C5/6 Disc Herniation: Case 11

Case Review #1: 38 year old female with a single level cervical disc herniation from Robert Pashman

A 38 year old female, presented with a one level disc herniation. Dr. Pashman treated her with an Anterior Cervical Discectomy and Fusion.

    Case Review:

    One Level ACDF for a C5/6 Disc Herniation

    Patient History:

    38 year old female
    C4-5 Degeneration with mild stenosis, but no C5 complaints
    C5-6 Degenerative Disc Disease
    Severe degenerative joint disease, C5-6
    Foraminal stenosis, C5-6
    Kyphotic spine, C5-6
    C6 radiculopathy, pain to the thumb and hands bilaterally
    Severe neck pain
    Failed conservative therapy
    We discussed fusion both C5- 6 and C4-5, but it appears to me at this point that she would be much better served by having a single anterior cervical diskectomy and fusion at the C5-6. She has no C5 nerve root complaints. I also told her that the probability is that instead of having a two-level fusion, she might do well by having an artificial disk replacement at C4-5 if this should ever become a problem.

    Pre-op Films:

    The patient has a disc herniation at the C5/6 level as marked. There is a mild bulge at C4/5, but this is asymptomatic.

    Indications for Surgery:

    Cervical 6 radiculopathy.
    Severe degenerative joint disease, C5-6.
    Foraminal stenosis, C5-6.
    Kyphotic spine, C5-6.
    Anterior mass of posterior osteophyte, necessitating subtotal vertebrectomy.
    Failed conservative therapy.

    Surgical Strategy:

    Radical diskectomy, C5-6.
    Subtotal vertebrectomy, anterior osteophyte, undergoing total osteophyte removal constituting one-third of vertebrae, C5 and C6.
    Anterior interbody fusion with a Cornerstone device with autogenous bone graft, measuring 7 mm, C5-6.
    Anterior plate fixation using an four-hole plate atC5-6.
    Intraoperative somatosensory evoked potentials.
    Intraoperative fluoroscopy.

    Post-Op Films:

    The patient is status post anterior cervical discectomy and fusion and is doing quite well. She has minimal shoulder pain. Her symptoms are much improved over her preoperative status. Her x-rays look good. Incision is well-healed. She has no more numbness and tingling in the fingers or hand.