**6.1 Case 1 C56 ADR C67 ACDF**

51 year old female who presents with cervical pains which she describes as 80% neck pain and 20% arm/shoulder pain, which is 100% left-sided in a C6 and C7 distribution. MRI of the cervical spine demonstrated a C5-C6 3 mm disc herniation with facet arthropathy and severe bilateral foraminal stenosis (**Figure 7a,b**). At C6-C7 a 2 mm left paracentral disc protrusion was noted with severe bilateral foraminal stenosis (**Figure 7c**). For her pain, the patient had tried a prolonged course of conservative management in the form of physical therapy, heating pads, and ice packs. She had tried medications in the form of NSAID's, muscle relaxants and narcotics. She had consulted with pain management and undergone injection procedures in the form of transforaminal epidural injections at C56 and later

### **Figure 7.**

*(a) Sagittal MRI of the cervical spine demonstrated a C5-C6 and C67 disc herniations. (b) Axial MRI of the cervical spine demonstrated a C5-C6 bilobed herniation with severe bilateral foraminal stenosis. (c) At C6-C7 a 2 mm disc protrusion was noted with severe bilateral foraminal stenosis. (d) AP Xray artificial disc replacement at C56 and anterior cervical discectomy and fusion at C67. (e) Lateral Xray artificial disc replacement at C56 and anterior cervical discectomy and fusion at C67.*

at C67, which each provided one hundred percent pain relief and lasted for one month. Patient underwent an uncomplicated Artificial Disc Replacement at C56 and Anterior Cervical Discectomy and Fusion at C67, and has since noted complete resolution of her symptoms (**Figure 7d, e**).

## **6.2 Case 2 C45 ACDF C56 ADR C67 ACDF**

48 year-old female who presented with 95% neck pain and 5% shoulder pain, which is 50% right-sided and 50% left, sided in a C5, C6, and C7 distribution. MRI of the cervical spine demonstrated at the C4-C5 level moderate central spinal

### **Figure 8.**

*(a, b) Sagittal MRI of the cervical spine demonstrated herniations at the C4-C5, C56, C67. (c) Axial MRI of the cervical spine demonstrated C45 large disc herniation with neuroforaminal stenosis. (d) Axial MRI of the cervical spine demonstrated 56 eccentric disc herniations with left sided neuroforaminal stenosis. (e) Axial MRI of the cervical spine demonstrated C67 eccentric disc herniation with right sided neuroforaminal stenosis. (f) AP Xray artificial disc replacement at C56 and anterior cervical discectomy and fusion at C45, and C67. (g) LATERAL Xray artificial disc replacement at C56 and anterior cervical discectomy and fusion at C45, and C67.*

### *The Cervical Hybrid Arthroplasty DOI: http://dx.doi.org/10.5772/intechopen.95950*

canal stenosis, a 4 mm disc protrusion with moderate-to-severe neural foraminal, narrowing bilaterally and impingement on the exiting nerve roots bilaterally **Figure 8a-c**. At the C5-C6, level, there was a 4 mm left paracentral disc protrusion with severe neural foraminal narrowing on the left and moderate foraminal narrowing on the right. There is impingement on the exiting nerve roots bilaterally greater on the left than the right (**Figure 8d**). At the C6-C7 level, there was a 5 mm right paracentral disc protrusion with severe neural foraminal narrowing on the right with impingement on the exiting nerve roots on the right (**Figure 8e**). There is moderate neural foraminal narrowing on the left and moderate central spinal canal stenosis. For her pain, the patient had tried a prolonged course of conservative management in the form of physical therapy, chiropractic treatment, heating pads, and ice packs. She had tried medications in the form of NSAID's, muscle relaxants and narcotics. She had consulted with pain management and undergone three injection procedures in the form of transforaminal epidural injections at C45, C56 and later at C67, each of which provided seventy percent pain relief and lasted for one to three months. Patient underwent an uncomplicated Artificial Disc Replacement at C56 and Anterior Cervical Discectomy and Fusion at C45 and C67, and has since noted resolution of her symptoms (**Figure 8f**, **g**).
