14. Calado S, Viana-Baptista M. Benign cerebral angiopathy; postpartum cerebral angiopathy: characteristics and treatment. Curr Treat Options Cardiovasc Med 2006;8:201–12. 15. Hajj-Ali RA, Furlan A, Abou-Chebel A, et al. Benign angiopathy of the central nervous system: cohort of 16 patients with clinical course and long-term follow-up. Arthritis Rheum 2002;47:662–9. doi:10.1016/j.jocn.2008.03.014 Cervical arthroplasty for myelopathy adjacent to previous multisegmental fusion Ralph J. Mobbs a , Nicholas Mehan b , Peter Khong a, * a Department of Neurosurgery, Prince of Wales Hospital, Barker Street, Randwick, New South Wales 2031, Australia b University of New South Wales, Sydney, New South Wales 2052, Australia Received 14 March 2008; accepted 2 April 2008 Abstract In recent years, there has been increasing interest in the use of cervical arthroplasty for the treatment of degenerative cervical pathol- ogy. In its relative infancy, the applications for this technique are still being explored. In this report, we present the use of cervical arthro- plasty in the treatment of progressive cervical myelopathy due to adjacent segment disease related to previous multisegmental fusion. Ó 2008 Elsevier Ltd. All rights reserved. Keywords: Cervical; Arthroplasty; Myelopathy; Fusion; Surgery; Adjacent segment 1. Introduction Anterior treatment of cervical pathology has classically involved three principle techniques: anterior cervical disecto- my alone, anterior cervical disectomy with fusion, and ante- rior cervical disectomy and fusion with anterior plating. 1 Despite proven success, the shortcomings of such rigid ante- rior cervical arthrodesis have led to the development of alter- native techniques such as artificial disc replacement. Cervical arthroplasty for myelopathy has received little attention in the literature. This report demonstrates the use of this technique adjacent to a previous multisegmental fusion in a patient with myelopathy. 2. Case report A 55-year-old male presented with rapidly progressive cervical myelopathy including limb numbness and parasthe- sia, functional decline of his hands, urinary dysfunction and gait dysfunction with multiple falls. Relevant background history includes a C5/6 and C6/7 anterior cervical disectomy and fusion procedure with iliac crest grafting and plating performed 4 years prior to the current presentation. The ori- ginal fusion was performed for 2-level radiculopathy second- ary to degenerative disc disease, and there was initial complete resolution of symptoms. Examination revealed hyper-reflexic upper extremities and gait spasticity with a sensory level at C4, confirming a myelopathic picture. Pre-operative X-ray and MRI of the cervical spine are shown in Figs. 1 and 2, respectively. The X-ray confirms a solid fusion from C5 to C7, while the MRI demonstrates significant degenerative disc disease at C4/5 adjacent to the fused segment, with cord signal change. There is also evi- dence of disc degeneration at the C3/4 level with minor spinal canal impingement. A decision was made for urgent decompression of the C4/5 level. At operation, the previous anterior plate was identified and removed to precisely ‘‘seat” the C4/5 disc prosthesis. The plate and bone overgrowth around the plate was removed to allow accurate anterior placement. Microdiscectomy at this level was performed and a PRES- TIGE disc replacement (Medtronic, Memphis, TN, USA) inserted. Following surgery, the patient was reviewed at 6 weeks and then at 4 months. He returned to the functional level that he experienced after his initial disectomy and fusion procedure. No operative or hardware complications were identified. Flexion and extension radiographs were obtained at the 6-week mark (Fig. 3). Follow-up MRI at 9 months did not reveal any further deterioration of the C3/4 disc above the disc arthroplasty. On review at 18 months, the patient continued to experience improvement in hand function and sensation, as well as sphincteric con- trol, and no longer required a walking stick to mobilize. Gait spasticity, however, was unchanged. * Corresponding author. Tel.: +61 2 9382 2222; fax: +61 2 9650 4902. E-mail address: petekhong@yahoo.com (P. Khong). 150 Case Reports / Journal of Clinical Neuroscience 16 (2009) 150–152