Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon
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Degenerative / Spine Case

Acute cervical disc herniation

61 year old man undergoes 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 No neck pain Neuro exam with sensory loss in medial hands and radial forearm into axilla Proximal leg weakness Urgent MRI c-spine obtained

Description

61 year old man undergoes 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
No neck pain
Neuro exam with sensory loss in medial hands and radial forearm into axilla
Proximal leg weakness
Urgent MRI c-spine obtained

Gallery

Images

Figure 1C-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.
Figure 2Myelogram - 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.
Figure 3Sagittal 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.
Figure 4Axial 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.
Figure 5Intraoperative 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
Figure 6Intraoperative 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.
Figure 7Intraoperative 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.
Figure 8Intraoperative 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
Figure 9Intraoperative photo showing placement of the expandable cage placed between C6 and T1 to bear the weight of the head. (Globus Medical, Audubon, PA)
Figure 10An anterior cervical plate now covers the interbody cage, securing the construct and stabilizing the cervical spine.
Figure 11Postoperative c-spine x-rays taken on the day after surgery. The C6-T1 construct is seen maintaining proper spinal alignment.
Figure 12CT c-spine taken about 1 month postop after patient suffered a minor fall. These views are limited, but show stability of construct.
Figure 132-D reconstructions of the 1 month postop CT c-spine (seen in figure 12) better demonstrating the construct and spinal alignment.
Figure 14Postoperative c-spine x-rays taken about 3 months postop. It shows stable construct and alignment. Patient’s neurological symptoms have resolved.
Figure 15Illustration demonstrating the interbody biomechanical device and anterior cervical plate used for this surgery. (Provided by Globus Medical

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