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CASE report
By K. Brandon Strenge, MD
K. Brandon Strenge, MD
Education:
Areas of Interest:
The patient presented with right shoulder and arm radiculopathy.
He had weakness on exam in the right deltoid and biceps. The patient had no left arm symptoms at all.
The patient served in the Army and is a retired veteran.
MRIs illustrated mild degenerative disc disease from C4-6 with disc herniations at both C4-5 and C5-6. The axial slice through C4-5 showed a right central disc herniation causing central and mainly right-sided foraminal stenosis. The axial slice through C5-6 showed a central disc herniation also causing central and mainly right-sided foraminal stenosis. The axial slice through C6-7 showed a left-sided disc herniation causing some left-sided foraminal stenosis, however, the patient did not demonstrate any left-sided symptoms.
Upon examination, the patient had good motion on flexion-extension, so fusion was not considered at all. My operative plan was to use prodisc cervical devices and replace both discs at C4-5 and C5-6, giving me the flexibility to use either a domed or flat implant.
On his last office visit, 3 months post-operatively, his arm pain was gone and his strength was improving, with only slight residual weakness. He was working with physical therapy for it. All medications used pre-operatively were already discontinued at that point.
During the procedure, prodisc C Vivo fit well within the C4-5 concave endplate. I expected to use a flat endplate prodisc C SK at C5-6, however I trialed the domed prodisc C Vivo and it actually looked good, so I unexpectedly used matching implants.
It was very helpful to have the flexibility to use either a flat or a domed implant at either level. Having the different size options available to truly match patient anatomy that the Match-the-Disc™ System provides enabled me to avoid having to alter the patient’s anatomy to fit the device.
In future cases, I expect to use prodisc C Vivo to match the concavity with non-degenerated levels, and prodisc C SK for more degenerated levels, where flatter endplates may be needed. It is very useful to have a system that can adapt to the degenerated anatomy as needed.
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