C5/6 Herniated Disc Treated with a Prestige Artificial Disc: Case 6

Case Review #6: 62 year old male presented with C5/6 Disc Herniation from Robert Pashman

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.

    Case Review: 

    62 year old male with C5/6 Herniated Disc. Treated with a Prestige Artificial Disc

    Patient History:

    62-year-old male
    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.

    Surgical Strategy:

    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.

    Inter-operative Findings:

    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.

    Pre-Op/Post-op Comparison:

    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.