Reversal of anterior cervical fusion with a cervical arthroplasty prosthesis.
This case report describes a 38-year-old-man who initially underwent a C5-C6 anterior cervical decompression and interbody fusion and plating for a right C6 radiculopathy. Within a few months of his surgery, he developed bilateral C7 radiculopathies, with imaging confirming adjacent segment foraminal stenosis. Repeat imaging suggested some subsidence of the original interbody graft but no overt pseudoarthrosis, and flexion/extension films showed no evidence of movement at the fused level. Six months after the original surgery, he underwent re-exploration. Decompression and arthroplasty were effected at the C6-C7 level. The old fusion was removed at the C5-C6 level and remobilized, and an arthroplasty was performed. At discharge, the patient's neck pain and hand symptoms had improved, and he had motion demonstrable on radiologic imaging at C5-C6. This is the first reported case of reversal of a cervical fusion with re-establishment of motion and represents an alternate acceptable management of pseudoarthrosis or recent spinal fusion.
Sekhon
Lali H S
LH
Department of Neurosurgery and Spinal Injuries Unit, Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia. surgeon@spinalneurosurgery.com
D000328:Adult; D001178:Arthroplasty / Q000295:instrumentation / Q000379:methods*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D006801:Humans; D016268:Internal Fixators / Q000592:standards; D008297:Male; D019547:Neck Pain / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019736:Prostheses and Implants / Q000592:standards*; D011542:Pseudarthrosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013126:Spinal Nerve Roots / Q000293:injuries / Q000473:pathology / Q000503:physiopathology; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome