62 year old female with neck pain and left arm weakness. On MRI, the patient was found to have spinal stenosis. Dr. Pashman treated the patient with an Anterior Cervical Discecomy and fusion C4-/7.

1. Case Review:
62 year old female
presented with neck pain
and left arm weakness.
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 62-year-old female
• Left shoulder scapular area, upper arm, deltoid area, forearm and
has fuzzy feeling on the left thumb and index finger.
• She had cortisone injection x 3, one helped a little bit but nerve
block two weeks ago worsened her symptoms.
• Profound deltoid, biceps with intermittent triceps weakness on
the left-hand side.
• The patient has significantly hyperreflexic patellar and Achilles
reflexes indicating to me that the patient probably has an element
of myelopathy associated with her problem.

3. Pre-op X-rays

4. Indications for Surgery
1. Myeloradiculopathy due to massive spinal stenosis, spinal cord
compression at C4-C5, C5-C6 and C6-C7.
2. Massive neural foraminal stenosis bilaterally C4-C5, C5-C6 and
C6- C7.
3. Failed conservative therapy.
4. Increasing neurologic deficit with numbness of left hand.

5. Surgical Strategy
• Radical diskectomy under the microscope for spinal cord
decompression and neural foraminal stenosis C4-C5, C5-C6 and
C6-C7.
• Interbody fusion C4-C5, C5-C6, C6-C7
• Subtotal vertebrectomy of C5 and C6, due to one third of
removal of vertebra anterior-posterior uncovertebral osteophyte.
• Four-level anterior plate fixation using a 8-hole screw-plate
construct C4-C5, C5-C6 and C6-C7.
• Intraoperative somatosensory evoked potentials.
• Intraoperative fluoro.

6. Post-op Films

7. Pre-Op/Post-op Comparison
Normal disc height
has been induced,
thus the cervical
lordosis (natural
curve of the neck)
has been restored.