Progressive OPLL s/p laminoplasty

• 49 year old woman cc: L posterior arm pain L trapezial pain, neck pain, L IF pain

• HPI:C2C7 laminoplasty removing half of C2/C7 plates on C3-6, L C5C6 foramenotomy 1/9/14; initial symptoms 2013 were L shoulder pain elbow, forearm, L hand numbness

• MEDS: Benicar, HCTZ, Lexapro, Lipitor• SH: RHD mother 4 children, cashier and advocate at Wegmans, married• EXAM: 5’3” 210 lb negative clonus, hoffmans, 0/4 dtr normal motor,

normal shoulder exam

Old images from 2014 postop

Postop 1/10/14

Postop 1/10/14

Postop 1/10/14

Postop 1/10/14

c2

c3

Postop 1/10/14

Postop 1/10/14

C2c3 disc space

C3 pedicle

Next are recent images

5/11/16: note progression of OPLL at C2C3

May 2016 note OPLL At c3, flexion view

c2c3

c3

May 2016Note increasedOPLL at c2c3

2014

2016

Compare sagittal imagesTo view progression C2C3

c6c7

c5c6

c4c5

c3c4

c2c3

• Questions:• 1. c2 laminoplasty with plate enough?• 2. remove c3?• 3. fusion to stop progression of disease?• 4. L c6c7 foramenotomy• 5. fusion c2c3, lateral mass screws, fusion c6c7?