This patient, a 36 year-old otherwise healthy data analyst, presented with intractable neck pain and burning cramps down his left arm, particularly in the tricep region. Physical therapy, non-steroidal anti-inflammatory medications, cervical traction and epidural steroid injections did not provide adequate relief or restoration of quality of life over a two month period of nonoperative management. Magnetic resonance imaging of the cervical spine was performed and demonstrated two levels of significant disk disease at C4-5 and C5-6, with acute herniations lateralizing to the left and corresponding to the patient’s symptoms.
Figure 1: Acute disk herniation at the C4-5 level. Note the lateralization to the left, corresponding to patient symptoms.
Figure 2: Acute disk herniation at the C5-6 level. This herniated disk fragment is more centrally located and endangers the spinal cord as well as the C6 nerve root.
Given the failure of nonoperative management the patient was taken to the operating room for a two level diskectomy in order to decompress his nerves and spinal cord. Taking his young age and otherwise good health into account, a two level artificial disk replacement was performed in lieu of a fusion surgery following removal of the herniated disks, in order to preserve spinal motion at the operated segments. The patient tolerated the procedure well and woke with resolved pain in his left arm. He was discharged from the hospital within 24 hours of the surgery and continued to improve at home. On initial follow-up his neck pain had almost completely resolved as well and he was requesting early return to work.
Figure 3: Postoperative dynamic flexion-extension Xrays demonstrating clear preservation of motion at the operated levels, with the arthroplasty devices allowing natural immediate neck movement. No cervical collar is required.
With modern techniques and appropriate case selection, many patients may find it possible to avoid a fusion surgery in the cervical spine and have a motion preserving surgery performed instead. This has been shown to significantly decrease the risk of requiring further operations as the spine ages, which is a known complication of fusion surgery, with equivalent or improved patient outcomes. This case illustrates the importance of selecting a board-certified complex spinal surgeon who is well versed and experienced with all currently available options available in the field.
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