Physician 1st Quarter 2016 Spine Surgery IRR - Case Study #4
50-year-old female with prior authorization request for C 4–5 ACDF.
FOV 6/2015. The patient has chief complaint of neck pain which is severe and radiates to the right shoulder and elbow. She has a history of cervical fusion from C5–C7 in 2008.
Interval history suggests a motor vehicle accident in February 2015 when she developed additional symptoms including worsening of neck pain and radiculopathy. She underwent three epidural injections over the last six months and continues to have symptoms.
Her physical examination shows weakness in the right shoulder elevation and external rotation graded 4/5 with a positive Spurling sign.
X-rays of the cervical spine demonstrate a solid fusion from C-5 through C7.
MRI and CT scans of the cervical spine show right-sided severe C4–5 facet arthropathy with significant cord compression at C4–5.
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