Cervicothoracic Junction Arthroplasty

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:

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.

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.