Revision Surgery Treats Intractable Neck Pain & Cervical Deformity

REVISION SURGERY TREATS INTRACTABLE NECK PAIN & CERVICAL DEFORMITY

Clinical Presentation

The patient is a 61-year-old female with a history of rheumatoid arthritis. She is 2-1/2-years status post C3-C7 laminectomy with posterior instrumentation and fusion. This procedure was performed to treat multilevel disc herniations with spinal cord compression following a motor vehicle accident.

She did well for several years, but then developed new onset of intractable neck pain with radiation to both upper extremities. She also had difficulty holding her head up.

Clinical Management & Treatment

Her rheumatologist ordered an x-ray which showed anterolisthesis of C7-T-1 with kyphosis and instability (Fig 1 right).

The patient underwent a one-day, two-stage procedure. Stage 1 was a C6-7, C7-T1 anterior cervical discectomy and fusion with reduction of the anterolisthesis and correction of the kyphosis.

Stage 1 was immediately followed by Stage 2 which was extension of her posterior instrumentation   and fusion from C3 down to T3. Neuro-navigation was used to assist with the difficult anatomy of the upper thoracic spine.

Conclusion:

The patient had an uneventful postoperative course with significant improvement in her preoperative symptoms and is now able to maintain a good posture (Fig 2 right).

Author:  Dr. Ben Cohen, Neurosurgeon