To study the changes in degree of nerve compression on MRI in patients suffering from cervical disc herniation treated with cervical traction collar in combination with conservative treatment.
Trang 1THE CHANGES IN DEGREE OF NERVE COMPRESSION ON MAGNETIC RESONANCE IMAGING IN PATIENTS SUFFERING FROM CERVICAL DISC HERNIATION TREATED WITH
CERVICAL TRACTION COLLAR IN COMBINATION WITH
CONSERVATIVE TREATMENT
Do Danh Thang 1 ; Nguyen Van Chuong 2 ; Nhu Dinh Son 2
SUMMARY
Objectives: To study the changes in degree of nerve compression on MRI in patients suffering from cervical disc herniation treated with cervical traction collar in combination with conservative treatment Subjects and methods: A prospective, cross-sectional study with control group was conducted on 99 patients, of which 54 patients enrolled in the study group and 45 patients in the control group Results:
- After 2 weeks of treatment: The average anteroposterior compression ratio increased (p = 0.003) while the average degree of compression decreased (p = 0.007) in comparison with pre-treatment There was no difference between treatment group and the control one after two weeks of treatment in terms of MRI results
- After 6 months of treatment: The degree of compression decreased, while Torg-ratio and anteroposterior increased compared to pre-treatment These changes were statistically significant, except for the change in SSI
Conclusion: The treatment of cervical disc herniation by cervical traction collar in combination with conservative treatment proved to be effective in decreasing the degree of nerve compression, which was shown by the results of MRI
* Keywords: Cervical disc herniation; Nerve compression; MRI; Cervical traction collar; Conservative treatment
INTRODUCTION
Spinal disc herniation is a fairly common
disease, with the most incident one is
lumbar disc herniation, followed by cervical
disc herniation [4, 6] Cervical spondylotic
myelopathy is a common degenerative
disease associated with spinal stenosis in
the elderly Spinal stenosis can be caused
by a variety of factors, including disc herniation or swelling, osteophytes and ossification of the posterior longitudinal ligament Those factors that compress the spinal cord can cause spinal cord ischemia, leading to changes in the histopathology
of the spinal cord [2] There are several
1 110 Military Hospital
2 103 Military Hospital
Corresponding author: Đỗ Danh Thắng (dodanhthang@gmail.com)
Date received: 20/07/2018
Date accepted: 20/09/2018
Trang 2methods of evaluating the degree of
spinal stenosis as well as disc herniation
[3], but MRI is currently the most common
diagnostic imaging method to accurately
measure spinal stenosis Not only does it
reveal the width and length of the spinal
canal, but it also demonstrates in details
the spinal cord, intervertebral disc,
osteophytes, and ligaments, which are
potential causes of spinal stenosis [1, 2]
Therefore, we conducted the study with
the aim: To study the changes in degree
of nerve compression on Magnetic
Resonance Imaging in patients suffering
from cervical disc herniation treated with
cervical traction collar in combination with
conservative treatment
SUBJECTS AND METHODS
1 Subjects
99 patients with cervical disc herniation
diagnosed by MRI were included These
patients were treated at 103 Military
Hospital from December 2012 to December
2015
* Selection criteria of patients with
cervical disc herniation:
- Clinical:
+ related-cervical spine syndrome
+ at least one of the syndromes:
Nerve root compression
Cervical cord compression
vertebrobasilar insufficiency
- Subclinical: MRI of cervical spine with
results of disc herniation
* Exclusion criteria:
- Patients had comorbidity between cervical disc herniation and other diseases
of the spinal cord including spondyloarthritis, Pott disease, tumors, infections, amyotrophic lateral sclerosis and disseminated sclerosis
- Patients had cervical spinal surgeries due to disc herniation and injuries
- Patients had peripheral neuropathy
- Patients had diabetes and alcoholism
- Patients under the age of 18 or over the age of 70
* Randomly divided the patients into two groups:
- Group I (54 patients): The treatment group, which was treated with cervical traction collar in combination with conservative treatment regimen
- Group II (45 patients): The control group, which was treated only with conservative treatment regimen
2 Method
- Stretching method: Use CS300 neck spine extension, 30 minutes on time and
3 times a day
- A cross-sectional descriptive study with comparative control group
- The MRI of cervical spine was performed on the system of MAGNETOM ESSENZA 1.5 TESLA; Siemens - Germany,
in the Department of Diagnostic Imaging,
103 Military Hospital
Trang 3- Indicators included:
Diameter of the vertebral body
+ Anteroposterior compression ratio (APCR):
APCR = Anteroposterior diameter of the cord x 100%
Transverse diameter of the cord + Segmental stenotic index:
SSI = The diameter of the narrowest spinal canal
The diameter of the widest spinal canal in the same vertebra + The degree of nerve compression had 4 levels and were called degree 1; degree 2; degree 3; degree 4 according to Nguyen Van Chuong
- Data was analysed by SPSS software version 20.0
RESULTS
Table 1: The MRI results of diameter (mm) of spinal canal and cord at the herniation
before the treatment
Indicators
Treatment group (n = 54) (X ± SD)
Control group (n = 45) (X ± SD) p
The diameter of the widest spinal
There was no difference between the treatment and control group in terms of the diameter of spinal canal and cord
Table 2: The degree of herniation according to each evaluation method
Indicators Treatment group (n = 54)
(X ± SD)
Control group (n = 45)
There was no difference between the treatment and control group in terms of the degree of herniation according to different methods of evaluation
Trang 4Table 3: The comparison of spinal stenosis after 2 weeks of the treatment group
between 2 study groups
Indicators Treatment group (n = 54)
(X ± SD)
Control group (n = 45)
There was no difference demonstrated by the MRI results between the treatment and control group after 2 weeks of treatment
Table 4: The comparison of MRI results on spinal stenosis of treatment group after 2
weeks of treatment
