Female, 62, with cervical spinal stenosis: Case 18

Case Review #8: 62 year old female with cervical spinal stenosis from Robert Pashman

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 Diskectomy and fusion C4-/7.

Case Review:

62 year old female presented with neck pain and left arm weakness.

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.

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.

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.

Pre-Op/Post-op Comparison:

Normal disc height has been induced, thus the cervical lordosis (natural curve of the neck) has been restored.