June 21, 2024

Minimally Invasive Posterior Cervical Revision Fusion Case Study – J.S.

J.S. - Overview

  • 46 yo male weight lifter

  • Originally had neck pain with severe left shoulder and arm weakness

  • Underwent ACDF with stand alone interbody devices

  • Strength improved after 6 months and was told fusion was complete

  • Unfortunately developed very similar symptoms of weakness and arm pain on the opposite right side with recurrent neck pain

  • Was offered an open posterior decompression and revision fusion with instrumentation – would mean significant trauma to posterior neck muscles, significant recovery time, increased infection risk

  • Sought a second opinion for a more minimally invasive option

Preop Lateral

C5-6 solidly fused
C6-7 has lucency through spacer
Consistent with non-union or pseudoarthrosis

Preop AP

C5-6 solidly fused
C6-7 has lucency through spacer
Consistent with non-union or pseudoarthrosis

Preop MRI

Fused C5-6 level has no stenosis
C6-7 has either residual or recurrent stenosis causing recurrent symptoms

CT scan images

Lucency through C6-7 (Line through the spacer from side to side = Non-union)

2 week postop xrays

Minimally invasive posterior instrumentation placed through 2 small incisions less than 1 cm in size

3 month postop xrays

Patient has no pain and strength improving substantially

Lucency across C6-7 space beginning to fill in with bone on its way to fusion

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