History

The patient is a 54-year-old left-hand dominant male. He is a plumber and presented to Dr. Stieber with complaints of left arm weakness and numbness. The patient reported difficulty walking with balance problems and a loss of manual dexterity (e.g., difficulty writing).

Examination

On physical examination, he was found to have an unsteady gait, hyper-brisk reflexes (reflexes are increased), as well as significant left arm weakness and numbness.

Pre-Treatment Images

Cervical Myelopathy case study

Figure 1

Cervical Myelopathy case study

Figure 2

Figures 1 and 2 are preoperative X-Rays that show a narrow spinal canal from birth (congenital spinal stenosis) and radiographic evidence of disc degeneration/herniation.

Cervical Myelopathy case study

Figure 4

Figure 4. MRI; arrow points to a level of spinal cord compression

Cervical Myelopathy case study

Figure 5A. C3-C4

Cervical Myelopathy case study

Figure 5B. C4-C5

Cervical Myelopathy case study

Figure 5C. C6-C7

Cervical Myelopathy case study

Figure 5D. C6-C7

Figures 5A-5D are axial or overhead views of specific levels of the spine.

Diagnosis

Cervical spondylotic myelopathy; compression of the spinal cord at multiple levels resulting in spinal cord dysfunction.

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Cervical Myelopathy case study

Selected Treatment

The patient was treated with a C3-C7 cervical laminoplasty. The roof of the spinal canal was split and hinged open at each level (eg, C3-C4, C5-C6, C6-C7). The patient’s own bone was affixed to create an expanded arch, increasing space for the spinal cord and nerves while maintaining motion.

Post-operatively, the patient was placed in a soft cervical collar for two weeks.

Figure 6

Figure 6. Post-operative anteroposterior (front to back, AP) x-ray.

Cervical Myelopathy case study

Figure 7

Cervical Myelopathy case study

Figure 8

Cervical Myelopathy case study

Figure 9

Cervical Myelopathy case study

Figure 10

Figures 7 and 8 demonstrate that surgery maintained cervical (neck) motion.

Outcome

The patient experienced near complete resolution of his symptoms two weeks following the cervical laminoplasty. Strength in his left arm was completely restored. Walking and writing substantially improved. At one year after surgery, the patient’s cervical range of motion was maintained. He returned to his demanding work as a plumber.

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NYC spine surgery specialist, Dr. Jonathan Stieber, provides his patients with the most effective treatment options available, all of which are tailored to meet your individual needs. With Dr. Stieber guiding your care, it is possible to say goodbye to pain and enjoy an active lifestyle once again.

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