Case Review #4: Cervical Spine Surgery with Prestige Disc
Case Review:Prestige Artificial Discabove a previous fusionRobert S Pashman, MDScoliosis and Spinal Deformity Surgerywww.eSpine.com
Patient History57 yr old maleStatus post Anterior Cervical Discectomy and Fusion atC6/7 for radiculopathy.Massive neck pain and arm painOn MRI found to have myeloradiculopathy due to asecond level supra adjacent degeneration disk herniationat C4-5. The disk herniation effacing the cord into theneural foramen bilaterally.The patient was offered either a 3-level fusion, (becausedoing a fusion above and below a normal segment wouldput this segment at too much risk of having spinal corddecompression) or a cervical total disk replacement atthe C4/5 level.
Pre-op X-rays This patient is a unusual situation where there is a healthy level between the prior fusion andC4/5 Degenerated current discDisc degeneration at C4/5. An Anterior Cervical Discectomy and Normal Disc Fusion would require Space treating the healthy disc as well as the Previous degenerated disc. Fusion The Artificial Disc allowed us to treat only the affected area.
Indications for SurgeryDisk herniation at C4-5, cervical myelopathy.Status post anterior cervical diskectomy and fusion atC6-7.Normal C5-6 interval space.Failed conservative therapy.Motor sensory deficit
Surgical StrategySubtotal vertebrectomy, C4-5, removal of massiveuncovertebral osteophyte compressing spinal cord andnerve roots bilaterally.Radical diskectomy, C4-5, under the microscope withspinal canal decompression.Prestige total cervical disk replacement, 7 by 16, forreconstruction of cervical C4-5 disk space.Intraoperative somatosensory evoked potentials.Intraoperative fluoroscopy.