Fig. 12.1
Pre-operative radiographs in anteroposterior (a), lateral (b) and trans-oral (c) projetions
Fig. 12.2
Pre-operative CT scans of the C2 lesion, pathognomonic for osteoblastoma
Fig. 12.3
Pre-operative angiography and sub-sequent embolization
Fig. 12.4
Intra-operative images, lateral and posterior approach
Fig. 12.5
Post-operative CT scan
Fig. 12.6
Post-operative standing plain radiographs
Fig. 12.7
4-months follow-up CT-scan
Fig. 12.8
3-years follow-up CT-scan
12.2 Subaxial Cervical Spine
12.2.1 Anterior Procedures
12.2.1.1 Anterior Cervical Discectomy and Fusion (ACDF)
Forty-three-year-old female, complaining of neck pain radiating to the right arm in territory of C7, resistant to a six-week course of conservative treatments. She referred paresthesias and numbness, and physical examination revealed a mild (4/5) motor deficit in wrist flexors and finger extensors and hyporeflexia in triceps reflex.
Sagittal and axial MRI shows herniated C6–C7 disk, obliteration of the anterior liquoral column, and cord compression.
Anterior left prevascular approach was performed. After intraoperative fluoroscopic control, C6–C7 discectomy was completed in order to achieve decompression of the canal and the root. Distraction is applied to adjacent levels during end plate preparation. Wire locking PEEK and tantalum interbody cage was placed stand-alone, and mild compression is applied before final locking (3-month follow-up plain radiographs and CT scan) (Figs. 12.9, 12.10, and 12.11).
Fig. 12.9
Pre-operative MRI
Fig. 12.10
Post-operative standing radiographs
Fig. 12.11
Post-operative CT-scan
12.2.1.2 Cervical Disk Prosthesis
Forty-eight-year-old female, complaining of neck pain radiating to the right arm in territory of C6, resistant to six-week course of conservative treatments. She referred paresthesias and numbness, and physical examination revealed a mild (4/5) motor deficit in wrist extensors and hyporeflexia in brachioradialis reflex.
Sagittal and axial MRI shows herniated C6–C7 disk, obliteration of the anterior liquoral column, and cord compression.
Anterior left prevascular approach was performed. After intraoperative fluoroscopic control, C5–C6 discectomy was completed in order to achieve decompression of the canal and the root. Distraction is applied to adjacent levels during end plate preparation. C5–C6 Bryan Cervical Disc System was placed to restore disk height and allow motion at the treated level (Figs. 12.12, 12.13, 12.14, 12.15, and 12.16).
Fig. 12.12
Pre-operative standing radiographs
Fig. 12.13
Pre-operative MRI
Fig. 12.14
Post-operative standing radiographs
Fig. 12.15
Post-operative CT-scan
Fig. 12.16
Post-operative flexion-extension radiographs
12.2.1.3 ACDF for Revision of Cervical Disk Prosthesis Failure
Fifty-six-year-old female, presenting with recurrency of progressive neck pain 10 months after C6–C7 disk arthroplasty. AP and LL radiographs show posterior dislocation of the implant; thus, dynamic exam did not reveal segmental instability.
Intraoperative picture shows removal of the device, and carbon fiber-reinforced polymer (CFRP) cage was placed as interbody device to restore segmental stability and provide anterior column support. Additional plate was placed to restore the anterior tension band (Figs. 12.17, 12.18, 12.19, 12.20, 12.21, 12.22, and 12.23).
Fig. 12.17
Pre-operative standing radiographs
Fig. 12.18
Pre-operative flexion-extension radiographs
Fig. 12.19
Pre-operative CT-scans
