62 year old male presented to Dr. Pashman after a previous fusion at C4/5. The patient had severe degeneration from C2/3-C5/6. Dr. Pashman treated the patient with an Anterior Cervical fusion followed by a Posterior Cervical Fusion.
Case Review #5: 62 year old male with degenerative disc disease C2-C6
Case Review:Complex CervicalReconstruction of C2-C6Robert S Pashman, MDScoliosis and Spinal Deformity Surgerywww.eSpine.com
Patient History62 year old maleStatus post anterior cervical diskectomy, C4-5Now with sub-adjacent disc herniation with spinal cordcompression, cervical stenosis and neural foraminalstenosis.The patient also has massive posterior cervicaldegeneration at C2-3, C3-4, C4-5, and C5-6 causingincreasing axial neck pain, arm pain.The patient has been taking an escalating amount ofnarcotics for 7 years.The patient has impending neurologic deficit with posteriorcervical pain, shoulder pain indicative of mild myelopathy.
Indications for SurgeryStatus post anterior cervical diskectomy and fusion,C4-5.Now with sub-adjacent disc herniation and spinal cordcompression, C5-6.The patient on CT scan had massive arthrosis at C2-3,specifically on the left-hand side. This is superjacent to a highlymobile segment. The significant subaxial degeneration hadcaused the patient to have dysfunctional pain.Severe posterior subaxial arthritis.Failure to thrive with increase narcotic usage.Motor-sensory deficit and neurologic sequela.Partial cervical kyphosis.
Surgical StrategyThe strategy would be removal of Anterior interbody fusion, C5-6, 8-mm,plate anteriorly, sub-adjacent anterior with autogenous bone graft.cervical diskectomy and fusion. The Anterior cervical plate fixation, C5-6posterior spinal fusion from C2 to C6 with a 4-hole Atlantis Vision plate.would cause necessarily significant Removal of retained hardware, Zephyrsub-adjacent degeneration, spinal plate, C4-5.canal compression, especially with A Mayfield pin placement andthe cervical disc herniation. positioning.Radical diskectomy, C5-6 under the Posterior cervical fusion, C2 to C6,microscope with spinal cord using posterior cervical screw-rod construct.decompression. Posterior spinal fusion, C2 to C6, usingSubtotal vertebrectomy, C5 with locally harvested autogenous boneremoval of posterior uncovertebral and puttyosteophyte, anterior osteophyte Intraoperative SSEPs.constituting 1/3 of the vertebra and Intraoperative fluoroscopy.spinal canal decompression withbilateral neural foraminaldecompression.