Cervicothoracic Junction Arthroplasty

Peer Reviewed

Introduction
Cervical arthroplasty is being performed increasingly throughout the world. In the United States FDA studies are currently underway evaluating single level arthroplasties from C3-C7. No case to date has looked at the cervicothroacic junction (C7/T1) with its altered biomechanical properties and difficult access.

History
This 25-year-old woman presented with a remote history of having undergone an two-level C5/6 and C6/7 anterior cervical decompression and fusion with plating and grafting five years previously at age 20. She had been well until approximately 12 months prior to the current presentation at which time she presented with a variety of complaints. Firstly, she had severe mechanical neck pain, worse on flexion. Secondly she had bilateral arm and shoulder pain suggestive of bilateral C4/C8 dysfunction. Initial imaging is shown below with a solid arthrodesis noted at the instrumented levels:

C4/C8 solid arthrodesis

Figure 1

The MR confirms adjacent segment degeneration at the C4/5 and C7/T1 levels with disc degeneration and neural compression at these levels.

C4/5 C7/T1 MR degeneration

Figure 2

In view of her current clinical and radiological profile she was offered surgical intervention. Because of her age and already extensive fusion, she was reluctant to undergo further fusion surgery. Consequently, she elected to have a Bryan® disc cervical prosthesis (Medtronic Sofamor-Danek, Memphis, TN) placed after decompression at both levels.

Updated on: 09/26/12
Todd Albert, MD
This case represents an interesting utilization of cervical total disc arthroplasty for junctional breakdown next to cervical fusion. The use of a cervical disc prosthesis at C-4/5 and C7-T1 adjacent to the solid fusion at C5-7 probably represents what will ultimately be the ideal indication for cervical disc arthroplasty. However, as yet the long-term results are completely unknown of this procedure and hence the reason for current FDA endorsed IDE trials. Caution should be utilized in assessing this case, as the author does not provide long-term follow up and it is reported in isolation of the longer term series currently available in the literature. Theoretically, it remains an exciting technology for this indication and time will tell whether it is the appropriate utilization and whether this particular device is the appropriate device.
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