A 54-year-old woman presented with neck pain radiating to her right shoulder, arm, and hand. Imaging showed cervical deformity from C2 to T1 with multiple levels of disc degeneration, stenosis, and prior fusions from C6 to C7 on the right and C7 facet fracture on the left. Her problems included right C8 radiculopathy, C4-C5 disc degeneration, previous C6-C7 fusion, right C7 pedicle fracture, left C7 facet fracture, small lateral mass size, history of smoking, and C7-T1 anterolisthesis with mild C3-C6 stenosis. She was being evaluated for surgical treatment of her cervical deform