Cervical disc herniation diagnosis [Neurosurgery Wiki]

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====== Cervical disc herniation diagnosis ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1F7_W1KYjb2XxwUjevivo-wPcKeLaF0R8G6sYcj1UVfUxCYQND/?limit=15&utm_campaign=pubmed-2&fc=20240222175717}}
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see [[Cervical radiculopathy diagnosis]].


===== Evaluation for myelopathy =====

[[Upper motor neuron]] findings usually in the lower extremities.

[[Weakness]] may occur without [[atrophy]] or [[fasciculation]]s.

Spasticity: Poor control of the legs when walking, scissoring of the legs.
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Sensation:

Any loss below the level of involvement will follow spinal cord patterns:

Complete loss

[[Brown Sequard]] pattern.

[[Central cord syndrome]].

Pathologic reflexes: [[Hoffmann's reflex]], [[Babinski sign]], [[ankle clonus]].

===== Magnetic resonance imaging =====

[[Cervical disc herniation Magnetic resonance imaging]].

===== Computed tomography =====

CT requires less time to perform than MRI and is considered superior to MRI for evaluation of disc containment (e.g., bone) 
((Douglas-Akinwande AC, Rydberg J, Shah MV, Phillips MD, Caldemeyer KS, Lurito JT, et al. Accuracy of contrast-enhanced MDCT and MRI for identifying the severity and cause of neural foraminal stenosis in cervical radiculopathy: a prospective study. AJR Am J Roentgenol. 2010;194:55–61.)).

[[Multidetector row computed tomography]] (MDCT) and MRI showed a moderate-to-substantial degree of inter-modality agreement for the assessment of herniated cervical discs. MDCT images have a tendency to underestimate the anterior/posterior extent of the herniated disc compared with MRI
((Yi JS, Cha JG, Han JK, Kim HJ. Imaging of Herniated Discs of the Cervical
Spine: Inter-Modality Differences between 64-Slice Multidetector CT and 1.5-T
MRI. Korean J Radiol. 2015 Jul-Aug;16(4):881-8. doi: 10.3348/kjr.2015.16.4.881.
Epub 2015 Jul 1. PubMed PMID: 26175589; PubMed Central PMCID: PMC4499554.
)).
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Additionally, contrast-enhanced CT 
((Douglas-Akinwande AC, Rydberg J, Shah MV, Phillips MD, Caldemeyer KS, Lurito JT, et al. Accuracy of contrast-enhanced MDCT and MRI for identifying the severity and cause of neural foraminal stenosis in cervical radiculopathy: a prospective study. AJR Am J Roentgenol. 2010;194:55–61.))
and CT myelography 
((Larsson EM, Holtås S, Cronqvist S, Brandt L. Comparison of myelography, CT myelography and magnetic resonance imaging in cervical spondylosis and disk herniation. Pre- and postoperative findings. Acta Radiol. 1989;30:233–239.))
remain useful imaging tools in the evaluation of cervical radiculopathy, but they carry the risk of anaphylactic reactions and nephrotoxicity with the use of iodinated contrast material.
===== Electrodiagnosis =====

see [[Electrodiagnosis of cervical radiculopathy]].