Restoration of Spinal Motion: Conversion of Anterior Cervical Fusion With Pseudarthrosis to Artificial Disc Replacement

Case example of a 38-year-old male with a pseudoarthrosis at C5–C6 and disc degeneration at C4–C5. Preoperative anterior-posterior (AP), lateral, flexion, and extension radiographs (a, b). Preoperative computed tomography (CT) cuts through the median sagittal, right paramedian, and left paramedian axes (c) demonstrate pseudoarthrosis. Cuts through the right and left facet joints (d), demonstrating no arthropathy. Preoperative magnetic resonance imaging demonstrates disc degeneration at C4–C5 with left foraminal stenosis (e). Intraoperative fluoroscopic images demonstrate the use of the intradiscal Cloward spreader to open up the disc space after the prior bone graft had been excised using the high-speed drill, followed by trialing (f). Trialing and final artificial disc replacement (ADR) insertion was performed after the disc space was mobilized (g). Postoperative AP, lateral, flexion, extension, and side bending radiographs demonstrate restoration of motion at the C5–C6 level and maintained motion at C4–C5 after ADR (h–j).