Conservative Treatment of Large Lateral Cervical Discs Without Myelopathy; A One Year Follow-Up

Abstract
Background: The natural history of cervical disc prolapse is not fully known and clear indications for operative inter-vention, apart from evident weakness or radiological evidence of cord injury, cannot be established from the literature.
Several studies have shown that the largest lumbar disc appear to have the greatest tendency to resolve but there are not enough studies about prolapsed cervical discs.
Aim of the Study: The aim of this study was to investigate whether large lateral cervical prolapsed discs without mye-lopathy can be safely managed conservatively leading to clinical & radiological improvement.
Patients and Methods: Twenty-four patients were studied by clinical assessments and magnetic resonance imaging (MRI) over the period of one year through which they received intermittent medical treatment (tizanidine, celecoxib, prega-balin).
All patients had severe brachialgia at first presentation, but began to show clinical improvement despite the large lateral disc herniations evident on initial imaging. Clinical assessment was done by neurological appraisal. The karnofsky performance Scale was used to measure function and changes in function. Repeat MRI studies every six months allowed measurement of volume changes of the herniated disc material.
Results: Initial follow up at three and six months showed positive response in twenty two patients (91.6%). Follow-up at an average of 12 months revealed that twenty-one patient (87.5%) had a complete and sustained recovery. Only threep-atients had unsatisfactory progress and required discectomy. The average karnofsky performance score improved from 60% to 90%.
Volumetric analysis of serial MRI scansfound an average reduction of 50% in disc size. There was poor correlation between clinical improvement and the extent of disc resolution.
Conclusion: A large lateral cervical disc herniation treat-edconservatively can pursue a favorable clinical course. If early progress is shown, the long-term prognosis is very good and even large disc herniations can be treated conservatively.