal cord was compressed. We communicated with the patient and his family to explain the necessity of surgery and obtained their consent to proceed with the treatment. The lesion was excised under general anesthesia and bone graft was placed to effectively relieve the spinal cord compression and enhance the stability of the cervical spine. After 4 weeks of surgery, the patient was advised to brake the cervical spine, take ibuprofen extended-release capsules and diclofenac sodium extended-release tablets for anti-inflammatory and analgesic treatment, and use methylcobalamin tablets for repairing damaged nerves. 2 weeks later, the patient’s condition progressed well, and was discharged from the hospital for convalescence and returned for review after 1 month.
III. Treatment effect
The patient’s muscle strength of the limbs gradually increased after 4 weeks of strict postoperative neck braking and 2 weeks of taking ibuprofen extended-release capsules, diclofenac sodium extended-release tablets and methocobalamin tablets. One month after discharge, the patient returned to the hospital for a follow-up examination. The wound at the surgical site was healing well, and he complained that the muscle strength of the right limb was significantly stronger than before surgery, and his gait was stable when walking. On repeat specialist examination, the muscle strength of the limbs was grade 5, and Babinski’s sign was negative. On repeat MRI, the C3/4, C4/5, C5/6, and C6/7 discs returned to normal position, and the signal in the spinal cord at the C5/6 level was normal, and the patient made good progress in recovery. The patient was instructed to adhere to the rehabilitation exercise and return to the hospital for timely review if there were any abnormal symptoms such as limb weakness or numbness during the period.
IV. Notes
After the patient’s condition improved, I was also happy for him. In order for the patient to get a better recovery, I did not forget to emphasize that the following points should be noted in life after surgery.
1. pay attention to a balanced diet, especially calcium and protein supplementation, you can eat more eggs, beef, fish and other foods, which will promote the recovery of the disease.
2.Strengthen the protection of the neck after surgery, the action should be gentle during the braking period, and it is recommended that family members accompany around when getting out of bed to avoid accidental injuries such as falls and slips due to poor muscle strength in the early postoperative period.
3. Pay attention to rest, establish good doing habits, ensure sufficient sleep, and avoid staying up late and overworking.
V. Personal insight
Cervical disc herniation occurs in the middle-aged and elderly population, it is recommended that such people have a routine physical examination every six months, which can detect the disease in time. For this disease, the prognosis is good for the lighter ones through conservative treatment, while the heavier ones require surgery, and early intervention can improve the quality of life of patients and reduce the pain caused by the disease. In this case patient, the symptoms of limb weakness appeared for 1 year, and after half a year of conservative treatment, the symptoms worsened to the point of unstable walking, and the disease progressed slightly at the time of diagnosis, which would have been largely improved by early detection and early treatment.