This is what my doctor is proposing. He is from what I have been informed one of the top 10-20 docs in world for cervical reconstruction. My previous posterior surgery I believe has caused these problems indicated. any ideas, comments or suggestions would be appreciated. Thank you, Bill
I have just had a telephone conversation with Mr. Bill and his wife to discuss potential surgical options for treatment of his cervicothoracic deformity. Mr. Bill is a 62-year-old man who has had multiple cervical procedures done elsewhere. These have included multilevel anterior cervical fusions as well as posterior C4-C7 instrumented arthrodesis. He presented to me with what appears to be a cervicothoracic kyphotic deformity. We have since obtained a CT myelogram of his cervical and thoracic spine. Given that Mr. Bill lives quite some distance away from the University, he wished to have a phone conference call to discuss his potential surgical options for treatment. I discussed with Mr. Bill and his wife, that with regard to surgery, my recommendation would be for a C2- T10 instrumented arthrodesis with a T2 pedicle subtraction osteotomy. We would likely need to remove at least in part if not completely his previous posterior instrumentation and potentially redirect some of the screws that are in place. I discussed with them that this would likely be a most of a day procedure with an anticipated 7 to 10-day hospital stay. We discussed potential risks that include, but are not limited to, spinal cord injury with paralysis, nerve injury, infection, need for blood transfusion, durotomy, failure to fuse with potential instrumentation failure and need for revision, adjacent level disease, instrumentation failure and/or compression fracture especially at the junctional levels, failure to relieve some or all of his symptoms, death, stroke, heart attack, coma, blindness, blood clots including in the legs and the lungs that could be lethal. In addition, we discussed off-label use of bone morphogenetic protein to assist with fusion. We discussed some of the potential risks of using BMP in the spine, which may include excess bone formation, fluid collection, nerve irritation, and possibly some increased risk of neoplasm. All of their questions were answered to their satisfaction. At this point, they would like to consider their options and their timeframe. They indicate they have a son getting married in early October and that if they decide to pursue surgery they would need to coordinate with this event. I did discuss with them that should they wish to hold off on surgery that I would be more than happy to follow them clinically as well. They have our contact information and we will await to hear from them should we be able to be of further service to them. They certainly know should they have any questions in the meantime they should feel free to reach out to us."