Prestige Artificial Disc above a previous cervical fusion: Case 4

Case Review #4: Cervical Spine Surgery with Prestige Artificial Cervical 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.