A 62 year old male presented with a C5/6 disc herniation and arm weakness. Dr. Pashman treated him with a Prestige total disc replacement.
62 year old male with C5/6 Herniated Disc. Treated with a Prestige Artificial Disc
Acute disk herniation at C5-6.
Biceps weakness and hypesthesia, paresthesias into the thumb of the right hand.
The patient presented with a complete workup. On MRI it was found that he has critical spinal stenosis, C3-4, with multiple level degenerative disk disease. Interestingly enough, the proximal and distal segments to theC5-6 disk are very stiff and therefore the concentrated stress atC5-6 has caused this cervical disk herniation and acute symptoms. The patient was told there are multiple options, including an cervical fusion, including the stenotic segments and/or just the removal of C5-6 acute disk herniation causing the acute radiculopathy.
Indications for Surgery:
Extruded disk herniation, C5-6.
Motor sensory deficit radiculopathy, right arm, C6 distribution.
Critical spinal stenosis of C3-4, non-symptomatic.
Multiple level degenerative disk disease of cervical spine.
Failed conservative therapy.
1. Radical diskectomy under the microscope with epidural decompression and removal of soft disk herniation at C5-6.
2. Bilateral neural foraminotomy with osteophytectomy and subtotal vertebrectomy, C5 and C6, for removal of mass of uncovertebral osteophyte and neuroforaminal stenosis.
3. Anterior cervical total disk replacement, C5-6, with paresthesias, 6 x 16, 7 x 16 sizing.
4. Intraoperative SSEP.
5. Intraoperative fluoroscopy.
At the time of operation, the disk was severely degenerative. There was mass of uncovertebral osteophyte, right and left. The patient had a massive central disk herniation measuring approximately 10 x 10mm disk compressing the central dural sleeve and extending into the right neural foramen. The patient had significant neuro foraminal stenosis which was also decompressed.
The patient is doing quite well, and back to playing golf. He has almost complete relief of his symptoms. His strength is good, and the X-rays look good.