Prestige Artificial Disc above a previous cervical fusion: Case 4

Case Review #4: Cervical Spine Surgery with Prestige Disc from Robert Pashman

A 57 year old male presented after a C6/7 fusion. He had a 2nd level supra adjacent disc herniation. (two levels above the fusion). Dr. Pashman treated him with a Prestige Artificial Disc.

    Case Review: 

    Prestige Artificial Disc above a previous fusion

    Patient History:

    57 yr old male
    Status post Anterior Cervical Discectomy and Fusion atC6/7 for radiculopathy.
    Massive neck pain and arm pain
    On MRI found to have myelo radiculopathy due to a second level supra adjacent degeneration disk herniation at C4-5.
    The disk herniation effacing the cord into the neural foramen bilaterally.
    The patient was offered either a 3-level fusion, (because doing a fusion above and below a normal segment would put this segment at too much risk of having spinal cord decompression) or a cervical total disk replacement at the C4/5 level.

    Pre-op X-rays:

    This patient is a unusual situation where there is a healthy level between the prior fusion and C4/5
    An Anterior Cervical Discectomy would require treating the healthy disc as well as the degenerated disc. The Artificial Disc allowed us to treat only the affected area.

    Indications for Surgery:

    Disk herniation at C4-5, cervical myelopathy.
    Status post anterior cervical diskectomy and fusion at C6-7.
    Normal C5-6 interval space.
    Failed conservative therapy.
    Motor sensory deficit

    Surgical Strategy:

    Subtotal vertebrectomy, C4-5, removal of massive uncovertebral osteophyte compressing spinal cord and nerve roots bilaterally.
    Radical diskectomy, C4-5, under the microscope with spinal canal decompression.
    Prestige total cervical disk replacement, 7 by 16, for reconstruction of cervical C4-5 disk space.
    Intraoperative somatosensory evoked potentials.
    Intraoperative fluoroscopy.

    Pre-Op/Post-op Comparison: 

    The patient is doing well post-operatively. His neck pain and arm pain have almost completely resolved.