Indicators Before treatment (X ± SD) After 2 weeks (X ± SD) p
Degree of nerve compression
In the treatment group, after 2 weeks of treatment, the average APCR increased (p = 0.003) while the average degree of nerve compression decreased (p = 0.007)
Table 5: The comparison of MRI results on spinal stenosis of the treatment group
after 6 months of treatment
Indicators Before treatment
(X ± SD)
After 6 months
Degree of nerve compression
In the treatment group, after 6 months of treatment, the average degree of nerve compression decreased, while Torg-ratio and APCR increased All the changes were statistically significant, except for the SSI
Trang 5DISCUSSION
Previous studies have described a
number of methods of assessing the
degree of cervical spinal stenosis While
many studies in the past conducted X-ray
imaging method, the MRI has recently
become the most common diagnostic
imaging one to accurately measure the
spinal stenosis Not only does the MRI
reveal the width and length of the spinal
canal but it also demonstrates in details
the spinal cord, intervertebral disc,
osteophytes, and ligaments, which are
potential causes of spinal stenosis [5]
In this study, we assessed the degree
of nerve compression based on 4 indices:
- Torg-ratio: Based on two measures:
Sagittal diameter of spinal canal/diameter
of the vertebral body Our results indicated
that the Torg-ratio of the treatment group
before the treatment was 55.13 ± 14.23
while this figure for the control group was
58.02 ± 18.76 There was no difference
between these groups prior to the treatment
When looking at the association with
clinical characteristics, we found positive
and quite strong correlation between
the muscle strength score and Torg-ratio;
and negative and moderate correlation
between the cervical spine function score
and Torg-ratio
- APCR: Defined by the 2 diameters of
the cord (anteroposterior diameter/transverse
diameter) Our pre-treatment results
showed the APCR of the treatment and
control group was 38.70 ± 8.24 and
41.93 ± 8.46, respectively There was
no difference between the two groups
When looking at the association with clinical characteristics, we found negative and moderate correlation between the VAS score for pain and APCR (r = 0.39; p = 0.003); negative and moderate correlation between the cervical spinal function score and APCR; and positive and quite strong correlation between muscle strength score and APCR
- SSI: Defined by the ratio between two measures: The diameter of the narrowest and widest spinal canal in the same vertebra, which reflected the degree of spinal stenosis more accurately Our pre-treatment results showed the SSI of the treatment and control group was 75.33 ± 10.59 and 79.51 ± 11.54, respectively There was no difference between the two groups When looking at the association with clinical characteristics, we found negative and moderate correlation between the VAS score for pain and SSI; negative and moderate correlation between the cervical spine function score and SSI; and positive and moderate correlation between muscle strength score and SSI
Even though these three indicators were frequently used to assess the degree of spinal compression on MRI, each index had certain disadvantages:
- Torg-ratio: By using two measures (sagittal diameter of spinal canal/posterior diameter of the same vertebral body) Allow us to evaluate based on the posterior diameter (central disc herniation)
It is not suitable for those cases of median nerve root compression (lateral disc herniation) although this is the most common form of disc herniation
Trang 6- APCR is defined by the 2 diameters of
the cord (anteroposterior diameter/transverse
diameter) This index can be affected
mainly due to the intrinsic variability of
spinal cord (myeloma, syringomyelia,
myelitis, cord swelling, etc.) and many
other external factors (posterior longitudinal
ligament, vertebra, etc.) In addition, the
majority of disc herniation is lateral, thus
the intervertebral disc does not directly
compress the upper diameters of the
spinal cord Therefore, in the course of
follow-up, there exists a discrepancy
between clinical and subclinical remission
- SSI: is defined by the ratio between
two measures: The diameter of the
narrowest and widest spinal canal in the
same vertebra However, in several
cases, the narrowest part of spinal canal
is not caused by disc compression but
other factors such as: the swelling and
hyperplasia of vertebra and ligament
system, etc Thus, if this indicator is used,
its results are sometimes inaccurate
As a result, in this study, we further
determined the degree of nerve compression
proposed by Nguyen Van Chuong “The
degree of nerve compression” was
determined by the MRI cross-sectional
image of the vertebra, at the maximal
level of compression of the intervertebral
disc on the spinal cord “The degree of
nerve compression” had 4 levels, called
degree 1; degree 2; degree 3; degree 4
according to the number on the picture
The severity also increased in accordance
with the order of degree The results prior
to the treatment indicated that “the average degree of nerve compression” was 2.87 ± 0.80 in the treatment group and 2.84 ± 0.93 in the control group, which implied
no difference between these two groups However, in the comparative analysis, we found no association between several clinical characteristics and the degree of disc compression The MRI results after two weeks of treatment suggested that the average APCR increased (p = 0.003) while the average degree of compression decreased (p = 0.007) in comparison with the results before the treatment Nevertheless, there was no difference between the two groups after two weeks of treatment in terms of MRI results After six months of treatment, the Torg-ratio and APCR increased, while the degree of compression decreased compared to the results before the treatment These changes were statistically significant with p < 0.05 The SSI after two weeks and six months of treatment increased and it had no statistical significance
CONCLUSION
The treatment of cervical disc herniation
by cervical traction collar in combination with conservative treatment proved to be effective in decreasing the degree of nerve compression, which was shown by the results of MRI
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