PMC6461846_01
Sagittal computed tomography image on admission of the patient to our department. We discern the plate and the cage after the anterior approach and decompression 2 years before at another institution
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Fig1
He had already had a double-level anterior cervical decompression and fusion (ACDF) with anterior plate and cage 2 years before in another institution (Fig. 1), although the symptoms didn't recede and became worse.
Sagittal magnetic resonance imaging image of the cervical spine showing the anterior plate and the cage on admission. This image demonstrates the significant compression of the cord at C4-C6 vertebrae level (blue arrow)
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Fig2
On this initial admission he was assessed as Nurick grade 3 and MRI revealed a multilevel significant posterior stenosis from the C4 to the C6 vertebrae (Fig. 2), with no sign of spinal cord ischemia.
Sagittal computed tomography image after the first decompression surgery to our department demonstrates the posterior decompression and fusion from C2 to C7, while no screw malposition was observed
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Fig3
Based on the clinical and radiological findings (compression onto the posterior cervical spinal cord) and with the limitation of the previous surgical intervention, he underwent posterior decompression from C3 to C6 and posterior fusion with lateral mass screws from C2 to C7 (Fig. 3).
Postoperative sagittal T2 magnetic resonance imaging image demonstrates a wide posterior decompression of the cervical spinal cord. A huge intramedullary hypertense area, exactly below the C6 vertebrae (green arrow) after the second surgery to our department approximately 24-28 h after the first surgery
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Fig4
Postoperatively, we performed cervical spine MRI that disclosed a hypertense signal in T2-weighted sequences at C6-C7 vertebrae (Figs. 4 and 5), just below the lowest level of our decompression.
Axial T2 magnetic resonance imaging image after the second surgery demonstrates clearly the intramedullary hypertense area (yellow arrow), highlighting the presence of the WCS
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Fig5
Postoperatively, we performed cervical spine MRI that disclosed a hypertense signal in T2-weighted sequences at C6-C7 vertebrae (Figs. 4 and 5), just below the lowest level of our decompression.