Clinical Course
40 year old with 4 year history of episodic arm pain with periods of no symptoms between episodes developed a constant right arm pain with numbness radiating into the forearm and severe right should blade pain.. Over the four year period, he was treated conservatively with physical therapy and medications with intervals of relief of symptoms.

Diagnostic Tests
A Cervical MRI scan revealed a right C6-C7 herniated disc. A cervical myelogram and contrast CAT scan showed lack of filling of the C7 nerve root sleeve with contrast dye and a herniated disc at the C6-C7 level.

Decision
The surgical options at the time consisted of anterior or posterior surgery and include fusion versus no fusion. The indications for surgery were severe arm pain and numbness in a C7 nerve root distribution.

Surgical Treatment
An anteror cervical discectomy and fusion with cervical plating was used with complete resolution of the patient's clinical symptoms. His arm and shoulder blade symptoms resolved with surgery and he returned to his full activities.

Surgeon's Comment
Both the anterior and posterior options were considered for this patient. Because of his recurrent episodes with promient shoulder blade pain, a fusion was felt to be a valuable aspect of the operation in conjunction with the herniated disc removal. A single level anterior cervical discectomy and fusion with cadaver bone has a high fusion rate and high clinical success rate for the selected patient with arm pain.