Upper thoracic spine arthroplasty via the anterior approach

Case report

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Significant progress has been made in lumbar and cervical disc replacement therapy. Several cervical disc prostheses have recently gained FDA approval. Although arthroplasty has not been previously described in the thoracic spine, selected patients with long-segment fusion to the level of C-7 have altered cervicothoracic and upper thoracic biomechanics and may benefit from motion-preservation therapy for T1–2 disc herniation. Currently, FDA-approved prostheses are indicated only for patients with single-level degenerative disc disease between C-3 and C-7 and no history of cervical arthrodesis.

The authors describe a 52-year-old woman who had previously undergone C3–7 fusion and returned 4 years later with symptoms of C-8 myeloradiculopathy and radiological evidence of T1–2 degenerative disc disease. She underwent T1–2 arthroplasty in which a Prestige artificial cervical disc was placed via an anterior cervicothoracic approach. Motion at C7–T1 and T1–2 was preserved, and the patient made an excellent clinical recovery.

Abbreviation used in this paper: DDD = degenerative disc disease.
Article Information

Contributor Notes

Address correspondence to: Kiarash Shahlaie, M.D., Ph.D., Department of Neurological Surgery, University of California, Davis, School of Medicine, 4860 Y Street, Suite 3740, Sacramento, California 95817. email: krshahlaie@gmail.com.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    An HSVaccaro ACotler JMLin S: Spinal disorders at the cervicothoracic junction. Spine 19:255725641994

  • 2

    An HSWise JJXu R: Anatomy of the cervicothoracic junction: a study of cadaveric dissection, cryomicrotomy, and magnetic resonance imaging. J Spinal Disord 12:5195251999

    • Search Google Scholar
    • Export Citation
  • 3

    Anderson PASasso RCRiew KD: Comparison of adverse events between the Bryan artificial cervical disc and anterior cervical arthrodesis. Spine 33:130513122008

    • Search Google Scholar
    • Export Citation
  • 4

    Bao QBYuan HA: Artificial disc technology. Neurosurg Focus 9:4e142000

  • 5

    Bastian LLange UKnop CTusch GBlauth M: Evaluation of the mobility of adjacent segments after posterior thoracolumbar fixation: a biomechanical study. Eur Spine J 10:2953002001

    • Search Google Scholar
    • Export Citation
  • 6

    Boockvar JAPhilips MFTelfeian AEO'Rourke DMMarcotte PJ: Results and risk factors for anterior cervicothoracic junction surgery. J Neurosurg 94:1 Suppl12172001

    • Search Google Scholar
    • Export Citation
  • 7

    Chang UKKim DHLee MCWillenberg RKim SHLim J: Changes in adjacent-level disc pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine 7:33392007

    • Search Google Scholar
    • Export Citation
  • 8

    Chung SSLee CSKang CSKim SH: The effect of lumbar total disc replacement on the spinopelvic alignment and range of motion of the lumbar spine. J Spinal Disord Tech 19:3073112006

    • Search Google Scholar
    • Export Citation
  • 9

    Daffner SDXin JTaghavi CEHymanson HJMudiyam CHongyu W: Cervical segmental motion at levels adjacent to disc herniation as determined with kinetic magnetic resonance imaging. Spine 34:238923942009

    • Search Google Scholar
    • Export Citation
  • 10

    Darling GEMcBroom RPerrin R: Modified anterior approach to the cervicothoracic junction. Spine 20:151915211995

  • 11

    David T: Long-term results of one-level lumbar arthroplasty: minimum 10-year follow-up of the CHARITE artificial disc in 106 patients. Spine 32:6616662007

    • Search Google Scholar
    • Export Citation
  • 12

    Delamarter RBFribourg DMKanim LEBae H: ProDisc artificial total lumbar disc replacement: introduction and early results from the United States clinical trial. Spine 28:S167S1752003

    • Search Google Scholar
    • Export Citation
  • 13

    Derincek AMehbod APinto MTransfeldt E: Degeneration of non-fused segments after floating lumbar fusion. Acta Orthop Belg 74:5075112008

