DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Cervical spinal stenosis with myelopathy.
2. Severe cervical congenital abnormality and scoliosis.
POSTOPERATIVE DIAGNOSES:
1. Cervical spinal stenosis with myelopathy.
2. Severe cervical congenital abnormality and scoliosis.
OPERATION PERFORMED: C4 corpectomy with decompression of the spinal canal and nerve elements with application of the titanium cage and local bone graft.
SURGEON: John Doe, MD
ANESTHESIA: General.
ASSISTANT: Jane Doe, MD
ESTIMATED BLOOD LOSS: 100 mL.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was brought to the operating room. Preoperative antibiotics were given. He was intubated and placed in the supine position. Throughout the surgery, spinal cord monitoring was performed to ensure the integrity of the spinal cord. All bony prominences were padded carefully. Cervical spine was draped in the usual sterile fashion.
Incision was made on the right aspect of his neck. Dissection was taken to the platysma muscle. Platysma muscle was opened along its fibers. He has significant rotation of the cervical spine with scoliosis, which make this approach challenging. His carotid artery was significantly posterior to its normal position. His anterior cervical spine was rotated significantly to the right side with scoliosis. Full dissection was performed, deep cervical fascia was identified and it was opened bluntly. Then, attention was directed to the next level. Esophagus was identified, and the esophagus and trachea were removed medially. The prevertebral fascia was identified. This fascia was thickened and it was opened along its fibers. As mentioned, his cervical spine was deformed and there was significant rotation and scoliosis.
The C-arm was brought in to identify the intended corpectomy level. At this point, the retractors were placed and colli longus muscle was detached and retractors were placed in. Corpectomy was performed by performing diskectomy at the level above C4 and below the C4. The C4 level, which was being corpectomized, had significant rotation to the right. Rongeur was used to remove the anterior aspect of the C4 vertebral body all the way posteriorly as much as possible. Then, corpectomy was continued with high-speed drill all the way to the posterior cortex. Attention was given to perform a wide cord decompression. The uncovertebral joints were used as reference to determine the width of the corpectomy. The corpectomy was performed all the way to the posterior cortex. At this point, Kerrison was used to gently remove the bone. There was significant pressure that was brought on the superior aspect, particularly on the left side. Meticulously, with the combination of small Kerrison and high-speed drill, corpectomy was performed all the way. Posterior longitudinal ligament was identified. At the end of the decompression, the neural foramen, superiorly and inferiorly, was completely free. Spinal cord was widely exposed and decompressed. To control hemostasis, FloSeal was used. Endplates were cleaned up of any remaining disk material and decorticated with good bleeding bone.
At this point, the width of the corpectomy was measured, appropriate size cage was assembled and it was packed with the bone graft taken from the corpectomy site as well as from allograft. The cage was gently placed in the interspace once the traction was applied to the cranium. The cage was gently tapped in place. It had a very nice fit and it was very solid. The plate was bent and it was placed on top of the cage. The screws were placed in C3 and C5. We had a very strong construct. Radiographs were taken that demonstrated the cage in appropriate position. Interpretation of plain radiographs is difficult and challenging at times due to the fact there is significant scoliosis and rotation. However, the C-arm was used in different angles and rotation and these showed that we had excellent placement of the cage, both radiographically and clinically. At the end of the case, he had excellent hemostasis. A drain was placed in.
Fascia closed in layers with 3-0 Vicryl. Final closure was done with a 2-0 Vicryl followed by 4-0 Vicryl. Steri-Strips were applied. The patient was awakened and taken to the recovery room. He was moving both upper extremities with no focal deficits. Due to the fact that it was a prolonged surgery, to avoid any respiratory complications, the patient was kept intubated overnight. There were no complications throughout this case. Due to its complexity, the surgery was undertaken in a meticulous stepwise fashion. All counts were correct at the end of the case. The next day, the patient was extubated and he was moving both upper and lower extremities. He had no focal deficit. Of note, due to the fact that he has scoliosis and rotation, to further stabilize this construct, I have recommended for the patient to have posterior spine stabilization.
