Prestige Disc For Herniated C4/5 C4.5

User Manual: C4.5

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Case Review:
60 year old male, with
massive herniation at C4/5.
Treated with a Prestige
Total Disc Replacement
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.NeckPainExplained.com
Patient History
60
60-
-year
year-
-old male
old male
Significant neck and arm pain with numbness.
Significant neck and arm pain with numbness.
Massive acute soft disk
Massive acute soft disk herniation
herniation at C4
at C4-
-5 causing significant cord compression
5 causing significant cord compression
and secondary
and secondary gliosis
gliosis changes in the cord.
changes in the cord.
Significant degeneration at C3
Significant degeneration at C3-
-4, C5
4, C5-
-6 and C6
6 and C6-
-7. The
7. The juxta
juxta vertebral stiffening no
vertebral stiffening no
doubt concentrated stress through the open C4
doubt concentrated stress through the open C4-
-5 level which caused the soft disk
5 level which caused the soft disk
herniation
herniation and compressed the cord at this particular level.
and compressed the cord at this particular level.
The problem is at this point that the patient would, in my opini
The problem is at this point that the patient would, in my opinion, need a much
on, need a much
larger reconstruction if fusion was done which would include pos
larger reconstruction if fusion was done which would include possibly multiple level
sibly multiple level
anterior cervical
anterior cervical diskectomy
diskectomy and fusion, and/or possibly that and posterior
and fusion, and/or possibly that and posterior
laminectomy or
laminectomy or laminoplasty
laminoplasty if the patient's neurologic status did not resolve.
if the patient's neurologic status did not resolve.
Therefore, after the alternatives, benefits and complications we
Therefore, after the alternatives, benefits and complications were discussed with
re discussed with
the patient completely, I discussed with him the option of doing
the patient completely, I discussed with him the option of doing a single level
a single level
anterior
anterior diskectomy
diskectomy and doing a total disk replacement at C4
and doing a total disk replacement at C4-
-5 interval to these
5 interval to these
other disks. It was my impression that
other disks. It was my impression that myeloradiculopathy
myeloradiculopathy was no doubt due to the
was no doubt due to the
soft disk
soft disk herniation
herniation, and this was a viable option. I told him that he may need
, and this was a viable option. I told him that he may need
further reconstruction including a fusion or a posterior decompr
further reconstruction including a fusion or a posterior decompression and that
ession and that
there was little precedent for this sort of strategy
there was little precedent for this sort of strategy--
--the use of artificial disk
the use of artificial disk
replacement for
replacement for myeloradiculopathy
myeloradiculopathy +/
+/-
-gliosis
gliosis or changes in the cord has been
or changes in the cord has been
hotly debated.
hotly debated.
Pre-op X-rays
Flexion/Extension X-rays
Indications for Surgery
Myeloradiculopathy
Myeloradiculopathy due to massive spinal cord
due to massive spinal cord
compression, C4
compression, C4-
-5.
5.
Multiple level degenerative disk disease, C3
Multiple level degenerative disk disease, C3-
-4, 5
4, 5-
-6, 6
6, 6-
-7,
7,
with combination of hard and soft disk and superimposed
with combination of hard and soft disk and superimposed
anterior effacement.
anterior effacement.
Early motor/sensory deficit due to massive extruded soft
Early motor/sensory deficit due to massive extruded soft
disk
disk herniation
herniation, C4
, C4-
-5, with
5, with gliosis
gliosis and spinal cord
and spinal cord
changes.
changes.
Failed conservative therapy.
Failed conservative therapy.
Significant arm and neck pain with numbness.
Significant arm and neck pain with numbness.
Surgical Strategy
1.
1. Cervical
Cervical vertebrectomy
vertebrectomy, C5, for removal of massive
, C5, for removal of massive
anterior and posterior
anterior and posterior uncovertebral
uncovertebral osteophyte
osteophyte and
and
compression.
compression.
2.
2. Spinal canal decompression under the microscope for
Spinal canal decompression under the microscope for
removal of extruded disk
removal of extruded disk herniation
herniation soft disk
soft disk
compressing the spinal cord terminally.
compressing the spinal cord terminally.
3.
3. Bilateral neural
Bilateral neural foraminotomy
foraminotomy with removal of
with removal of
uncovertebral
uncovertebral osteophyte
osteophyte, C4
, C4-
-5.
5.
4.
4. Placement of Prestige 7x16 total cervical disk
Placement of Prestige 7x16 total cervical disk
arthroplasty
arthroplasty for reconstruction of
for reconstruction of diskectomy
diskectomy site.
site.
5.
5. Intraoperative
Intraoperative somatosensory
somatosensory evoked potential and
evoked potential and
motor evoked potentials.
motor evoked potentials.
6.
6. Intraoperative
Intraoperative fluoroscopy.
fluoroscopy.
Post-Op Films
The patient’s symptoms
resolved immediately following
surgery. Within two weeks he
resumed his normal activities,
including driving an RV across
country to work on a Habitat
for Humanity construction site.
Post-Op Films
Pre-Op/Post-op Film Comparison
Pre-Op/Post-op Comparison
Pre-Op/Post-op Comparison

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