Conservative Treatment of Cervical Discs without Myelopathy: A Three Years Follow-up

Abstract Background: The natural course of disc prolapsed in the cervical region is not fully known, and clear indications for operative intervention apart from obvious weakness or radio-logical evidence of cord injury, cannot be established from the literature. Several works and reviews had demonstrated that most massive lumbar disc prolapse are the most likely to resolve, and still no enough studies about prolapsed cervical discs. Aim of Study: This study was designed to determine whether large lateral cervical prolapsed discs without mye-lopathy can be safely managed conservatively leading to clinical & radiological improvement. Patients and Methods: We prospectively collected the data from 48 patients followed at outpatient clinic in Cairo University and Bani-Souf University Department of Neuro-surgery from period from march 2011 to March 2014 during this period all cases undergo clinical assessments, magnetic resonance imaging (MRI) and received intermittent medical treatment. Selected patients had severe brachialgia at first presentation but began to show clinical improvement despite the one side disc migration evident on initial imaging. The Karnofsky Scale was used to measure function and changes in performance. Results: Initial follow-up at three and six months showed positive response in 44 patients (91.6%). Follow-up at a 12 months' average revealed that 42 patients (87.5%) had a complete and maintained recovery. Only 6 cases had unsatis-factory progress and need discectomy. The average scoring system to assess disability raised from 60% to 90%. The change that occurred in the volume of extruded disc material decreased of 50% in disc volume. There was no good associ-ation between medical improvement and the degree of disc regression. Conclusion: A large lateral disc material extrusion in the cervical vertebrae treated conservatively can pursue a favorable clinical course. If early improvement is shown, the far timed follow is excellent, and even substantial cervical disc prolapses can be dealt with non-surgically.