Patient with with arm weakness, severe spinal cord compression: Case 13

Case Review #3: 53 year old male with severe spinal cord compression from Robert Pashman

53 year old male presented with arm weakness, severe spinal cord compression, and degenerative disc disease. Dr. Robert Pashman treated the patient with an anterior cervical disectomy and fusion.

Case Review:

Complex Cervical Reconstruction

Patient History:

53-year-old male
Severe spinal cord compression
Myeloradiculopathy
Increasing weakness in the upper extremities.
Hypesthetic and hyperreflexic
The patient has severe cervical kyphosis centered at C4-5, C5-6 and C6-7 with posterior uncovertebral osteophyte and soft disk ridging against the spinal cord. There is a gliosis in the cord. The patient requires multiple-level osteotomy and vertebrectomies for correction of the cervical kyphosis and reconstruction.
Pre-op X-rays were taken

Indications for surgery:

1. Severe myeloradiculopathy due to spinal cord compression at C4-5, C5-6 and C6-7.
2. Degenerative disk disease, C4-5, C5-6, C6-7.
3. Severe cervical kyphosis and deformity, C4-5, C5-6 and C6-7.
4. Failed conservative therapy.

Surgical Strategy:

1. Segmental spinal instrumentation C4 to C7 using an eight-hole Atlantis Vision cervical plate.
2. Radical diskectomies with cervical deformity correction, C4-5, C5-6 and C6-7 using microscope spinal canal decompression for myeloradiculopathy.
3. Osteotomy, subtotal vertebrectomy, C4-5, C5-6 and C6- 7 for removal of severe uncovertebral osteophytes, lateral annular ossified ridges for correction of cervical kyphosis.
4. Anterior interbody fusion with cervical allograft devices measuring 6, 6, and 6 mm, C4-5, C5-6 and C6-7, with autogenous bone centrally.

Post-op Comparison x-rays:

It is important to notice that the natural cervical alignment was reconstructed with surgery. This removed the pressure from the spinal cord and discs, alleviating pain.