Early presentation of traumatic cervical disc herniation with neurologic deficit and without an adjacent bone lesion.

AIM OF THE STUDY: The purpose of this study was to explore clinical features and the operational opportunity of traumatic cervical disc herniation. METHOD: Patients with cervical spine injury (413) were retrospectively reviewed. Six patients with neurological deficits were identified to have disc herniation without adjacent bone lesion. The diagnosis was confirmed by MRI. The Japanese Orthopedic Association (JOA) score was used to assess the severity of clinical symptoms. Different grading systems have been used in analyzing various stages of herniated cervical discs. All patients underwent anterior cervical decompression, insertion of autologous iliac crest graft, and fixation with cervical plate. RESULTS: The causes of injury were road traffic accidents in four patients and sport and domestic accidents in one patient each. There were five patients with single intervertebral disc herniation and one patient with double. Pre-operative JOA score was 14 for three patients, the remaining three patients scored 10, 6, and 3 respectively. At final follow-up, the score was 17 for four patients and 14 for two patients. DISCUSSION: Traumatic cervical disc herniation with neurologic deficit and without adjacent bone lesion is a rare condition. MRI is the golden examination to confirm diagnosis. Early recognition is essential for appropriate therapy and to minimize the extent of neurological deficit. CONCLUSION: The MRI is mandatory in diagnosing different types of traumatic herniated cervical disc. Discectomy and anterior cervical interbody fusion using autologous iliac crest graft are the treatment options.

[Fracture-separation of the medial clavicular epiphysis: about 6 cases and review of the literature]. / Fracture-décollement de l'épiphyse médiale de la clavicule: à propos de 6 cas et revue de la littérature.

This study aims to describe the epidemiological characteristics and the different anatomo-clinical entities of the fracture-separation of the medial clavicular epiphysis but also to relate the morphological and functional results of bloody reduction followed by osteosuture using non absorbable thread. Five boys and one girl (mean age 14 years) showed a closed and isolated shoulder girdle trauma. Clinical examination and medical imaging, especially CT scan, allowed the diagnosis of epiphyseal separation and to classify the degree of medial clavicular epiphysiseal ossification indicating the direction of displacement as well as the nature of displacement according to the Salter-Harris classification. Bloody reduction followed by osteosuture using non absorbable thread (No. 1 decimal) was performed in 3 patients. One patient underwent cross-pinning the two younger patients were treated orthopedically. The displacement of the clavicle stump was anterior in 3 patients and retro-sternal in 3 patients. Posterior forms were complicated by odynophagia (n = 2) and asymptomatic compression of the subclavian vein (n = 1). One of the posterior forms was associated with an ipsilateral fracture of the medial one third of the clavicle. Consolidation was achieved in all patients with preservation of shoulder mobility. The fracture-separation of the medial end of the clavicle mimes clinically and radiologically the sternoclavicular dislocation. It can be serious because of the risk of visceral and vascular compression in its posterior form. Tomdensitometry is irreplaceable for an accurate diagnosis. Our preference is for bloody reduction followed by osteosuture using non metallic thread.