Cervical Disc Replacement Case Studies

Following are a handful of Dr. Tack’s Cervical Disc Replacement Case Studies.  If you have additional questions on anything, please fill out our form, below.

 

Click the image to view this patient's x-rays.

This patient experienced progressive recurrence of neck pain several years after undergoing a successful ACDF (fusion)at the C5-6,C6-7 levels. After a prolonged attempt of conservative therapy including medications, physical therapy, and spinal injections, surgical treatment was considered.  Evaluation prior to treatment included an MRI which demonstrated progressive degeneration of the C4-5 disc above the prior fusion.  Cervical discography was performed at this level (injection of the presumed painful disc) which confirmed this as the origin of the patients disabling symptoms.  Cervical disc arthroplasty with a Synthes Pro-disc C device was performed without removal of previously placed hardware.  The patient was discharged less than 23 hrs after surgery and returned to work within 2 weeks.  The disabling symptoms have been dramatically reduced allowing the patient to progressively discontinue analgesic medications on which they were previously dependent. X-rays performed after surgery demonstrate normal motion at the replaced disc and the non-fused segments of the spine. Click here to view this patient’s x-rays.

 

Click the image to view this patient's x-rays.

This patient sought treatment for chronic neck pain with associated numbness, pain, and weakness in her arms.  Previous treatment had included medications, spinal injections and physical therapy.  X-rays and MRI demonstrated a congenital fusion at C2-3, advanced disc space narrowing with spinal stenosis at C5-6, with disc degeneration and spinal stenosis at C6-7.  Surgical treatment was performed with an ACDF (fusion) at C5-6 and disc arthroplasty with a Medtronics Prestige implant at C6-7.  Following surgery the patient experienced dramatic pain relief and returned to full occupational activities without restriction.  Traditional treatment would have required a two level fusion in addition to the patients congenital fusion resulting in a three level fusion with significant risk of further breakdown of the untreated levels.  Disc arthritic change at C5-6 was sufficiently advanced to preclude disc replacement at this level. Click here to view this patient’s x-rays.

 

Click the image to view this patient's post-surgical x-rays.

This patient was injured during the course of his employment as a firefighter.  He sustained an acute disc herniation at the C6-7 level below an assymptomatic degenerative disc at C5-6.  Despite 3 months of symptomatic treatment he continued to experience pain, weakness and numbness in his arm.  The patient was seen by a Professor of Orthopedic Surgery at a local University who recommended a two level fusion.  After evaluation he was offered the option of a single level disc arthroplasty at the C6-7 level leaving the assymptomatic disc at C-6 untreated. A Synthes Pro-Disc C arthroplasty was performed  This option was made possible by the fact that a disc arthroplasty does not increase stress at adjacent spinal levels.  After treatment the patient experienced dramatic relief of his symptoms and was allowed to return to unrestricted physical activity. Click here to view this patient’s pre-surgical x-rays and post-surgical x-rays.

 

Click the image to view this patient's post-surgical x-rays.

This 30 year old patient was previously treated with a fusion at C4-5 and C5-6.  Several years after surgery  symptoms of pain and numbness in the patients arms and hands developed which markedly impaired their activities of daily living.  Evaluation demonstrated severe spinal stenosis at the adjacent C3-4 and C6-7 levels.  Due to the severity of symptoms surgical treatment was deemed necessary,  The surgical options included  ACDF (fusion) at C3-4 and C6-7 or decompression and cervical disc arthroplasty at the C3-4 and C6-7 levels.  The patient opted for cervical disc arthroplasty which was performed with Medtronics Prestige disc implants.  After surgery the patient experienced symptomatic relief while maintaining normal mobility at the previously unfused levels.  Had ACDF been performed a 4 level fusion would have resulted which would have significantly diminished neck mobility with significant risk for further breakdown and additional surgery. Click here to view this patient’s pre-surgical x-rays and post-surgical x-rays.

 

Click the image to view this patient's post-surgical x-rays

This young patient experienced chronic neck pain and pinched nerve symptoms for four years.  Treatment including chiropractic care, physical therapy, and medications failed to provide symptom relief.  After being told by numerous physicians that nothing else could be done surgical consultation was obtained.  The patients MRI demonstrated a degenerative disc at C5-6.  The Medtronics Prestige disc replacement device had recently been released by the FDA.  The options of ACDF (fusion) or disc replacement were offered.  Because of their young age the patient did not want a fusion and arthroplasty was selected.  Immediately after surgery the patient experienced dramatic relief of their chronic pain.  They were able to return to all physical activities with no requirement for use of analgesic medications. Click here to view this patient’s post-surgical x-rays.

