Total Disc Replacement or Fusion

Hello Doctor (MRI report below)

I have a pinched nerve in C5-6 causing limited ROM and top of shoulder/scapula aching. I do not currently have numbness or tingling, though I have periodically, and there is some weakness, though doesn’t really present unless the arm is under high load (e.g. holding a baby for a long time, etc.)

I am an otherwise healthy 47 year old (previous herniated lumbar discectomy w/ resolved discitis following)

I have had one epidural with little to no lasting impact, and I’m going to get an additional one on Monday.

Should I continue to have pain/discomfort, living with this is not an option given it’s a pretty persistent ache/pain.

My surgical options are Total Disc Replacement at C5-6 with a Mobi-C device or anterior discectomy with bone graft and fusion.

My doctor said that fusions are tried and true with small risk of it “not taking” – but has been a standard for >50 years with excellent success.

The TDR with Mobi-C, he said, is also excellent, good outcomes, but that there isn’t sufficient data to say it’s better or as good as fusion for a single disk (for 2, he said there is enough data).

He said he wouldn’t dissuade me from either option, he gave me the pros and cons of both. The biggest “con” of the TDR to me is that we don’t have 50 years of data that tells us how the Mobi-C will hold up 10, 20 years down the road.

What are your thoughts on these two procedures? I would prefer the TDR with Mobi-C b/c it doesn’t involve fusion and therefore permanent loss of ROM.

Thank you!

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EXAM: MRI CERVICAL SPINE WITHOUT CONTRAST

HISTORY: Neck pain for 2 weeks.

TECHNIQUE: Sagittal T1, sagittal STIR, sagittal FSE T2-weighted images of the cervical spine with axial T2 FSE and axial gradient-echo images of C2-3 through C7-T1 were obtained on a 1.2T MRI unit.

COMPARISON: None available.

FINDINGS: Mild grade 1 retrolisthesis C3-4 and C4-5 are present.
There are no compression fractures or other definite spondylolisthesis.
There is mild C3-4, C4-5 and mild/moderate C5-6 spondylosis.
There is mild desiccation of the C2-3 and 4 disc without significant loss of disc height.
There is no marrow edema or destructive marrow process.

Posterior fossa structures, skull base, craniocervical junction, cervical and upper thoracic spinal cord are unremarkable.
Spinal canal is relatively capacious.
There are no intraspinal or paraspinal mass lesions.

At C2-3, there are no disc herniations, significant disc bulge, spinal stenosis or foraminal narrowing.

At C3-4, there is mild posterior disc bulging, left greater than right-sided uncovertebral spurring with mild/moderate left-sided foraminal narrowing. Right neural foramen is patent.

At C4-5, there is posterior disc osteophyte formation, superimposed small central leftward disc herniation (axial gradient echo image 13, series 8), uncovertebral spurring and mild right-sided foraminal narrowing. Left neural foramen is patent. There is no spinal stenosis.

At C5-6, there is left greater than right-sided posterolateral spondylotic ridging, moderate severe left and mild right-sided foraminal narrowing. There is no spinal stenosis.

At C6-7, there is a small left paracentral disc herniation with mild thecal sac flattening. There is no spinal stenosis or significant foraminal narrowing.

At C7-T1, there are no disc herniations, spinal stenosis or foraminal narrowing.

IMPRESSION:
1. Mild grade 1 retrolisthesis C3-4 and C4-5.
2. Mild C3-4, C4-5 and mild/moderate C5-6 spondylosis, mild/moderate left C3-4, mild right C4-5, moderate severe left and mild right C5-6 foraminal narrowing.
3. Small central leftward C4-5 disc herniation with mild thecal sac flattening.
4. Small left paracentral C6-7 disc herniation with mild thecal sac flattening.
5. No spinal stenosis.