| Comments: |
| The history suggests significant myelopathy that is at risk for neurological worsening.
Surgical approaches, though varied, should ultimately address the ventral compression first, at the C6 C7 levels. A simple decompressive diskectomy may not adequately decompress the caudal and rostral extension of the lesion. Thus, anterior corpectomies, partial or total, may be needed, followed by C5 to T1 strut graft fusion and intrumentation.
The stenosis at the higher cervical levels, in particular, C2/3 may pose a significant problem as well. Addressing the span of C2/3 all the way to C7/T1 level via a single anterior approach is not reasonable, nor safe,in this elderly 64 year old patient. Risks of laryngeal injury, post operative hematoma, and dysphagia are high if attempted.
Thus, a staged decompression is the most reasonable approach. Firstly, address the major compression at the lower cervical spinal levels via an anterior approach. Subsequently, one can address the multiple level degenerative spinal stenosis via a posterior multi level laminectomy.
(Strictly speaking, a stand-alone laminectomy--without the anterior approach--would be dangerous for neurological worsening post-operatively because of the spondylolisthesis and the loss of normal lordosis.)
Peter J. Yeh, MD Bellaire, TX--Peter Yeh, 2005-10-28 |