 

Click the image to view this patient's post-surgical x-rays.

This patient was previously treated for neck pain and nerve pain in her arm with an ACDF at C5-6,C6-7.  She experienced excellent pain relief.  Several years later neck and arm pain reoccurred and became functionally disabling.  Evaluation demonstrated disc degeneration with spinal stenosis at the level above the previous fusion.  After failure of symptomatic treatment surgical options were considered.  Because of the relatively short interval between the prior ACDF and breakdown of the adjacent disc the patient did not want to undergo another fusion procedure.  The option of disc arthroplasty was discussed and selected.  A Medtronics Prestige implant was utilized above the previously placed hardware.  The patient experienced dramatic pain relief with rapid return to normal function. Click here to view this patient’s pre-surgical x-rays and post-surgical x-rays.

 

Disc replacement adjacent to cervical fusion: a biomechanical comparison of hybrid construct versus two-level fusion.

Lee MJ, Dumonski M, Phillips FM, Voronov LI, Renner SM, Carandang G, Havey RM, Patwardhan AG.
Source: Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, IL, USA.

Abstract

STUDY DESIGN: A cadaveric biomechanical study.

OBJECTIVE: To investigate the biomechanical behavior of the cervical spine after cervical total disc replacement (TDR) adjacent to a fusion as compared to a two-level fusion.

SUMMARY OF BACKGROUND DATA: There are concerns regarding the biomechanical effects of cervical fusion on the mobile motion segments. Although previous biomechanical studies have demonstrated that cervical disc replacement normalizes adjacent segment motion, there is a little information regarding the function of a cervical disc replacement adjacent to an anterior cervical decompression and fusion, a potentially common clinical application.

METHODS: Nine cadaveric cervical spines (C3-T1, age: 60.2 ± 3.5 years) were tested under load- and displacement-control testing. After intact testing, a simulated fusion was performed at C4-C5, followed by C6-C7. The simulated fusion was then reversed, and the response of TDR at C5-C6 was measured. A hybrid construct was then tested with the TDR either below or above a single-level fusion and contrasted with a simulated two-level fusion (C4-C6 and C5-C7).

RESULTS: The external fixator device used to simulate fusion significantly reduced range of motion (ROM) at C4-C5 and C6-C7 by 74.7 ± 8.1% and 78.1 ± 11.5%, respectively (P < 0.05). Removal of the fusion construct restored the motion response of the spinal segments to their intact state. Arthroplasty performed at C5-C6 using the porous-coated motion disc prosthesis maintained the total flexion-extension ROM to the level of the intact controls when used as a stand-alone procedure or when implanted adjacent to a single-level fusion (P > 0.05). The location of the single-level fusion, whether above or below the arthroplasty, did not significantly affect the motion response of the arthroplasty in the hybrid construct. Performing a two-level fusion significantly increased the motion demands on the nonoperated segments as compared to a hybrid TDR-plus fusion construct when the spine was required to reach the same motion end points. The spine with a hybrid construct required significantly less extension moment than the spine with a two-level fusion to reach the same extension end point.

CONCLUSION: The porous-coated motion cervical prosthesis restored the ROM of the treated level to the intact state. When the porous-coated motion prosthesis was used in a hybrid construct, the TDR response was not adversely affected. A hybrid construct seems to offer significant biomechanical advantages over two-level fusion in terms of reducing compensatory adjacent-level hypermobility and also loads required to achieve a predetermined ROM.

Click the image to view this patient's post-surgical x-rays.

This patient is a 46 year old who injured his neck during the course of his employment. He experienced neck pain radiating into his shoulder and arm.  He was initially treated with analgesics, anti-inflammatories, and activity modifications without improvement. Subsequent imaging demonstrated disc herniations and spinal stenosis at the C 5-6 and C 6-7 levels. Treatment with epidural steroid injections failed to alleviate his symptoms. He received a prolonged course of physical therapy without benefit. Due to the severity of symptoms and inability to return to employment the patient opted for surgical treatment. He was presented with the option of a 2 level fusion or a 2 level cervical disc arthroplasty. After researching the options he elected to proceed with the arthroplasty. Following surgery performed as an outpatient he noted dramatic relief of his symptoms. After a brief course of PT he was returned to work as a laborer. The patient’s radiographs demonstrate normal motion at the C5-6 and C6-7 discs.  Click here to view this patient’s x-rays.


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