Diagnosis
Extensive cervical spine stenosis at the C3–C6 levels. Severe cervical myelopathy secondary to spinal canal stenosis. Previously diagnosed spinal canal stenosis at the L3/L4 and L4/L5 levels.
Patient:
Female, 56 years old, Russia
Physician:
Prof. Dr. med. Martin Scholz, Head of Neurosurgery Department, Sana Hospital Duisburg
Patient’s Complaints:
Bilateral arm pain, paresthesias described as a "crawling" sensation, exertional discomfort, recurrent headaches, and lower extremity pain accompanied by numbness.
Expert Opinion by Prof. Martin Scholz:
Cervical spine stenosis causing marked narrowing of the spinal canal can lead to severe neurological complications and carries significant long-term risks if left untreated. In this case, surgical intervention via C4 and C5 corpectomies is indicated.
We perform these procedures microsurgically, without requiring autologous bone graft harvesting. Vertebral reconstruction is achieved using a titanium Harms Cage filled with cancellous bone harvested directly from the resected vertebral elements. Segmental stabilization is then accomplished using an anterior Medtronic Atlantis plate and fixation screws.
Patient’s Inquiries:
- Local doctors recommended a multi-stage procedure. Is it possible to perform everything in a single surgery?
- What are the main surgical risks?
- How long does rehabilitation take, and can myelopathy be fully resolved?
- Could the dural sac have adhered to the spine over the years, requiring tissue glues to prevent tears during removal?
- Where will the cancellous bone for the titanium cage be obtained?
- How will the surgical approach be executed?
Doctor's Answers:
The corpectomy procedure will be performed in a single stage. In our department, the risk rate for this surgery is approximately 6% to 7%. While transverse spinal cord syndrome is a theoretical risk in complex cervical spine surgery, that risk is equally present if severe spinal cord compression remains untreated.
Based on our extensive surgical experience, we can decompress the cervical spine safely and effectively. Throughout the procedure, nerve function is continuously monitored using intraoperative somatosensory and motor evoked potentials.
Typically, patients are mobilized under the guidance of a physical therapist on the first postoperative day. Symptoms of myelopathy gradually subside, and rehabilitation—especially in non-smoking patients—progresses rapidly with a favorable long-term prognosis.
Adhesion of the dura mater to adjacent bony structures is a natural anatomical phenomenon. To address this safely, we utilize a microsurgical "floating technique" that enables us to dissect surrounding tissue and free the dural sac without tearing. This is standard protocol for such cases. Should a minor dural tear occur, utilizing dural sealant films or adhesives to prevent cerebrospinal fluid (CSF) leaks is also a routine preventative measure, alongside other specialized neurosurgical techniques.
The cancellous bone needed to pack the titanium cage is collected directly from the autologous bone fragments generated while milling the vertebral bodies, promoting natural bony fusion.
The operation is performed via an anterior approach. The C3 and C6 vertebrae will be partially shaved down to adequately widen the spinal canal. While this is a major intervention, it is routine for our team and highly achievable.
Preliminary Cost Estimate: €22,800
Treatment Rendered:
The patient underwent microsurgical cervical spine corpectomy with titanium cage reconstruction and anterior plate stabilization spanning the C3 to C6 segments.
The postoperative recovery proceeded smoothly without complications. The patient was fully mobilized during her inpatient stay. She reported mild residual neck discomfort and transient light headaches.
Postoperative CT scans of the cervical spine confirmed proper implant positioning with no signs of hematoma or hygroma. On the tenth postoperative day, the patient was discharged in good clinical condition under the care of her local physician.
Actual Cost of Treatment: €21,390
Watch the patient’s video review on our YouTube channel here.
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