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

Cervical Fusion

Dx: cervical disc displacement, myelopathy, subluxation

Description

58 year-old woman presents complaining of neck and right arm pain and numbness.
Also reports loss of dexterity and off-balance walking.
Neurological exam with hand weakness, loss of sensation, and abnormally hyperactive reflexes.

Gallery

Images

Figure 1MRI c-spine (sagittal left, axial right) showing cervical disc disease and resulting spinal stenosis.
Figure 2A series of mid-sagittal T2 MRI images. The first (left) is from 6 years prior to presentation, the second (middle) is from 2 years prior, and the last (right) is the recent MRI. They show progressive degeneration of the cervical spine.
Figure 3X-rays of the cervical spine. Note the degenerative changes throughout the cervical spine. Also note the malalignment of C4 and C5 (red arrow).
Figure 4Cervical spine x-ray in the lateral planes with the patient in extension (left) and flexion (right). Note the overall change in shape of the cervical spine. Also note the change in the relationship between C3 and C4 in extension and flexion- they are aligned in extension (left) and there is anterior translation of C3 on C4 in flexion. This is abnormal motion.
Figure 5Intraoperative fluoroscopic images. The first (left) shows a localizing needle in the C4/5 disc space, and the second (right) shows the interbody biomechanical devices (cages) in the C3/4, C4/5 and C5/6 disc spaces and an anterior cervical plate secured to the front of the spine with 8 screws (2 into each vertebral bone).
Figure 6Postoperative x-ray of the cervical spine in the lateral (left) and AP (right) planes obtained 3 months postop. They show the hardware in place.
Figure 7Pre-operative (left) and postoperative (right) lateral x-rays of the c-spine. Note the improvement in the overall shape of the spine as well as alignment of the individual vertebral bodies in the postop image when compared to the pre-op. Measurement of Cobb angles reveals 1 degree of kypposis preop (forward angulation – abnormal in c-spine) preop, and 7 degrees of lordosis (backward curvature – normal) postop.
Figure 8A diagram of the interbody device that was used in this particular case.

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