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20-APRIL-2011  ABDALLA ABDEL-KAREEM AL-GHMEZ  57 YEARS  RESIDUAL AFTER FIXATION OF THE C7-D1 WITH PROGRESSIVE STENOSIS AT SAME LEVEL.

Anamnesis

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The patient was operated by me 21-July-2010 for fracture dislocation C7-D1 with quadriparesis, after what he dramatically improved.

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The patient then 20 days after the surgery started to complain the return of hypalgesia of the right side of the body below the umbilicus.

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The patient then came to the clinic 13-November-2010 complaining of further deterioration of the sensation reaching the right C6 level  with slight hypalgesia 10 cm below the left nipple. The power of the four limbs was full. He was advised to continue medical treatment.

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On examination: the patient has good power of the four limbs, but he us using crutches due to impaired sensation with complete aneasthesia of the right lower limb up to the knee.

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The patient was sent for MRI cervical spine and done 18-April-2011 showing mild stenosis at C7-D1. The major compression is due to the posterior elements, where the CSF is lacking at the lamina of C7. Dynamic studies of the cervical spine confirmed stability of the construct of Trinica cervical plates and screws at C7 and D1.

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Decompressive laminectomy of C7 and partial of C6 and D1 was performed. The compressed parts were lacking the epidural fat. The ligamentum flavum was adherent to the dura at the most compressed area, which was removed by sharp dissection to prevent dural tear.

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Routine closure of the wound. Smooth postoperative recovery with decrease of the numbness of the four limbs..


Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Comments

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This case and the case performed 26-March-2011 are similar in their scenarios, that after dramatic improvement, they showed deterioration of the posterior elements of the spinal cord.

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In this case the Fidji cage was used and sinking of the cage was mostly the cause of sensory deterioration.

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In the future, it is preferable to use a cage with wider and higher dimensions to to escape this sinking event, which necessitate for second surgery.

 


 

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