    • Search Google Scholar
    • Export Citation
  • 14

    DiAngelo DJRoberston JTMetcalf NHMcVay BJDavis RC: Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech 16:3143232003

    • Search Google Scholar
    • Export Citation
  • 15

    Dmitriev AECunningham BWHu NSell GVigna FMcAfee PC: Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an in vitro human cadaveric model. Spine 30:116511722005

    • Search Google Scholar
    • Export Citation
  • 16

    Duggal NPickett GEMitsis DKKeller JL: Early clinical and biomechanical results following cervical arthroplasty. Neurosurg Focus 17:3E92004

    • Search Google Scholar
    • Export Citation
  • 17

    Eck JCHumphreys SCLim THJeong STKim JGHodges SD: Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine 27:243124342002

    • Search Google Scholar
    • Export Citation
  • 18

    Elsawaf AMastronardi LRoperto RBozzao ACaroli MFerrante L: Effect of cervical dynamics on adjacent segment degeneration after anterior cervical fusion with cages. Neurosurg Rev 32:2152242009

    • Search Google Scholar
    • Export Citation
  • 19

    Fernström U: Arthroplasty with intercorporal endoprothesis in herniated disc and in painful disc. Acta Chir Scand Suppl 357:1541591966

    • Search Google Scholar
    • Export Citation
  • 20

    Finn MABrodke DSDaubs MPatel ABachus KN: Local and global subaxial cervical spine biomechanics after single-level fusion or cervical arthroplasty. Eur Spine J 18:152015272009

    • Search Google Scholar
    • Export Citation
  • 21

    Frymoyer JWWiesel SW: The Adult and Pediatric Spine ed 3PhiladelphiaLippincott Williams & Wilkins2004

  • 22

    Gieger MRoth PAWu JK: The anterior cervical approach to the cervicothoracic junction. Neurosurgery 37:7047101995

  • 23

    Guyer RDMcAfee PCBanco RJBitan FDCappuccino AGeisler FH: Prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: five-year follow-up. Spine J 9:3743862009

    • Search Google Scholar
    • Export Citation
  • 24

    Hilibrand ASCarlson GDPalumbo MAJones PKBohlman HH: Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:5195281999

    • Search Google Scholar
    • Export Citation
  • 25

    Jho HD: Endoscopic transpedicular thoracic discectomy. Neurosurg Focus 9:4e42000

  • 26

    Johnson JPFiller AGMcBride DQ: Endoscopic thoracic discectomy. Neurosurg Focus 9:4e112000

  • 27

    Kim KDBabbitz JDMimbs J: Imaging-guided costotransversectomy for thoracic disc herniation. Neurosurg Focus 9:4e72000

  • 28

    Lakshmanan PAhmed SAl-Maiyah MLyons KDavies PRHowes J: The low anterior cervical approach to the upper thoracic vertebrae: a decision by preoperative MR imaging. Diagn Interv Radiol 13:30322007

    • Search Google Scholar
    • Export Citation
  • 29

    Lehman RA JrLenke LG: Long-segment fusion of the thoracolumbar spine in conjunction with a motion-preserving artificial disc replacement: case report and review of the literature. Spine 32:E240E2452007

    • Search Google Scholar
    • Export Citation
  • 30

    Lehner SSchreiber U: Investigation of the Influence of Interbody Fusion on Biomechanics of the Cervical Spine Using a Computer Model BerlinSpringer2007

    • Search Google Scholar
    • Export Citation
  • 31

    Lemaire JPCarrier HSariali HSari Ali HSkalli WLavaste F: Clinical and radiological outcomes with the Charité artificial disc: a 10-year minimum follow-up. J Spinal Disord Tech 18:3533592005

    • Search Google Scholar
    • Export Citation
  • 32

    McAfee PCFedder ILSaiedy SShucosky EMCunningham BW: Experimental design of total disk replacement-experience with a prospective randomized study of the SB Charitè. Spine 28:S153S1622003

    • Search Google Scholar
    • Export Citation
  • 33

    McCormick WEWill SFBenzel EC: Surgery for thoracic disc disease. Complication avoidance: overview and management. Neurosurg Focus 9:4e132000

