Exemplificative Cases in Cervical Spine

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).