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27-JULY-2010  AMNEH MAHMOUD ABDALLAH  55 YEARS  OPLL WITH SEVERE CERVICAL STENOSIS C4-5, C5-6 AND C6-7 WITH HUGE EXTRUDED DISC C5-6 CENTRAL MORE TO THE RIGHT.

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

Anamnesis

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The patient came to the clinic 05-July-2010 complaining of right sided paralysis for one week. MRI cervical spine performed 01-July-2010 PCDs with severe CCS - pictures are of bad quality.

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On examination: the patient walking with the help of 2 persons, complaining of neck pain with complete paralysis of the right hand and weak biceps 4/5 and triceps 3/5 of the right upper limb. There is weak dorsi and planterflexion right foot 3/5 with quadriceps right leg 4/5. There is hypalgesia of the right hand and the left side of the body below D1 manifesting Brown-Sequard syndrome at the level of C5-6.

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MRI of the brain performed 14-July-2010 was normal and MRI of the cervical spine showed OPLL with severe stenosis at C4-5, 6-7  and huge extrusion C5-6 with severe spinal cord compression of this level. Cardiologic consultation was uneventful, despite the fact, that she is a known diabetic with hypertension and catheterization done 1 year ago which was non significant. The anticoagulant was not stopped before surgery.

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In supine position with traction applied to the skull 7 Kg, anterior discectomy of C5-6 was done and all the compressing elements were removed until the dura was free of any compression. Intradiscal decompression of C4-5 and C6-7 was done. Fidji cage 17X6.1X12 mm was inserted to the C5-6 level. Fidji cages 16X4.5X12 mm were inserted to C4-5 and C6-7 levels with Novabone.  Using Trinica cervical plate 3 level 66 mm length was used to fuse C4-5-6-7 with 14 mm length screws to each level.

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Smooth postoperative recovery and some improvement of the power of right side of the body.


Comments

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This case demonstrate that extrusion in the presence of stenosis could cause severe spinal cord injury such as Brown-Sequard syndrome with almost complete injury to the right half of the spinal cord as in this case at the level of C5-6.

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Inserting Fidji cages remove load stress in the inserted screws, decreasing the possibility of fracture or migration and the lock mechanism in the Trinica plate decrease the possibility of screw slipping.

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Inserting cages with the skull under traction 7 or more Kg will lessen the elements of stenosis by slight stretching of the ligaments.

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The patient will need long period for acceptable recovery.


Immediate postoperative X-ray showing the constructs.

Trinica Zimmer cervical miniplate


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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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