“Not every nail needs a hammer” should be the title of this case.

This patient is very active and fit. He lifts daily and is in a very high functioning profession. Suddenly he developed severe pain (+weakness) radiating down his arm into his hand.

He did months of physical therapy and never improved. 

We obtained X-rays of his neck and this demonstrated degeneration of the C5-6 disc. I then obtained an MRI which demonstrated a large disc herniation at C5-6 that was severely compressing the C6 nerve going to his hand.

Notice that he also has a smaller disc herniation at C6-7 though this was not symptomatic. Also notice, he has modic endplate changes in the C5 & 6 vertebral bodies. See how the bone above and below the disc look white. The most illustrative way to interpret this is to think of modic endplate changes as little stress fractures in the bone (not entirely accurate but pretty reflective of what is happening). 

Most surgeons, myself included, if I were to just look at this MRI would think that this patient needs a 2 level spine fusion. 

But, he had little to no neck pain and so we did a single level disc replacement. The operation took about 30 minutes, he went home the same day, and has done amazingly well over the last 5 years.

Follow-up with this patient is easy… I see him everyday at work!