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Intraoperative conversion of synthetic cervical disc substitute 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 substitute (ACDR) has been reported to be an efficient and secure surgical therapy for cervical spondylosis. Nevertheless, iatrogenic fracture throughout ACDR surgical procedure has hardly ever been reported. Contemplating its infrequency, we report a uncommon medical case, with the intention of sharing our expertise and exploring when to transform ACDR to fusion intraoperatively.
PATIENTS CONCERNS: A 47-year-old girl felt neck ache with weak spot 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 stage Grade-Four energy within the left wrist extensor and grip muscle power. Magnetic resonance imaging (MRI) confirmed disc herniation compressing the spinal twine 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 change C6/7 with a synthetic disc, however a transverse cleavage endplate cortical fracture was detected after slicing the blades. Thus, we terminated synthetic cervical disc substitute intraoperatively and adjusted to discectomy and fusion in C6/7.
OUTCOMES: The affected person’s signs have 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 apply. Full examination and another method decided earlier than surgical procedure are vital for operative security. Anterior cervical discectomy and fusion (ACDF) is advisable as a possible remedial surgical technique if ACDR fails intraoperatively.
PMID: 29382028 [PubMed – in process]