This report details a complex case of anterior cervical corpectomy involving C4–C5 using an expandable vertebral prosthesis in a male patient with severe degenerative cervical disease due to longstanding rheumatoid arthritis. The resulting spinal deformity and neurological deterioration led to cervical myelopathy and substantial functional impairment. Given the presence of coexisting osteoporosis, surgical intervention posed unique challenges. Corpectomy was indicated to decompress the spinal cord, prevent further neurological decline, and restore spinal alignment. Post-surgical stabilization was achieved using an expandable implant and a cervical plate. The case highlights the compounded surgical risks presented by the coexistence of rheumatoid arthritis and osteoporosis, emphasizing the critical need for a tailored and multidisciplinary treatment approach.

A 62-year-old male with a 10-year history of rheumatoid arthritis and osteoporosis presented with progressive symptoms of cervical myelopathy, including muscle weakness, imbalance, and limited ambulation. Preoperative imaging demonstrated significant vertebral body deformity, critical spinal canal stenosis, and altered spinal cord signals, particularly at C4. The patient’s physical capacity was severely limited, with assistance required for standing and ambulation. Surgical intervention included a C4–C5 corpectomy and C3-C6 fixation via anterior approach, decompression, and placement of an expandable C3-C6 Harms vertebral cage and anterior cervical plate. No subluxation in the posterior elements was noted, eliminating the need for a posterior approach. Postoperatively, the patient showed improved mobility and pain levels and was transferred to a rehabilitation center for further therapy. CT scans at 3 months post-op confirmed the stability of the surgical construct and effective spinal decompression.

Anterior cervical corpectomy, especially using expandable implants, has become a standard approach for treating multilevel cervical spine pathologies. Expandable cages allow better anatomical fit and restoration of vertebral height while reducing operative time and complications. In this patient, the chosen implant provided optimal stability and neural decompression, critical given his compromised bone quality from RA and osteoporosis. The decision against posterior stabilization was based on preoperative imaging and lack of facet subluxation. Literature supports the efficacy and safety of expandable implants in such settings, though long-term outcomes require further study. This case aligns with other reports indicating significant clinical improvements following such interventions.

Multilevel cervical corpectomy using an expandable prosthesis and anterior plating offers a viable surgical solution for managing complex spinal pathologies involving degenerative changes, RA, and osteoporosis. This case underscores the value of patient-specific surgical planning, comprehensive preoperative imaging, and postoperative rehabilitation. Continued long-term follow-up is necessary to evaluate implant durability and overall patient outcomes, especially in populations with systemic comorbidities like RA and osteoporosis.

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