Treatment of Two Level Artificial Disc Replacement for Cervical Spondylotic Myelopathy

Abstract

Cervical spondylotic myelopathy (CSM) is a common spinal disorder caused by compression of the spinal cord, due to degeneration of the cervical spine. We investigated post-operative results and suggest artificial disc replacement (ADR) as an effective surgical method for treating CSM. We present the case of a 36-year-old man, with nuchal pain; severe paresthesia of both upper and lower extremities; and pain, motor weakness, and difficulty in fine motor control of both hands. A cervical X-ray showed spondylotic changes at the C5-6, C6-7 level and MRI revealed cord compression at the C5-6, C6-7 level. ADR was performed at the C5-6, C6-7 level. After the surgery, the motor weakness of both upper extremities and paresthesia of both aspects improved. In addition, the JOA score and Nurick grade improved. A post-operative X-ray showed well positioned instruments, and post-operative MRI displayed no lesions of cord compression. Anterior cervical discectomy and fusion (ACDF) is widely accepted as a leading treatment for CSM, but ACDF may cause adjacent segment disease (ASD). We suggest that ADR also can represent a good surgical procedure for the management of multilevel spinal cord compression, as it can preserve cervical motion while avoiding ASD

Management of patients with cervical myelopathy

“…A cage implant is placed into the intervertebral space to restore its height and to stabilise the spine under the C arm control. Possible complications: C5 nerve root palsy (4.6%), reduced range of cervical motion, spinal cord injury, dysphagia (2-48%), hoarseness (temporary 3-11%), pseudarthrosis, perforation of the oesophagus, graft complication, carotid or vertebral artery injury (0.03%), dural tear with cerebrospinal fluid leakage, and degeneration of adjacent segments (3%) [4,17,18].…”

Evaluation of changes in cervical sagittal balance and clinical parameters in patients undergoing two-level anterior cervical discectomy and fusion

“…To restore its height and stabilize the spine, a cage implant is placed into the intervertebral space under C-arm guidance. 3,4 The anatomical structure of the vertebrae and the shape of the disc spaces ensure the positioning of the cervical spine in the lordosis position. To assess cervical lordosis, the cervical angle is measured (Cobb angle) as follows: lines are drawn along the upper endplate of the C2 vertebrae and the lower endplate of the C7 vertebrae and the angle between these 2 lines, where they intersect, is measured.…”