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Intraoperative conversion of synthetic cervical disc alternative to anterior cervical discectomy and fusion for iatrogenic fracture: A uncommon case report.
Medication (Baltimore). 2017 Nov;96(47):e8917
Authors: Wang BY, Wu TK, Liu H, Deng YX, Ding C
Summary
RATIONALE: Synthetic cervical disc alternative (ACDR) has been reported to be an efficient and protected surgical therapy for cervical spondylosis. Nevertheless, iatrogenic fracture throughout ACDR surgical procedure has not often been reported. Contemplating its infrequency, we report a uncommon scientific case, with the intention of sharing our expertise and exploring when to transform ACDR to fusion intraoperatively.
PATIENTS CONCERNS: A 47-year-old lady felt neck ache with weak point and numbness in each higher limbs for five months.
DIAGNOSES: The affected person had acquired discectomy and fusion process on C3/Four and C5/6 to alleviate her radicular ache practically Four years prior. Neurologic examination revealed a diminished sensation on the C6-C8 pores and skin areas and degree Grade-Four energy within the left wrist extensor and grip muscle power. Magnetic resonance imaging (MRI) confirmed disc herniation compressing the spinal wire at C6/7. Computed tomography (CT) scans confirmed intervertebral fusion in each the C3/Four and C5/6 segments.
INTERVENTIONS: Surgical procedure was carried out to take away the plate and substitute C6/7 with a synthetic disc, however a transverse cleavage endplate cortical fracture was detected after chopping the blades. Thus, we terminated synthetic cervical disc alternative intraoperatively and altered to discectomy and fusion in C6/7.
OUTCOMES: The affected person’s signs had been remarkably relieved. Postoperative CT scans confirmed a transverse cleavage fracture within the bottom of the C6 caudal endplate. Good fusion was achieved after 6 months.
LESSONS: Iatrogenic fracture throughout ACDR is uncommon however does happen in clinic observe. Full examination and an alternate strategy decided earlier than surgical procedure are necessary for operative security. Anterior cervical discectomy and fusion (ACDF) is really helpful as a possible remedial surgical technique if ACDR fails intraoperatively.
PMID: 29382028 [PubMed – in process]