By Jason Cuéllar, MD
This patient is a 36-year-old male with a history of neck pain radiating into both shoulders, numbness in radial 3 fingers of both hands. The onset was after he hit an open car while riding his bike, flipped over the handlebars, and hit his head. He was treated conservatively for a year with physical therapy and pain management.
He has no past medical history and is in excellent shape, very active physically.
His MRI demonstrated disc herniation at C5-6 without adjacent segment pathology. The herniation level corresponded to his radicular distribution (C6).
I planned pre-operatively to use prodisc C Vivo and therefore during surgery I did not use my usual drill carpentry on the upper endplate and left it intact convex. Trialing was critical–he is 6’5” tall so I started with a 6mm tall XL Deep trial and I felt this fit perfectly. The trial was easily moveable but not loose. The facet joint gapping matched that of the adjacent segments. I was able to place the dome within the endplate with a perfect match while also achieving perfect placement of the center of rotation. I honestly walked out of this case thinking how much I love prodisc C Vivo since it fits so perfectly.
At the four-month follow-up appointment, there was a complete resolution of symptoms.
Implant selection was a critical pre-operative consideration. This patient is a young athletic person, so I wanted to use a device with proven core longevity and biomechanics. Preoperative considerations included measuring his disc on the preop MRI – at 20mm deep, this excluded several implants that only make a 16mm deep footprint.
In addition, since he is 6’5” tall, I wanted a 7mm tall option available if needed; this also excluded some of my implant options. Finally, his superior endplate is concave, making an implant with a convex upper endplate an ideal fit.
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