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Female patient in her mid-40s with progressive history of severe paracervical pain and severe right upper extremity dysesthetic (meaning with abnormal sensation) nerve pain. These symptoms started about six months after her last surgery that was performed by a different surgeon. Overall, the patient had undergone three previous cervical spine surgeries with a different surgeon before presenting in my office for a second opinion. Her surgeries included an anterior cervical discectomy and fusion at C6-7 with a hybrid C4-5 and C5-6 disc replacement. This surgery failed and was followed by another surgery to remove the disc replacement at the C4-5 and C5-6 level and PLACE new cages with fusion at C4-5 and C5-6. She then developed pseudoarthrosis nonunion at C4-5 and C5-C6 that required a third surgery for a posterior C4, C5 and C6 instrumentation and fusion.
When presenting in my office, X-ray and CAT scan revealed further non-fusion anteriorly and posteriorly from C4-6 as well as a new spondylolisthesis at C7-T1, below the previous fusion. Review of the patient’s vertical spine parameters shows positive sagittal vertical axis with positive chin-brow angle and cervical kyphosis from C2-T2 as well as pseudoarthrosis and posterior hardware failure.
We performed a C7-T1 revision ACDF (Anterior cervical discectomy and fusion) with 20 degree hyper-lordodic cage followed by a C2-T2 instrumentation with posterior column osteotomies with removal of the failed hardware form the earlier surgery at C4-6.
Patient is doing very well post operatively and has had major improvement of her neck pain with resolution of her dysethetic nerve pain.
