Restoration of the degenerated cervical intervertebral space: how much should we distract? A magnetic resonance imaging study.

The aim of the study was to quantify normal cervical disc space measurements and to generate a normal values' database. Furthermore, during operative restoration of a degenerated intervertebral disc, it is difficult to calculate the amount of distraction required to restore the collapsed space to its normal height. A secondary purpose is personalizing the anatomical correction. Therefore, we expressed disc height based on measurements of its neighboring disc as an equation, by using simple linear regression. We reviewed MRI studies from asymptomatic healthy subjects (16 men-24 women, mean age 27.25 years). We measured midsagittal anterior, middle and posterior vertebral body and disc height, and disc diameter from C3 to T1 vertebra. We calculated mean disc height, disc height index (DHI) and disc convexity index per spinal level. C6-7 mean and anterior disc height were significantly greater than all respective measurements, except C5-6 (p<0.01). Middle C6-7-disc height was significantly greater compared to respective measurements in every other level (p<0.01). C5-6, C6-7 and C7-T1 mean disc height is significantly greater in men. Middle disc height is the greatest among disc heights in every spinal level. DHI does not differ between sexes, it increases from C3-4 to C5-6 with a slight decrease in C6-7, while its value significantly decreases in C7-T1 (p<0.0001). These measurements could be used for anatomical, individualized restoration of the degenerated intervertebral disc; thus, avoiding overdistraction. Our data could improve preoperative templating or implant design.

Symptomatic cervical perineural (Tarlov) cyst: a case report.

BACKGROUND: Perineural (Tarlov) cysts are benign, usually asymptomatic, cerebrospinal fluid filled cysts of the spine, most often found in the sacral region. DESCRIPTION OF CASE: We report a Tarlov cyst, located in the cervical spine, in a 44-year-old woman who presented with a 3-week history of radicular symptoms of the right C6 root. The perineural cyst was identified at the C5-C6 level following magnetic resonance imaging of the cervical spine. A conservative approach was chosen, with the use of a soft cervical collar for two weeks, a 15-day-course of oral non-steroidal anti-inflammatory medication and instructions concerning limitation of her activities. The outcome of this approach was 90% improvement of her symptoms 24 months after her diagnosis. CONCLUSION: This is the first report of a cervical Tarlov cyst treated conservatively without the use of oral or injected steroids. The perineural cyst should be included in the differential diagnosis of patients presenting with radicular symptoms. Hippokratia 2015, 19 (1): 76-77.