|
The patient came to the operating room with quadriplegia below C4
with mild movement of the right deltoid and biceps brachii mm.
Complete anesthesia was noted at the same level. The condition
started to deteriorate the last 2 months and he was bedridden for 45
days. The patient has spasmodic torticollis, with turning the head
to right and up. He could have dystonia musculorum deformans, but
due to quadriplegia it is hard to tell and the possibility of
Tourette's syndrome must be in the differential diagnosis.
Considering the rapid deterioration and the MRI findings of severe
CCS with secondary cervical scoliotic deformity, the patient was
sent to the operating room. In the laminectomy position laminectomy
of C3-5 was performed. The severe bony compression was removed at
the C3-4 right side at the last stage, where maximal compression was
noticed. It was noticed that the lateral mass of C3 in the right
side was shifted anteriorly. Using lateral mass screws rigid
fixation of c3 to C6 was performed after correction of the scoliosis
by distraction. The upper part of the rod was intentionally
positioned, so that some fixation of C2 was achieved, and to bring
the shifted anteriorly lateral mass of C3 backward. The gap between
the facets in the right side was filled with chips of bone.
Considering that the patient could have spasmodic torticollis,
Bertrand procedure with neuroectomy of the posterior motor branches
of C3-5 was performed from both sides.
Bridge was applied to the construct to aid more stability.
Routine closure and smooth postoperative recovery. Slight
improvement of the right upper limb with the left deltoid start to
function. Some movements of the left lower limb start to be noticed.
The jerky movements decreased in intensity. |
