Spondylotic Cervical Myelopathy Treated with Two Level Artificial Disc Placement

Post-Operative Course
After surgery all arm symptoms resolved within 24 hours. Neck pain was minimal and there were no swallowing or voice problems. The patient was mobilized the morning after surgery, commenced oral intake and was discharged on postoperative day 3, without cervical immobilization in a collar. She returned to work 2 weeks postoperatively.

Postoperative imaging is shown below:

Figure 5A
Neutral xrays showing placement of the artificial
disk prostheses at the C5-6 and C6-7 levels.

Figure 5B
Flexion xrays showing placement of the artificial
disk prostheses at C5-6 and C6-7 levels.

Figure 5C
Extension xrays showing placement of the artificial
disk prostheses at the C5-6 and C6-7 levels.

Figure 6
Postoperative sagittal CT scans at C5-6 (left) and C6-7 (right)

Figure 7
Coronal reconstruction CT scans at C5-6 (left) and C6-7 (right).

Figure 8A
Axial CT scans at C5-6 (above).

Figure 8B
Axial CT scans at C6-7 (above).

Adequate decompression at these levels is observed with satisfactory decompression of the neural structures and reasonable alignment.

Discussion
Cervical disk replacement represents an exciting new technology is the management of cervical spondylotic disease. Typically only 1 level replacements are performed. This case illustrates that artificial disk replacement can be done at more than one level safely, with good clinical and radiological results. The long-term results of cervical arthroplasty are not known but at this early stage this technique represents a powerful tool in the management of spondylotic cervical disease.