The patient came to the clinic 13-January-2016 complaining of progressive tetraparesis with numbness right upper limb 1 weeks after the performed diskectomy C4-5 15-June-2015 at Amman Surgical Hospital with progressive weak both lower limbs and coldness left side of the body the last 45 days. MRI of the cervical spine done before surgery 19-May-2015 showing very huge extruded central disc C4-5 with severe compression of the spinal cord. MRI performed 21-November-2015 after surgery showing the same compression with a Medtronic PEEK Prevail version with destroyed upper part of the C5 body with loose alignment with kyphotic deformity.  The patient has sleep apnea and using O₂ mask during sleep with hypertension for 20 years and using Baby aspirin. 

On examination: the patient is limping with pain when turning the head to all directions. There is weak right biceps 4/5 grip and extension right hand 3/5. Extension left hand 4/5 triceps left upper limb 3/5 and 4/5 left. There is weak all muscles right lower limb 4/5. Hoffmann positive right side, Babinski positive both sides with DTR D>>S.  SLRS 30 degrees right side due to weakness.

The patient was sent for new investigations: MRI cervical spine showing the extruded huge disc C4-5 still in place with central severe compression of the spinal cord with malacia at this level. Dynamic studies showing the Prevail in place with the lower screw in the destroyed upper C5 body. with kyphotic deformity. The patient was sent for cardio evaluation and stopped Baby aspirin for 5 days before surgery.

A new projectional incision done, because the old  incision was far lateral and not respecting the crease.  Massive scar was fronted during approach. The construct was exposed. The upper screw was removed but the lower was flail and removed. Due to lack of records about the first surgery, it was very difficult to remove the Prevail and it was necessary to drill it out because it became clear after 4 hours work that it was inserted to the upper part of the body of C5. The shallow disc space was hanging over the cavity and drilling was continued until the dura was seen all over the disc space. It was thin transparent and bulged to the cavity after decompression. A Cornerstone cage 6 mm height x 14x11 mm was inserted with bone graft.  Using Atlantis 2 level plate 42 mm length, fusion of C4-6 was achieved using 3 4x15 mm screws and one 4.5x15 mm screw. Attempt to include the C5 with the fusion, failed because there is no bone lifted to insert the screws. All stages of surgery were performed using the C-arm. Routine closure of the wound.

Smooth postoperative recovery. The power of right upper limb became better the the power of the right lower limb became normal.

PEEK Prevail is suitable for minor problem when the patient has one level without violating the bony body of the adjacent vertebrae. The lower body was violated and failure of fixation took place.

To resolve the problem, it s necessary to completely decompress the compression until the dura seen all over and put a higher PEEK with multilevel fixation to resolve the kyphotic deformity.

Removal of Prevail is very difficult due to its complex structure.