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24-MAY-2008  AMAL AL-FAQIR  48 YEARS  SLIPPED UPPER SCREWS IN THE POSTERIOR CERVICAL FUSION DEVICE.

Preoperative X-rays showing the construct.

Anamnesis:

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The patient came to the clinic 05-February-2008 still complaining of agonizing neck pain and unable to move her left upper limb. CT-scan performed 05-December-2007 showing good alignment of the four lower screws, but with partial slipping of the upper two screws. She was advised to keep in medications and protelose to accelerate the bony fusion.

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The patient was advised to be seen after 4-5 months.

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MRI lumbar spine performed 22-April-2008 showed good alignment of the spinal cord and the bony structures, but did not gave information about the position of the posterior fusion screws.

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The patient then came 17-May-2008 and there was some improvement of her condition, but limitation of the neck movements and the feeling that the upper screws are pushing the upper cervical spine anteriorly, causing massive muscle spasm.

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The patient was sent for CT-scan of the cervical spine and simple cervical X-rays, which confirmed further slipping of the upper screws.

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Considering that, a sufficient time elapsed since the last surgery, and the necessity of the upper screws is null and in contrary, they are causing such muscle spasm and limitation of neck movement, the patient was advised to undergo partial removal of the upper third of the construct.

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In the laminectomy position, posterior approach was refreshed and the rods were exposed, just above the level of the middle screws. The connecting bridge was removed. Drilling of the rods was performed, as demonstrated in the postoperative pictures. The flail screws were removed together with rods.

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Routine closure of the wound with smooth postoperative recovery.

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The patient showed dramatic improvement after the surgery, that myself could not believe in that. With gradual decrease of pain killers, she kept in good condition and she was discharged 5 days after surgery.

Comments

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With the rapidly growing technologies, new problems arise and with practice, the good judgment could lead to better outcome.

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The posterior fusion device, as every device has its merits and laps. This case is a good demonstration, that the slipping of the upper screws could lead to very agonizing pain and limitation of neck movement.

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Such a simple procedure, as removing the upper third of the device brought the patient back to normal life. She was disparate and this condition, including the previous surgeries caused to her a major psychological impact.

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When the patient has depression and as be seemingly minor morphologic problem, such as slippage of the upper screws, do not hesitate to correct the problem. The idea is to bring all the surgical data to perfect.

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The patient still showing the residual of the previous sympathectomy, such as anhydrosis and warming of the left upper limb. These manifestation are welcome in her clinical status.


Postoperative X-rays showing the acceptable device positioning.

 

 


Back Up!

Notice: Not all operative activities can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also escaped from the plan .

     

  

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