This is a 61 year old male who undergoes an unrelated surgical procedure. Upon waking from surgery reports new pain, numbness, tingling in his forearms and hands and weakness of his legs. No prior history of arm problems. He has no neck pain. Neuro exam with sensory loss in medial hands and radial forearm into axilla. He has proximal leg weakness. An urgent MRI c-spine was obtained.
C-spine MRI. Midsagittal image (left) shows C7-T1 malalignment and disc displacement (yellow arrow). Axial images (left) are degraded by patient motion during the MRI scan. They show probable disc displacement and cord compression at C7-T1, but are inadequate to plan surgery. Disc displacement is shown by yellow arrow and spinal cord is designated by yellow star.
Myelogram - Fluoroscopic images of lumbar spine in the lateral (left) and AP (right) planes. Both images show results of recent lumbar spine surgery. Seen in both images is a needle that has been placed into spinal canal (lumbar puncture, yellow arrow). X-ray dye has been injected into the spinal canal and ascending up the back (green arrow). Note the dye outlining the lumbar nerve roots of the cauda equina.
Sagittal images of post-myelogram CT of c-spine. They demonstrate a filling defect in dye within the ventral spinal canal (yellow arrow), consistent with disc displacement.
Axial images of post-myelogram CT of c-spine. They demonstrate a filling defect in dye within the ventral spinal canal (yellow arrow), consistent with disc displacement. Here, the cord compression is evident.
Intraoperative fluoroscopic images (lateral projections) taken during the C7 corpectomy and fusion procedure. Left image shows localizing needle in the C7-T1 disc space. Right images show the expandable interbody biomechanical device (aka cage) being applied. The upper image shows the top of the cage while the lower image shows the bottom.
Intraoperative photo taken during corpectomy. The instrument in the field is a suction tube. It is deep in the field where the C7 vertebral body is being removed. The blue arrow shows a large piece of the C7 bone that has not been removed more superficially.
Intraoperative photo taken after the removal of the bone of the C7 vertebral body. Soft tissue – displaced disc material and posterior longitudinal ligament (PLL) remain. The arrow is demonstrating a hole in the PPL- the dura can be seen underneath.
Intraoperative photo taken after the removal of all bone and soft tissue. The dura overlying the spinal cord has been decompressed. The inferior endplate of C6 and the superior endplate of T1 are seen to the right & left (respectively) of the corpectomy defect.
Intraoperative photo showing placement of the expandable cage placed between C6 and T1 to bear the weight of the head. (Globus Medical, Audubon, PA)
An anterior cervical plate now covers the interbody cage, securing the construct and stabilizing the cervical spine.
Postoperative c-spine x-rays taken on the day after surgery. The C6-T1 construct is seen maintaining proper spinal alignment.
CT c-spine taken about 1 month postop after patient suffered a minor fall. These views are limited, but show stability of construct.
2-D reconstructions of the 1 month postop CT c-spine (seen in figure 12) better demonstrating the construct and spinal alignment.
Postoperative c-spine x-rays taken about 3 months postop. It shows stable construct and alignment. Patient’s neurological symptoms have resolved.
Illustration demonstrating the interbody biomechanical device and anterior cervical plate used for this surgery. (Provided by Globus Medical, Audubon, PA)