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CASE report
By Jason Cuéllar, MD
Jason Cuéllar, MD
Education:
Areas of Interest:
The patient has pain that radiates into the right trapezium and down into the forearm with numbness, tingling, and hand cramping. Symptoms have worsened over the past 18 months despite conservative treatments including physical therapy and chiropractic care.
Patient is tall and very active; he runs a men’s healthcare company.
Pre-op MRI demonstrates partial disc height collapse and foraminal stenosis at C5-6 and C6-7.
Pre-op dynamic radiographs demonstrate partial loss of disc height at C5-6 and C6-7 without instability or scoliosis.
Pre-op CT demonstrates right C5-6 uncovertebral joint osteophyte causing foraminal stenosis but minimal facet arthrosis.
Fusion was not considered for this active patient. Disc replacement is my ‘default’: if there is not a major reason to do a fusion—such as spinal instability—disc replacement is my automatic go-to.
Based upon pre-operative imaging, a two-level prodisc C Vivo was expected, however a mixed prodisc C Vivo & prodisc C SK was considered possible, as well.
During intra-operative trialing after discectomy and foraminotomies, I felt that the best fit at the C6-7 level was with a prodisc C SK—6mm tall by 18mm deep (Figure 6a). I then performed the discectomy and trialing at the C5-6 level and felt that the prodisc C Vivo was a perfect fit here (Figure 6b).
The patient’s height likely contributed to needing a 6mm size. About 25% of the time, I find I need to bump up to a 6mm implant—but, ultimately, I base my decision upon what I see during trialing.
The patient’s symptoms have completely resolved. The x-rays in Figure 8 were taken at the first post-op visit at 2 weeks.
I love having access to the variety of options that prodisc offers. As a backup during the procedure, I even have the original prodisc C implant available in the room to see what fits best during surgery.
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