Cervical disc herniation as a trigger for temporary cervical cord ischemia.
BACKGROUND
Disc herniations are only reported in few case reports as a rare cause of acute spinal ischemia. A surgical treatment has not been described so far in these reports with analysis of diffusion weighted magnetic resonance imaging (DWI/MRI) before and after surgery. The aim of our study is to report a case of cervical spinal cord ischemia caused by cervical disc herniation and discuss the literature concerning diagnostic and treatment options.


METHODS
A 72-year-old female patient developed an acute progressive tetraparesis with emphasis on the upper extremities. MRI showed a disc herniation at the cervical segment 5/6 (C5/6) with consecutive spinal canal stenosis and additional signs of spinal cord ischemia in T2-weighted imaging (T2WI) and DWI reaching from C3 to C5 level. With the MRI being highly suggestive for anterior spinal cord ischemia, we hypothesized that this might be caused by compression of the anterior spinal artery through the significant disc herniation. Therefore, we decided to perform an anterior discectomy and fusion at C5/6 level.


RESULTS
Following surgery, the patient's symptoms showed immediate regression with complete recovery after two months in correspondence with the normalization in the control MRI scan of cervical cord.


CONCLUSIONS
Assumedly our patient suffered from a partial anterior spinal artery syndrome, possibly caused by a disc herniation-related compression that was reversible following surgery. This was accompanied by a complete resolution of spinal cord signal abnormalities in T2WI and DWI.
Department of Neurosurgery and Center for Stroke research Berlin (CSB), Berlin, Germany.
Güliz
G
Acker
Department of Neurosurgery and Center for Stroke research Berlin (CSB), Berlin, Germany.
Ulf C
UC
Schneider
Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Zarko
Z
Grozdanovic
Department of Neurosurgery and Center for Stroke research Berlin (CSB), Berlin, Germany.
Peter
P
Vajkoczy
Department of Neurosurgery and Center for Stroke research Berlin (CSB), Berlin, Germany.
Johannes
J
Woitzik
Spinal cord ischemia; anterior cervical discectomy and fusion (ACDF); diffusion weighted imaging (DWI); disc herniation
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