M. Ronai - ArgoSpine

Parallel presentation of two similarcases, with similar surgical solution anddifferent clinical outcome.Márton Rónai M.D.National Center for Spinal Disorders,HungaryNational Center for Spinal Disorders

64 y/o male Medical history• Hypertonic• Neck and right sided arm pain, numbness in the rightarm for one year despite of conservative treatment.• Fatigue in the lower extremities in the afternoonleeding to difficulties to walk.• No pain or numbness in the lower extremities or inthe low back.National Center for Spinal Disorders

Physical examination• Dysbasic walk.• No motor deficit in the upper nor in the lower extremities.• Paraesthesia in the right arm but not radicular.• Hyper reflexes in the lower extremities• Hypo reflex in the right upper extremity• No Babynsky nor Hoffmann-TrömnerNational Center for Spinal Disorders

National Center for Spinal Disorders

C4/5National Center for Spinal Disorders

What is the diagnosis/main pathology to treat?multiple choice1. Myeloncompression2. right sided radicular compression3. left sided radicular compression4. arteria spinalis anterior syndrome5. otherNational Center for Spinal Disorders

Our diagnosis was myeloncompression withclinical signes of myelopathy and right sidedradicular compression.National Center for Spinal Disorders

What treatment solution would you chose?single choice1. conservative treatment2. dorsal decompression3. dorsal decompression and stabilization4. dorsal decompression and anterior stabilization5. anterior decompression and stabilization6. otherNational Center for Spinal Disorders

We have chosen anterior decompression and stabilization.Which level/s would you include?multiple choice1. C3/42. C4/53. C5/64. C6/75. C7/D16. otherNational Center for Spinal Disorders

Our decision was to operate from C3 to C7 including C.5.corpectomyWhat implant would you use?single choice1. Autologous bone graft and plate C3-72. Titanium/PEEK cages and plate C3-73. Titanium/PEEK cages and plate C4-7and C3/4 prosthesis4. Bone cement and plate C3-75. otherNational Center for Spinal Disorders

Surgery on the 4th december 2008:Anterior discectomy C3/4, C4/5, C5/6, C6/7, C5 corpectomy, bothsided foraminal decompression, C3/4 Discover Prosthesis, C4-6modular PEEK cage, C6/7 PEEK cage with BCP.National Center for Spinal Disorders

One year FU:The patient’s not using any medication, has occasionaly (underload) local pain. No lower extremities fatigue6 mos FU6weeks FU 4° motion3 month FU 2° motion1 year FU 0° motionNational Center for Spinal Disorders

Similar case of a 41 y/o maleLeft sided arm painSever C5., C.6., C.7. sensomotor deficitElectrophisiology showes C5., C.6. radiculopathyNational Center for Spinal Disorders

Surgery on the 7th may 2008.Anterior discectomy C3/4, C4/5, C5/6, C6/7,C3/4 and C6/7 Discover prosthesis,C4-6 autologus bone graft + plateNational Center for Spinal Disorders

Good mobylity at 18 month FUNo arm pain, no neurological deficitBut local pain needing pain medication and repeated facet injections13° at C3/42° at C6/7National Center for Spinal Disorders

ConclusionHigher age, painfree facet arthrosis are realcontraindications?Is the main interest to reserve healthy ROM ormaybe only the capacity to optimise the patientssagital balance?National Center for Spinal Disorders

Thank You!National Center for Spinal Disorders