[firefighter]

Here's what we have decided to proceed with: the doctors chart notes -
We are hoping for the best possible outcome.

I had a long discussion with the patient and his wife regarding surgical options. I propose to remove the artificial disks. I am going to remove the anterior osteophytes at from C4 to C6.
Reconstruct the bony defects using allograft spaces. I am also going to use vivigen allograft with immature osteoblasts to help with the fusion and reconstructing the bone mass. If the anterior construct appears to be solid I think there is an 80% chance to avoid posterior fusion. In case the anterior graft is not solid the might proceed with an immediate posterior fusion procedure. I told the patient and his wife that complications this procedure include infections, CSF leaks, permanent or transient neurological deficits. There is also a risk dysphagia and hoarseness. There also is a risk of nonunion. I told the patient at this approximately 20%. If the patient's signs of nonunions at the 3 months follow-up I would then proceed with a posterior fusion construct. Also told the patient is a chance of plate fracture screw pullout. Is also risk associated with anesthesia such as stroke death and blindness.

The patient and his wife agree, asked appropriate questions and were willing to proceed.