Complex Cervical Reconstruction of C2-C6: Case 15

Case Review #5: 62 year old male with degenerative disc disease C2-C6 from Robert Pashman

62 year old male presented to Dr. Pashman after a previous fusion at C4/5. The patient had severe degeneration from C2/3-C5/6. Dr. Pashman treated the patient with an Anterior Cervical fusion followed by a Posterior Cervical Fusion.

    Case Review:

    Complex Cervical Reconstruction of C2-C6

    Patient History:

    62 year old male
    Status post anterior cervical diskectomy, C4-5
    Now with sub-adjacent disc herniation with spinal cord compression, cervical stenosis and neural foraminal stenosis.
    The patient also has massive posterior cervical degeneration at C2-3, C3-4, C4-5, and C5-6 causing increasing axial neck pain, arm pain.
    The patient has been taking an escalating amount of narcotics for 7 years. The patient has impending neurologic deficit with posterior cervical pain, shoulder pain indicative of mild myelopathy.

    Indications for Surgery:

    Status post anterior cervical diskectomy and fusion,C4-5.
    Now with sub-adjacent disc herniation and spinal cord compression, C5-6.
    The patient on CT scan had massive arthrosis at C2-3,specifically on the left-hand side. This is superjacent to a highly mobile segment. The significant subaxial degeneration had caused the patient to have dysfunctional pain.
    Severe posterior subaxial arthritis.
    Failure to thrive with increase narcotic usage.
    Motor-sensory deficit and neurologic sequela.
    Partial cervical kyphosis.

    Surgical Strategy:

    The strategy would be removal of the plate anteriorly, followed by an anterior cervical discectomy and fusion C5-6, followed by a posterior cervical fusion C2-C6.
    Intraoperative SSEPs.
    Intraoperative fluoroscopy