Cervikalt diskusprolaps
Sist revidert:
Sist revidert av:Terje Johannessen
Definisjon:
Et cervikalt discusprolaps er et utposning av nucleus pulposus gjennom et brudd i annulus fibrosus i en mellomvirvelskive i nakken
Forekomst:
Årlig insidens er ca. 60-100 per 100.000. Forekomst øker med alderen. Ca 90% av alle prolaps forekommer i nivå C6 eller C7
Symptomer:
Kan komme akutt eller snikende over lengre tid. Nakkesmerter, radikulære smerter, ev. relasjon til hodebevegelser
Funn:
Nedsatt bevegelighet i nakken, funksjonstesting utløser smerter, radikulære utfall relatert til hvilken rot som er affisert
Diagnostikk:
MR er den foretrukne undersøkelsen
Behandling:
Konservativ for de fleste. Ev. operativ behandling er artroplastikk eller dekompresjon + fusjon
- Nasjonal kompetansetjeneste for kirurgisk behandling av rygg- og nakkesykdommer - nettside
- Kothari MJ. Clinical features and diagnosis of cervical radiculopathy. UpToDate, last updated Apr 25, 2022. UpToDate
- Childress MA, Becker BA. Nonoperative management of cervikal radiculopathy. Am Fam Physician. 2016 May 1;93(9):746-754. PMID: 27175952 PubMed
- Bono CM, Ghiselli G, Gilbert TJ, et al.; North American Spine Society. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J. 2011;11(1):64–72.
- Spurling RG, Scoville WB. Lateral rupture of the cervical intervertebral discs: a common cause of shoulder and arm pain. Surg Gynecol Obstet 1944; 78: 350-8. PubMed
- Nasjonal faglig retningslinje for bildediagnostikk ved ikke-traumatiske muskel- og skjelettlidelser. Anbefalinger for primærhelsetjenesten. Oslo, Helsedirektoratet 2014 www.helsedirektoratet.no
- American College of Radiology. ACR Appropriateness Criteria: chronic neck pain. National Guideline Clearinghouse. Available at http://guideline.gov/summary/summary.aspx?doc_id=8297. Accessed: March 24, 2009.
- Malanga GA. Cervical radiculopathy. Medscape, last updated Oct 08, 2018. emedicine.medscape.com
- Bussiéres AE, Taylor JA, Peterson C. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults—an evidence-based approach—part 3: spinal disorders. J Manipulative Physiol Ther 2008; 31: 33-88. PubMed
- Graham N, Gross A, Goldsmith CH, et al. Mechanical traction for neck pain with or without radiculopathy. Cochrane Database Syst Rev. 2008;(3):CD006408. Cochrane (DOI)
- Kuijper B, Trans JTJ, Beelen A, et al. Cervical collar or physiotherapy versus wait abd see policy for recent onset cervical radiculopathi: randomised trial. BMJ 2009; 339: b3883. BMJ (DOI)
- Coxib and traditional NSAID Trialists' (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 2013; 382(9894): 769-79. DOI: http://dx.doi.org/10.1016/S0140-6736(13)60900-9
- Ghasemi M, Masaeli A, Rezvani M, Shaygannejad V, Golabchi K, Norouzi R. Oral prednisolone in the treatment of cervical radiculopathy: a randomized placebo controlled trial. J Res Med Sci. 2013;18(suppl 1):S43–S46.
- Anderberg L, Annertz M, Persson L, Brandt L, Säveland H. Transforaminal steroid injections for the treatment of cervical radiculopathy: a prospective and randomised study. Eur Spine J 2007; 16: 321-8. PubMed
- Cohen SP, Hayek S, Semenov Y, et al. Epidural Steroid Injections, Conservative Treatment, or Combination Treatment for Cervical Radicular Pain: A Multicenter, Randomized, Comparative-effectiveness Study. Anesthesiology. 2014 Nov;121(5):1045-55. PubMed
- Bhatia A, Flamer D, Shah PS. Perineural steroids for trauma and compression-related peripheral neuropathic pain: a systematic review and meta-analysis. Can J Anaesth. 2015. pmid:25744141 PubMed
- Kwon JW, Lee JW, Kim SH, et al. Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors. Skeletal Radiol. 2007;36(5):431–436.
- Diwan S, Manchikanti L, Benyamin RM, et al. Effectiveness of cervical epidural injections in the management of chronic neck and upper extremity pain. Pain Physician. 2012;15(4):E405–E434.
- Cohen SP, Hayek S, Semenov Y, et al. Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain: A multicenter, randomized, comparative-effectiveness study. Anesthesiology 2014; 121:1045. doi: 10.1097/ALN.0000000000000409 DOI
- Mesregah MK, Feng W, Huang WH, et al. Clinical Effectiveness of Interlaminar Epidural Injections of Local Anesthetic with or without Steroids for Managing Chronic Neck Pain: A Systematic Review and Meta-Analysis. Pain Physician. 2020 Jul;23(4):335-348. www.painphysicianjournal.com
- Gross A, Kay TM, Paquin JP, et al.; Cervical Overview Group. Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2015;(1):CD004250. Cochrane (DOI)
- Kothari MJ. Treatment and prognosis of cervical radiculopathy. UpToDate, last updated Sep 08, 2021. UpToDate
- Patel KC, Gross A, Graham N, et al. Massage for mechanical neck disorders. Cochrane Database Syst Rev. 2012;(9):CD004871. Cochrane (DOI)
- Fritz JM, Thackeray A, Brennan GP, Childs JD. Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. J Orthop Sports Phys Ther. 2014;44(2):45–57.
- Zhu L, Wei X, Wang S. Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence, and a meta-analysis. Clin Rehabil. 2015. pmid:25681406 PubMed
- Nikolaidis I, Fouyas IP, Sandercock PA, Statham PF. Surgery for cervical radiculopathy or myelopathy. Cochrane Database Syst Rev 2010; :CD001466. Cochrane (DOI)
- Yin S, Yu X, Zhou S, et al. Is Cervical Disc Arthroplasty Superior to Fusion for Treatment of Symptomatic Cervical Disc Disease? A Meta-Analysis. Clin Orthop Relat Res 2013 Feb 7. pmid:23389804 PubMed
- Engquist M, Lofgren H, Oberg B, et al. Surgery Versus Nonsurgical Treatment of Cervical Radiculopathy: A Prospective, Randomized Study Comparing Surgery Plus Physiotherapy With Physiotherapy Alone With a 2-Year Follow-up. Spine (Phila Pa 1976) 2013 Sep 15;38(20):1715-1722. PMID: 23778373 PubMed
- Lees F, Turner JW. Natural history and prognosis of cervical spondylosis. Br Med J 1963; 2: 1607-10. PubMed
- Terje Johannessen, professor i allmennmedisin, Trondheim
- Ingard Løge, spesialist i allmennmedisin, Trondheim
Tidligere fagmedarbeidere
- Espen Dietrichs, professor og avdelingsoverlege, Universitetet i Oslo og Nevrologisk avdeling, Rikshospitalet, Oslo