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22-OCTOBER-2012 SHARIF MAHMOUD MISHREF 35 YEARS
CONDITION AFTER DISCECTOMY C5-6. C6-7 WITH STILL PERSISTING FRAGMENTS IN THE
LEFT C5-6 FORAMEN.
Anamnesis
The patient came to the clinic 20-October-2012
complaining of neck and left upper limb pain for
what he was operated 2 weeks ago with
intradiscal cleaning of C5-6, C6-7 with
insertion of cages. The pain persisted as before
surgery, for what he performed MRI
18-October-2012 confirming the presence of the
C5-6 foraminal occlusion due to missed
fragments.
On examination: the patient have neck pain when
looking to all directions with
limitation and using collar. There is
profound weakness of the grip and extension left
hand and the left triceps all -4/5.
Exposure of the old wound, which it seems too
low, for what further dissection upward to
sufficiently expose the C5-6 and C6-7 levels.
The Stryker Solis 5x14 cage was removed from the
C5-6 level. The intradiscal space of C5-6 still
having disc material in the left side. It was
removed and osteophytectomy and cleaning of the
disc fragments at the left foramen were removed,
until the root was seen. The posterior border of
Leuschko joint was nibbled from behind for 3 mm.
Fidji cage 14x19x6.1 mm inserted to the C5-6
level with NovaBone. Using Trinica 2 level plate
42 mm length and 4 variable screws 14x4.2 mm
were inserted to C5 and C7 bodies. 2 fixed same
size screws were inserted to C5 level.
Routine closure of the wound. Smooth
postoperative recovery with normalization of the
power of the left upper limb and the agonizing
left radicular pain disappeared.
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Comments
The patient has extruded
disc C5-6 with foraminal occlusion requiring
surgery. The old extrusion of C6-7 was included
to prevent possible future escalation and
correct the inverted curvature of the cervical
spine.
Intradiscal cleaning is not sufficient to
resolve the patient problem. Removal of the
fragments occluding the left foramen will only
make him feel relief.
Insertion cages within 2 levels without
performing fusion is a wrong strategy. All the
patients came and seen by me are suffering from
such approach.
The level of incision was too low, making the
performance of the procedure difficult during
first surgery.
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