Female with a massive C5/6 disc herniation after a surfing accident: Case 10

Case Review #10: Urgent Cervical Spine Surgery with Prestige Disc from Robert Pashman

36 year old female with a massive C5/6 disc herniation after a surfing accident. Dr. Pashman immediately put the patient in a cervical collar, followed urgent surgery. Dr. Pashman performed an anterior cervical discectomy with a Prestige Cervical Disc.

    Case Review: 

    A Massive C5/6 disc herniation treated urgently with a Prestige Artificial Disc

    Patient History:

    36 year old female
    Patient presented with neck pain radiating to the bilateral trapezial region,numbness and weakness in the hands, for approximately 3 weeks.
    She has had PT, yoga and chiropractic, but no nerve blocks or medicines.
    She went to see physiatry who ultimately referred her over to a spine surgeon who discussed alternatives of various surgeries, but then discharged her without medicine or protection.
    She sought another surgical opinion, but the physician had not performed Total Disc Replacement surgery on a patient before.
    The same day she had a consult in my office. The patient then came to see me for complaints of trapezial pain, numbness and weakness in the hands. At this point, the patient says that she has clumsiness in her hands and weakness. The patient had difficulty with forced abduction of her arms over her head at this point.
    On MRI the patient has a massive extruded disk herniation at C5-6 causing myeloradiculopathy with impending severe neurologic deficit including numbness and tingling in the hands, weakness, trapezial upper extremity with hyperreflexia in the upper and lower extremities and upper motor neuronsigns.

    Indications for Surgery:

    1. Massive extruded disk herniation, C5-6, with myeloradiculopathy.
    2. Spinal cord compression with evolving upper motor neuron signs, weakness in the upper and lower extremities, evidence of severe nerve compression.
    3. Degenerative disk disease, C5-6.
    4. Failed conservative therapy.
    5. Evidence of normal disks proximal and distal to extruded disk herniation, C5-6.

    Surgical Strategy:

    Radical diskectomy, spinal cord decompression under themicroscope, C5-6.
    Placement of Prestige Artificial Disc replacement measuring 6×16, at C5-6.
    Intraoperative somatosensory evoked potentials.
    Intraoperative fluoroscopic control.

    Post-operative Films:

    The disc is perfectly aligned in the spine.