Cervical herniated disc with neck pain: Case 12

Case Review #2: 40 year old female with a subadjacent cervical disc herniation from Robert Pashman

A 40 year old female presented with a cervical disc herniation subjacent to previous cervical fusion. Dr. Pashman performed a revision surgery. The surgical procedure was an anterior cervical discectomy and fusion.

Case Review

Subadjacent Cervical Disc Herniation, treated with an Anterior Cervical Disectomy

Patient History:

Status post anterior cervical discectomy and fusion on 2/16/2005 from C4- C5 and C5-C6.
Increasing neck pain at the base of the neck.
MRI today shows a disc herniation with degenerative disc at C6-C7, this is causing effacement of the cord.
There is no motor or sensory deficits, no neurological deficits, no focal motor or neuron signs.
Pre-op X-rays were taken

Indications for Surgery:

Subadjacent degeneration and disk herniation, C6-C7.
Status post anterior cervical diskectomy and fusion onC4 to C6.
Now with failed conservative therapy.
Axial neck and bilateral shoulder pain.
Multiple co-morbidities

Surgical Strategy:

Radical anterior cervical diskectomy with epidural decompression under the microscope and spinal cord decompression at C6-C7.
Anterior interbody fusion with allograft/autograft combination 8-mm plank to graft C6-C7.
Anterior cervical plate fixation, 4-hole plate, C6- C7.
Removal of retained hardware plates, C4 to C6.
Intraoperative SSEPs.
Intraoperative fluoro.

Findings at Surgery:

Severe degeneration of C6-C7. There was uncovertebral loss and cord compression with posterior longitudinal ligament buckling. The bone was good quality. The plate was intact. There was no loosening of the screws. The fusion was solid.

Pre-Op/Post-op Comparison: 

Patient is doing well post-surgery. Instrumentation looks good.