Herniated Disc after cervical fusion: Case 14

Case Review #4: 51 year old female with adjacent segment degeneration from Robert Pashman

A 51 year old female, presented after a previous 3 level cervical spine fusion. The patient developed a cervical disc herniation adjacent to the previous fusion. Dr. Pashman treated her by extending her cervical fusion.

Case Review:

Cervical Adjacent Segment Degeneration

Patient History:

51 year old female
Status post fusion at C4-5, C5-6 and C6-7
The patient has superadjacent degeneration at C3-4 above the previous fusion.
The patients symptoms have gotten very bad. She has right shoulder pain. There is no problem at C7-T1. The effacement of the spinal cord and fractional kyphosis is noted.
She has been treated conservatively with blocks and physical therapy for a long time.
Pre-op x-rays were taken

Indications for Surgery:

Status post anterior cervical discectomy and fusion, November 2004, at C4-C5, C5-C6, and C6-C7.
Superjacent degeneration at C3-C4 with spinal cord compression.
Fractional kyphosis.
Some motor/sensory deficit.
Significant proximal pain radiating to the trap region into her arms and intermittently into her back.
Failed conservative therapy.

Surgical Strategy:

Radical discectomy, C3-C4, with spinal cord decompression under the microscope.
Anterior interbody fusion using Cornerstone 7-mmdevice, C3-C4, with autogenous bone centrally.
Anterior cervical plate fixation with four-hole plate, C3-C4.
Removal of retained instrumentation and exploration of fusion mass, C4 to C7.
Intraoperative somatosensory-evoked potentials.
Intraoperative fluoroscopy.

Pre-Op/Post-op Comparison:

Normal disc height has been restored   Patient is doing well. Incision well-healed. X-rays look good. No evidence of problems with the instrumentation. Sub adjacent spine is fused.