For patients with multilevel cervical stenosis at nonadjacent segments, one of the traditional approaches has included a multilevel fusion of the abnormal segments as well as the intervening normal segment. In this video we demonstrate an alternative treatment plan with tailored use of a combination of anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) with an intervening skipped level.
The authors present the case of a 72-year-old woman with myeloradiculopathy and a large disc herniation with facet joint degeneration at C3–4 and bulging disc at C5–6. After nonoperative treatment failed, she underwent a single-level ACDF at C3–4 and single-level arthroplasty at C5–6, which successfully relieved her symptoms. No intervention was performed at the normal intervening C4–5 segment. By using ACDF combined with arthroplasty, the authors have avoided a 3-level fusion for this patient and maintained the range of motion of 2 disc levels.
The video can be found here: https://youtu.be/OrxcPUBvqLk.