Case Review #10: Urgent Cervical Spine Surgery with Prestige Disc
36 year old female with a massive C5/6 disc herniation after a surfing accident. Dr. Pashman immediately put the patient in a cervical collar, followed urgent surgery. Dr. Pashman performed an anterior cervical discectomy with a Prestige Cervical Disc.
Published on: Mar 4, 2016
Transcripts - Case Review #10: Urgent Cervical Spine Surgery with Prestige Disc
Case Review:A Massive C5/6 discherniation treated urgentlywith a Prestige Artificial DiscRobert S Pashman, MDScoliosis and Spinal Deformity Surgerywww.eSpine.com
Patient History36 year old femalePatient presented with neck pain radiating to the bilateral trapezial region,numbness and weakness in the hands, for approximately 3 weeks.She has had PT, yoga and chiropractic, but no nerve blocks or medicines.She went to see physiatry who ultimately referred her over to a spine surgeonwho discussed alternatives of various surgeries, but then discharged herwithout medicine or protection. She sought another surgical opinion, but thephysician had not performed Total Disc Replacement surgery on a patientbefore. The same day she had a consult in my office. The patient then cameto see me for complaints of trapezial pain, numbness and weakness in thehands. At this point, the patient says that she has clumsiness in her hands andweakness. The patient had difficulty with forced abduction of her arms overher head at this point.On MRI the patient has a massive extruded disk herniation at C5-6 causingmyeloradiculopathy with impending severe neurologic deficit includingnumbness and tingling in the hands, weakness, trapezial upper extremity withhyperreflexia in the upper and lower extremities and upper motor neuronsigns.
Indications for Surgery1. Massive extruded disk herniation, C5-6, with myeloradiculopathy.2. Spinal cord compression with evolving upper motor neuron signs, weakness in the upper and lower extremities, evidence of severe nerve compression.3. Degenerative disk disease, C5-6.4. Failed conservative therapy.5. Evidence of normal disks proximal and distal to extruded disk herniation, C5-6.
Surgical StrategyRadical diskectomy, spinal cord decompression under themicroscope, C5-6.Placement of Prestige Artificial Disc replacement measuring6x16, at C5-6.Intraoperative somatosensory evoked potentials.Intraoperative fluoroscopic control.
Post-operative Films The disc is perfectly aligned in the spine.