CASE report

28-Year-Old Male with 6-Week History of Right-Sided Neck and Arm Pain

By Ehsan Jazini, MD

  Cervical Total Disc Replacement with prodisc C Vivo

Ehsan Jazini, MD

Virginia Spine Institute

Reston, VA


Medical School 
Albert Einstein College of Medicine, Bronx, NY

University of Maryland Medical Center, Baltimore, MD

Combined Neurosurgery and Orthopedic Fellowship in Adult & Pediatric Spine Surgery Norton-Leatherman Spine Center, Norton Hospital, Kosair’s Children’s Hospital

Areas of Interest:

Dr. Jazini’s reputation for providing the most customized treatment options has proven to elevate his patient outcomes. He was the first in the nation and in some instances, the world to perform advanced surgical techniques in cervical and lumbar disc replacement, augmented reality (AR) spine surgery, and robotic spine surgery. He performs these advanced surgeries using modern technology which improves operative control and patient safety and makes surgery less invasive for patients.

Patient History

28-year-old male presented with 6-week history of right-sided neck pain and right bicep, dorsal forearm and first- and second-digit pain and numbness. He also reports objective weakness of the right arm. The patient notes his pain began after sleeping in an uncomfortable position on a couch. He does note a similar episode a few months back; however, he notes it was much less severe and resolved within a few days. At this point the patient has tried a prednisone taper which did improve his pain slightly, however he still rates his pain 6 to 8 out of 10 on the visual analog pain scale. His neck to arm ratio 70:30. He denies difficulties with balance or dexterity. He denies specific exacerbating or alleviating factors regarding his pain.



No acute distress, AOx3, positive Spurling’s on the right.

Cervical Neurological Exam
Fasciculations Not present bilaterally
Hoffman’s Not present bilaterally
Clonus Not present bilaterally
Babinski Not present bilaterally
Biceps Reflex 2/4 bilaterally
Brachioradialis Reflex  2/4 bilaterally
Triceps Reflex  2/4 bilaterally
Grip Strength  5/5 bilaterally
Intrinsics Strength  5/5 bilaterally
Finger Flexor Strength 5/5 bilaterally
Finger Extensor Strength  5/5 bilaterally
Wrist Flexor Strength 5/5 bilaterally
Wrist Extensor Strength  5/5 left  |  4/5 right
Biceps Strength  5/5 left  |  3/5 right
Triceps Strength  5/5 bilaterally
Deltoids Strength  5/5 bilaterally
Shoulder Atrophy Not present bilaterally
Arms/Forearms Atrophy Not present bilaterally
Hand Atrophy Not present bilaterally

Cervical x-rays demonstrated loss of cervical lordosis with 50%-disc collapse at C5/6 with focal kyphosis. Mild scoliosis in his neck with apex at C5/6, <10 degrees. 

Cervical MRI demonstrated large right foraminal stenosis at C5/6 causing severe foraminal stenosis and cord displacement. 

Initial recommendation was epidural steroid injection and PT with close follow up in 2 weeks.

Patient reported continued right interscapular pain, arm weakness, arm numbness. Right biceps was 3/5, wrist extension 3/5 on the right.

FIGURE 1a: Pre-Operative A/P Radiograph
FIGURE 1b: Pre-Operative Lateral Radiograph
FIGURE 2a: Pre-Operative Flexion Radiograph
FIGURE 2b: Pre-Operative Extension Radiograph

Operative Planning

One level ACDR, prodisc C Vivo at C5-6. Vivo was selected due to relative domed shaped at C4-5. In this case given patient’s young age and no evidence of facet arthropathy on cervical radiographs CT was not obtained. Intraoperative fluoroscopy and findings after complete discectomy and release confirmed the decision making to stick with prodisc C Vivo due to endplate morphology.

FIGURE 3a: Pre-Operative MRI in Axial View at T2
FIGURE 3b: Pre-Operative MRI in Sagittal View at T2
FIGURE 4: One-Year Post-Operative A/P Radiograph
FIGURE 5a: One-Year Post-Operative Flexion Radiograph
FIGURE 5b: One-Year Post-Operative Extension Radiograph



Complete resolution of neck and arm pain with great restoration of motion and alignment goals.

Motion analysis (AI generated)
Adjacent: physiologic motion & abnormal level
Pre-Operative Flexion
C4/5 5.8 6.1 11.9  
C5/6 (abnormal) 5.5 0.7 6.2  
C6/7 5 2 7  
6 Months Flexion
Net Motion
C4/5 6 6.2 12.2 0.3
C5/6 (abnormal) 6.5 6 12.5 6.3
C6/7 6 1 7 0
Cervical Alignment Pre-Operative Post-Operative  
C2-7 degrees 6 kyphosis 8.6 lordosis  


AI Motion Analysis Interpretation 

Physiologic motion at upper levels are usually higher than lower levels as confirmed here. There is a relative lack of motion at C5-6 compared to C4-5 being down by 50%.

After surgery the motion at C4-5 and C5-6 are nearly identical with no changes at C6-7. 

The net motion gained is virtually all at C5-6. 

Alignment improved from 6 degrees of kyphosis at 8.6 degrees of lordosis.

Important Note: The information presented is for general education purposes only. As with any spine surgery, there are potential benefits, complications, and risks associated with disc replacement and spinal fusion procedures. Individual results may vary.

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