case_images: PMC9834929_01
case_images: Gait and gesture images and MRI of the patient. (a) Gait and balance
  disturbances can be observed in this patient. (b) Involuntary and excessive
  movements of the upper extremities were observed. (c) T2-weighted sagittal
  MRI view of cervical spine. Disk protrusions were observed in C3 to C7
  levels, and high signal intensities were observed in the spinal cord. (d)
  T1-weighted sagittal MRI view of the cervical spine.
case_images: 10.1177_2050313X221147191-fig1.jpg
case_images: PMC9834929_01_10.1177_2050313X221147191-fig1.jpg
case_images: fig1-2050313X221147191
case_images: The patient had generalized chorea including the head, neck, and extremities, though her cognitive ability seemed to be average (Figure 1). The Japanese Orthopedic Association (JOA) score was 11, visual analog scale (VAS) of neck pain was 6 (Figure 1). C3/4, C4/5, C5/6, and C6/7 levels, with increased spinal cord signal intensity from the C3/4 to C5/6 level on the T2-weighted sagittal MRI view (Figure 1). Cervical X-ray showed degenerative features in multiple segments, hyperplasia of Luschka joints, and formation of vertebral osteophytes (Figure 2).
case_images: (a) Preoperative cervical X-ray image. (b) Postoperative cervical X-ray image
  (3 days after operation). (c) Cervical X-ray 6 months after the operation.
  (d) T2-weighted sagittal MRI image six months after the operation.
case_images: 10.1177_2050313X221147191-fig2.jpg
case_images: PMC9834929_01_10.1177_2050313X221147191-fig2.jpg
case_images: fig2-2050313X221147191
case_images: C3/4, C4/5, C5/6, and C6/7 levels, with increased spinal cord signal intensity from the C3/4 to C5/6 level on the T2-weighted sagittal MRI view (Figure 1). Cervical X-ray showed degenerative features in multiple segments, hyperplasia of Luschka joints, and formation of vertebral osteophytes (Figure 2). After 6 months, the JOA score recovered to 16, and the X-ray showed well-placed instrumentation (Figure 2). MRI showed no compression of the cervical spinal cord, and the increased spinal cord signal on the T2-weighted image reduced to some extent (Figure 2).
case_images: Debridement of postoperative cervical hematoma. (a) Neck swelling and bruise
  can be observed around the incision postoperatively, which indicates
  postoperative hematoma. (b) Hematoma can be seen during initial wound
  opening. (c) A mess of dark red blood clots as well as exudation were
  removed from the peri-vertebral space.
case_images: 10.1177_2050313X221147191-fig3.jpg
case_images: PMC9834929_01_10.1177_2050313X221147191-fig3.jpg
case_images: fig3-2050313X221147191
case_images: Twenty minutes later, subcutaneous congestion around the incision could be seen, and tissue tension was high around the neck, and the patient complained of feeling neck swelling (Figure 3). During surgical exploration, a mess of dark red blood clots as well as exudation were seen under the platysma muscle (Figure 3). Until the last follow-up, the patient is satisfied with the treatment and feels significant improvement after the surgery (Figure 3).