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03-JUNE-2010  MUHAMED HMOUD ALI  30 YEARS  CONDITION AFTER DISCECTOMY C6-7 WITH MASSIVE DESTRUCTION OF C6 AND INSTABILITY OF THE C6-7 SEGMENT.

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


6 hours after surgery with the patient ambulating with check X-ray AP and Lateral.

Anamnesis

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The patient came to the clinic 01-June-2010 complaining of severe neck pain and weak left upper limb after performing discectomy in Egypt 2 months ago for small disc of C6-7, followed by massive infection in the anterior and posterior aspect of the paravertebral spaces.

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MRI of the cervical spine performed 08-May-2010 after surgery showing severe destruction of C6 with almost the lower 2/3 of the body is removed with a cavity full of puss and inflammatory process involving the anterior and posterior aspect of the paravertebral tissues.

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On examination; there is severe weak left triceps muscle3/5 and the grip and extension of the left hand was 4/5. There is no myelopathic syndrome.

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MRI of the cervical spine performed 02-June-2010 showing regression of the inflammatory process of the posterior aspect of the paravertebral tissues with huge empty space at the C6-7 level with destruction of C6. Routine X-rays of the cervical spine showed instability of the bony structures. There still liquid inside the cavity.

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Using part of the incision which was running parallel to the SCMM, the bony defect of C6-7 was identified and the infected disc material of C6-7 was removed. It became clear that the surgeon attacked not the disc space, but instead the lower 2/3 of C6 bony body. A 17 mm fibular graft was harvested from the right leg and reconfigured so as to accept the bony and disc space level, Using Atlantis Medtronic 2 level miniplate 35 mm length the fibular graft was attached to the miniplate and  fusion of C5-6-7 was achieved. All the stages were controlled under image-intensifier. Check for stability of the construct was performed with different stress manipulations.

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Routine closure of the wound and smooth postoperative recovery with full recovery of the power of the left upper limb.


Comments

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From the start, the patient was not in need for any surgery. This can be concluded from the MRI data performed 27-March-2010.

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The incision was a strange one, extending to the right sterno-clavicualr junction, which means that the first surgeon is not familiar with these kinds of surgeries.

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Partial lower 2/3 coporectomy of C6 was performed, not discectomy, which also confirming that the surgeon is acting without minimal knowledge to the anatomy.

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Infection must be localized to the area of surgery, but it was spreading far reaching the inferior aspect of the occipital bone. It is the first time in my life have the opportunity to see such spread of infection.

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Using cage in this case is not the right option. The best option is to use fibular graft, which can be freely drilled and reconfigured to accept the space. It can resist  infection in the near future. The iliac bone graft is not ideal, because it is fragile and can be resorbed by possible inflammatory process.

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This case is an example for some surgeons, that they do surgery without trying even to know the essential basics of surgery.


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