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- Spinal Disorders
S.W. is a 45 year old woman with several years of worsening neck pain that radiated into her shoulders. She was developing some finger numbness. She spends a lot of time working on her laptop with her neck in a bent forward position. XRAYs and CT scan demonstrated a loss of her normal alignment. She is an example of what we have termed "text neck". MRI shows disc degeneration and disc herniations at C5-6 and C6-7causing some spinal cord and nerve root compression. Non-surgical treatments including physical therapy, NSAIDs, stretching and acupuncture failed to improve her pain. We therefore decided to proceed with a two-level artificial disc replacement.
Pre-surgery XRAYs, CT and MRI:
Post-operative XRAYs after two level artificial disc replacements:
Her neck pain is now improved, she no longer has radiating pain and her neck alignment has improved.
D.N. is a 36 year-old male with nearly 20 years of progressive low back pain. He loves to mountain bike and hike but his progressive low back pain was preventing him from doing these activities that he enjoys. This pain was likely from a degenerative disc at L5-S1. He then had a disc herniation at L5-S1 that caused radiating pain down into his buttock, thigh and leg into his foot, which prompted him to undergo a microdiscectomy that temporarily improved his leg pain. However, his pain returned and worsened and his low back pain also worsened. He was unable to mountain bike and hike and even had difficulty doing regular daily activities such as sitting and driving. He had failed all non-surgical treatments including physical therapy and injections. We therefore made the decision together to treat him with an anterior lumbar discectomy and artificial disc replacement.
Pre-surgical XRAYs of the lumbar spine showing extensive collapse of the L5-S1 disc. His other disc spaces look well maintained. Prior to deciding to perform an artificial disc replacement I performed extensive analysis of imaging, making sure that his pelvic tilt and pelvic incidence were not too great to prevent successful outcome after an artificial disc replacement.
Pre-surgical CT scan of the lumbar spine confirms near complete collapse of the L5-S1 disc. I also use a CT scan to evaluate the facet joints. This is an important thing to look at when deciding whether a patient is an ideal candidate for an artificial disc replacement.
After surgery he was discharged from the hospital one day after surgery and was walking well. By his 6 weeks post-surgical visit he was off all of his pain medications and walking 3 miles per day with minimal back pain and no leg pain. At 3 months post-op he reports that for the first time in 15 years he has zero back pain and no leg pain. He is back to participating in long hikes and is back on his mountain bike. Although not every patient achieves this kind of amazing result, this case highlights how an excellent outcome with an artificial disc replacement can be truly life-changing!
Post-operative XRAYS show optimal placement of the Aesculap ActivL artificial disc at the L5-S1 level and good motion during flexion and extension bending.
J.H. is a 27 year old gentleman over a year of neck pain and severe left arm pain that radiated into his middle finger. He has tried non-surgical treatments for over a year without improvement. XRAYs and CT demonstrated some mild degenerative collapse at C6-7. MRI demonstrated a disc herniation at C6-7 that was causing left C7 nerve root compression. Since he had not improved after over a year of non-surgical treatment and the nerve compression shown on MRI correlated with his pain, we decided to proceed with surgical treatment. We made the decision together to perform an artificial disc replacement to remove the diseased disc while maintaining motion by avoiding a fusion.
Pre-surgical XRAY, CT and MRI showing disc herniation at C6-7 with nerve root compression:
After surgery he went back to work the following week, his neck and radiating arm pain are now completely gone.
N.D. is a 44 year old gentleman with several years of low back pain, intermittent back spasms and more recently bilateral buttock pain. He exercises regularly and the pain has interfered with his exercise and with his job. XRAY demonstrated some collapse at L5-S1 and MRI demonstrated degenerative disc disease with disc bulging causing bilateral narrowing of the exiting space for the nerves. After long-standing pain and failure of non-surgical treatments we elected to proceed with an anterior lumbar discectomy and artificial disc replacement. He went home from the hospital the day after surgery. He began physical therapy 6 weeks after surgery and his low back pain and buttock pain are greatly improved.
Post-surgical XRAYs showing artificial disc replacement:
51 year old gentleman who works as a massage therapist with progressively worsening neck pain radiating into his right shoulder. He began to develop weakness in his right arm which made it difficult to perform his job as a therapist. Pre-surgical imaging demonstrated two levels of cervical degenerative disc disease with nerve compression. We elected to proceed with a two-level artificial disc replacement. He returned to work within two weeks, his neck pain and range of motion are greatly improved and his right arm pain and strength also improved.
Pre-surgical XRAYs and CAT scan:
Post-surgical XRAYs including forward bending (flexion), backward bending (extension) and side bending views show good range of motion of the artificial discs.
M.H. is a 63 year old gentleman with a history of ankylosing spondylitis causing his entire spine to be fused in a bent forward position (kyphosis). This position was making it very difficult for him to look up from the ground to talk to other people. It was also impossible for him to sit upright normally in a chair and he was unable to walk for more than a few minutes before his back muscles become very tired and painful.
After a lengthy discussion about the potential risks of a major deformity correction (“realignment”) surgery we decided to proceed with the surgery. We then spent a significant amount of time together planning the surgery. We ended up performing two osteotomies known as pedicle subtraction osteotomies (PSOs) at L1 and L3 with pedicle screws and rods from T11 to L5. The surgery was successful and he woke up without neurologic deficits, was up walking in the hospital two days later, and left the hospital on post-op day 6. He went home after spending a week in an inpatient rehab center. Mark is very happy with his new position. He has a comment in the patient testimonial section and his case has also been presented on SpineUniverse.
S.M. is a 56 year old male with neck pain and numbness in both hands. His symptoms started predominantly after falling and hitting his neck. On examination he had diminished sensation in his fingers on both sides and signs of spinal cord compression, referred to as myelopathy.
XRAYs of the cervical spine show collapsed disc spaces at 3 levels in his cervical spine with loss of his normal curvature.
CT scan of the cervical spine shows collapse of the disc spaces C4-5, C5-6 and C6-7 without arthritis of the facet joints.
MRI of the cervical spine shows disc herniations with compression of the spinal cord at these 3 levels.
He elected to undergo a 3-level anterior cervical discectomy and artificial disc replacement at C4-5, C5-6 and C6-7. At 3 months after the operation he reports no neck pain and his hand numbness slowly improved over this period.
Post-operative lateral flexion and extension XRAYs show maintained motion after three-level artificial disc replacement using the Medtronic Prestige LP
Note: The FDA has approved the Medtronic Prestige LP artificial disc for single and two-level use.
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