Introduction: High cervical disc disease(hcdd i.e.C2-3 and C3-4 pivd ) is a relatively rare entity with incidence of about 6.3 % of the total cases of degenerative cervical disc disease 4.There is a paucity of literature regarding etiology , clinical course and radiological features of hcdd. The aim of this study to establish predisposing factors,describe clinical course and radiological parameters associated with hcdd.
Methods: Thirty seven patients of C3-4 pivd were compared with 45 patients of C5-6 pivd. Nurick`s grade was used for clinical assessment. Radiological parameters like congenital and osteoarthritic changes at cvj along with measurement of stress levels in flexion extension x-rays was done.
Results: Mean age of C3-4 pivd patients was significantly higher than C5-6 pivd patients (p < 0.001). Cvj pathology was seen in significantly higher proportion in patients with C3-4 pivd (18 / 37) in comparison to C5-6 pivd (4 / 45) (p < 0.001).
Mean preop Nurick`s grade in C3-4 and C5-6 pivd group is 4.03 and 2.98 respectively
(p < 0.001).T2 hyperintense intramedullary signal changes was seen in 91.8% (34/ 37)of C3-4 pivd cases as compared to 66.67 % (30 / 45) of C5-6 pivd cases (p < 0.001). The presence of preop T2 hyperintense intramedullary signal changes was seen in 90.3% (28 / 31) patients with a poor post-op Nurick`s grade (p = 0.004).
Conclusions: Cvj pathology is a predisposing factor for hcdd. Hcdd presents in a poorer Nurick`s grade compared to Lower cervical pivd and majority of the patients have T2 hyperintense intramedullary signal changes in MRI. Presence of T2 hyperintense intramedullary signal changes is associated with poorer pre-op clinical status and poorer post-op outcome.
Patient Care: It describes clinical and radiological parameters which help prognosticate outcome following surgery.It also hypothesizes the possible role of craniovertebral junction pathology in high cervical disc disease
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of cord signal changes on outcome in disc disease, 2)Describe the clinical differences between the patients with high and low cervical disc prolapse, 3) Describe the role of craniovertebral junction pathology in high cervical disc disease