PMC9633090_01
A, B: Cervical images of the acute phase of head trauma. A: Computed tomography shows anterior dislocation of a cervical vertebral body (arrow: C6 vertebral body). B: Magnetic resonance T2-weighted image shows compression of the spinal cord at the C6/7 level.
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C, D: Cervical images of the chronic phase after cervical fusion surgery. C: Reset and fusion of the cervical vertebral body are confirmed via computed tomography. D: Magnetic resonance T2-weighted image demonstrates residual high-intensity findings of the spinal cord at the C6/7 level.
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E: Schematic diagram shows the location of sensory disturbances (dark gray: pain, light gray: numbness).
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F-G: Cervical X-rays show the location of spinal cord stimulation devices (red circle: location of spinal cord injury). F: Cylinder-type electrodes placed at the caudal side of the spinal cord injury. G, H: A paddle-type electrode placed at the rostral side of the spinal cord injury.
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Computed tomography (CT) showed dislocation of a cervical vertebral body (Fig. 1A). C6/7 level was detected (Fig. 1B). Cervical fusions were performed in the acute traumatic stage (Fig. 1C). MRI demonstrated residual high-intensity findings of the spinal cord (Fig. 1D). Motor function was noted to improve gradually, although pain at bilateral upper extremities remained (Fig. 1E). Adhesion was so strong that the cylinder-type electrodes were placed on the caudal side of the SCI (Fig. 1F). Then, a paddle-type electrode (Model 977C190; Medtronic Inc.) was placed at the rostral side of the previous surgical site by laminectomy under general anesthesia (Fig. 1G, H).
PMC9633090_02
A, B: Lumbar images after the second spinal surgery. A: Computed tomography shows Th10/11 and L5/S1 fusions. B: Magnetic resonance T2-weighted image shows compression of the spinal cord by thoracic disc herniation with high-intensity findings at the Th10/11 level.
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C, D: Lumbar images after the third spinal surgery. C: Thoracic posterior decompression is confirmed on computed tomography. D: Magnetic resonance T2-weighted image demonstrates residual high-intensity findings of the spinal cord at the Th10/11 level.
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E: Schematic diagram shows the location of sensory disturbances (dark gray: pain).
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F, G: Thoracic X-rays show a paddle-type electrode placed at the rostral side of the spinal cord injury (red circle: location of spinal cord injury).
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The first surgery was Th10/11 anterior lateral fusion 8 years earlier, and the second surgery was L5/S1 fusion 6 years earlier, and these fusions were confirmed on CT (Fig. 2A). Th10/11 level (Fig. 2B). The third surgery, that is, thoracic posterior decompression, was performed 5 years earlier. Laminectomies of Th10 and 11 were confirmed on CT (Fig. 2C). MRI showed residual high-intensity findings of the spinal cord (Fig. 2D). After the third surgery, pain and numbness of the bilateral lower extremities and a gait disturbance were noted to appear (Fig. 2E). Therefore, a paddle-type electrode (Model 977C165; Medtronic Inc.) was placed at the rostral side of the previous surgical site via laminectomy (Fig. 2F, G).
PMC9633090_03
A: Schematic diagram shows the location of sensory disturbances (dark gray: pain, light gray: numbness).
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B-E: Cervical images before implantation of the spinal cord stimulation device.
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B-D: Magnetic resonance T2-weighted images show C4/5 and C6/7 level spinal cord compression with high-intensity findings (C, white arrows: C4/5, D, block arrows: C6/7). E: Computed tomography shows the previous fusion of C6/7 and spinal canal stenosis.
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F, G: Cervical images show cervical posterior decompression and placement of a spinal cord stimulation device (F: magnetic resonance image, I: computed tomography).
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H, I: The X-rays show a paddle-type electrode located at the rostral side of the C6/7 level (red circle: location of spinal cord injury).
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Unfortunately, he presented with new-onset pain in his bilateral upper extremities and deteriorated gradually (Fig. 3A). CT showed C4/5 and C6/7 level spinal cord compression with high-intensity findings and spinal canal stenosis (Fig. 3B-E). Combination surgery of posterior decompression and paddle-type electrode placement was performed, using the following surgical procedures. The vertebral arches from C3 to C6 were opened in double-door form, the superior margin of the C7 vertebral arch was whittled, the yellow ligament was removed, a paddle-type electrode was placed (Model 977C265; Medtronic Inc.), laminoplasties were performed, and an IPG was implanted (Fig. 3F, G). The X-ray showed the paddle-type electrode located at the rostral side of the C6/7 level (Fig. 3H, I).