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Cervical intradural disc herniation: A systematic review
Insights
Cervical intradural disc herniation (CIDH) is rare but challenging to diagnose. Surgical intervention is effective for CIDH, offering definitive diagnosis and improved neurological function with a low risk of cerebrospinal fluid leakage.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Radiology
Background:
- Cervical intradural disc herniation (CIDH) is a rare condition with diagnostic and therapeutic challenges.
- This systematic review and meta-analysis addresses the complexities of CIDH.
Purpose of the Study:
- To systematically review and analyze the literature on the diagnosis and treatment of cervical intradural disc herniation (CIDH).
- To identify key diagnostic indicators, common presentations, and effective management strategies for CIDH.
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Inclusion of English-language studies and case reports from inception to 2017.
- Extraction of data on presentation, imaging, diagnosis, management, outcomes, and pathogenesis.
Main Results:
- 23 patients from 20 articles were analyzed; lower cervical spine (C5-C6, C6-C7) most affected.
- Spontaneous herniation (61%) and cervical trauma (39%) were noted. Brown-Sequard's syndrome (56.5%) and quadriparesis (34.8%) were common.
- MRI with "halo" and "Y-sign" were key indicators; 87% diagnosed intraoperatively. Surgery improved outcomes, with low CSF leakage rates after dural tear repair.
Conclusions:
- CIDH predominantly affects the lower cervical spine, often occurring spontaneously.
- Diagnosis is challenging; surgery is effective for treatment and definitive diagnosis.
- Meticulous surgical repair of dural tears minimizes postoperative cerebrospinal fluid leakage.
Background:
Cervical intradural disc herniation (CIDH) is rare, and diagnosis and treatment are challenging. We conducted a systematic review and meta-analysis of the literature on the diagnosis and treatment of CIDH.
Method:
The presentation, imaging manifestations, diagnosis, management, prognosis and possible pathogenesis were reviewed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English-language studies and case reports published from inception to 2017 were retrieved. Data on presentation, imaging characteristics, diagnosis, management, outcomes and pathogenesis were extracted.
Results:
Twenty articles involving 23 patients were selected. The most common involved level was C5-6 (43.5%), followed by C6-7 (30.4%), C4-5 (13%), and C3-4 (13%). Spontaneous IDH occurred in 61% of the patients, and relevant cervical trauma was present in 39%. Brown-Sequard's syndrome (56.5%), quadriparesis (34.8%), and radiculopathy (8.7%) were the main presentations. Magnetic resonance imaging (MRI) was the most commonly used diagnostic technique, and the "halo" and "Y-sign" were strong indicators of CIDH. Three (13%) patients were diagnosed as having CIDH preoperatively, and 87% were confirmed intraoperatively. All patients underwent surgical intervention primarily (73.9%) through an anterior approach. Neurological function improved postoperatively in all patients but one. Dural and arachnoid mater tears were managed by direct suture or covering with a substitute, and only one patient sustained cerebrospinal fluid (CSF) leakage after surgery.
Conclusion:
IDH mostly involves the lower cervical spine. More than half of the patients had spontaneous CIDH, and some had a relevant cervical trauma history. BSS was the main presentation. It is difficult to diagnose CIDH depending on clinical presentations and radiographic findings. Surgery was an effective treatment for CIDH and can provide a definitive diagnosis. With meticulous management of dural and arachnoid tears, the postoperative incidence of CSF leakage was found to be low.
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