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Introduction
Anterior cervical decompression and fusion is a very commonly performed procedure.
Disc arthroplasty using artificial disc prostheses is a relatively new technology
used to try and maintain normal motion at the levels instrumented. This is the
first reported case of reversal of an instrumented cervical fusion using an
artificial disc prosthesis.
History
This 38-year-old male initially presented 7 months previously with arm pain
suggestive of a C6 radiculopathy. Imaging at that time showed a C6 disc protusion
compressing the exiting C6 nerve roots with no cord compression. He underwent
an anterior cervical decompression and fusion using allograft and a cervical
locking plate (see image below):
Approximately 6 months after his initial surgery he was reviewed with new symptoms
that had appeared after the initial surgery. He had pain and bilateral finger
flexor and extensor weakness suggestive of bilateral C7 radiculopathies. Repeat
imaging confirmed foraminal stenosis at the C6-7 level with no evidence of the
cord compression (see below):
Lateral MRI
Axial (overhead) MRI
The C5-6 level had not completing fused but no movement occurred on flexion/extension
studies and there was no evidence of hardware failure (see below):
Flexion
Extension
The patient requested surgical intervention for the C7 radiculopathies. It
was felt that the arthrodesis at the C5-6 level had contributed to the failure
of the C6-7 level. It was also requested, if at all possible to readdress the
C5-6 level.
Preoperative high resolution CT scanning confirmed failure of fusion of the
facet joints:
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