    • Search Google Scholar
    • Export Citation
  • 34

    Mihir BVinod LUmesh MChaudhary K: Anterior instrumentation of the cervicothoracic vertebrae: approach based on clinical and radiologic criteria. Spine 31:E244E2492006

    • Search Google Scholar
    • Export Citation
  • 35

    Mobbs RJMehan NKhong P: Cervical arthroplasty for myelopathy adjacent to previous multisegmental fusion. J Clin Neurosci 16:1501522009

    • Search Google Scholar
    • Export Citation
  • 36

    Moquin RR: Operative techniques for fusion across the cervical-thoracic junction. Spine J 6:6 Suppl308S316S2006

  • 37

    Mummaneni PVRobinson JCHaid RW Jr: Cervical arthroplasty with the PRESTIGE LP cervical disc. Neurosurgery 60:4 Suppl 23103152007

    • Search Google Scholar
    • Export Citation
  • 38

    Murrey DJanssen MDelamarter RGoldstein JZigler JTay B: Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J 9:2752862009

    • Search Google Scholar
    • Export Citation
  • 39

    Nabhan ASteudel WINabhan APape DIshak B: Segmental kinematics and adjacent level degeneration following disc replacement versus fusion: RCT with three years of follow-up. J Long Term Eff Med Implants 17:2292362007

    • Search Google Scholar
    • Export Citation
  • 40

    Phillips FMAllen TRRegan JJAlbert TJCappuccino ADevine JG: Cervical disc replacement in patients with and without previous adjacent level fusion surgery: a prospective study. Spine 34:5565652009

    • Search Google Scholar
    • Export Citation
  • 41

    Pickett GEMitsis DKSekhon LHSears WRDuggal N: Effects of a cervical disc prosthesis on segmental and cervical spine alignment. Neurosurg Focus 17:3E52004

    • Search Google Scholar
    • Export Citation
  • 42

    Pickett GERouleau JPDuggal N: Kinematic analysis of the cervical spine following implantation of an artificial cervical disc. Spine 30:194919542005

    • Search Google Scholar
    • Export Citation
  • 43

    Pointillart VAurouer NGangnet NVital JM: Anterior approach to the cervicothoracic junction without sternotomy: a report of 37 cases. Spine 32:287528792007

    • Search Google Scholar
    • Export Citation
  • 44

    Porchet FMetcalf NH: Clinical outcomes with the Prestige II cervical disc: preliminary results from a prospective randomized clinical trial. Neurosurg Focus 17:3E62004

    • Search Google Scholar
    • Export Citation
  • 45

    Prabhakar MMThakker T: Anterior decompression for cervicothoracic pathology: A study of 14 patients. J Spinal Cord Med 29:1631662006

    • Search Google Scholar
    • Export Citation
  • 46

    Riew KDBuchowski JMSasso RZdeblick TMetcalf NHAnderson PA: Cervical disc arthroplasty compared with arthrodesis for the treatment of myelopathy. J Bone Joint Surg Am 90:235423642008

    • Search Google Scholar
    • Export Citation
  • 47

    Sasso RCBest NM: Cervical kinematics after fusion and bryan disc arthroplasty. J Spinal Disord Tech 21:19222008

  • 48

    Sasso RCSmucker JDHacker RJHeller JG: Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients. Spine 32:293329422007

    • Search Google Scholar
    • Export Citation
  • 49

    Sasso RCSmucker JDHacker RJHeller JG: Clinical outcomes of BRYAN cervical disc arthroplasty: a prospective, randomized, controlled, multicenter trial with 24-month follow-up. J Spinal Disord Tech 20:4814912007

    • Search Google Scholar
    • Export Citation
  • 50

    Sekhon L: Cervicothoracic junction arthroplasty after previous fusion surgery for adjacent segment degeneration: case report. Neurosurgery 56:1 SupplE2052005

    • Search Google Scholar
    • Export Citation
  • 51

    Sekhon LHSears WDuggal N: Cervical arthroplasty after previous surgery: results of treating 24 discs in 15 patients. J Neurosurg Spine 3:3353412005

    • Search Google Scholar
    • Export Citation
  • 52

    Sharan ADPrzybylski GJTartaglino L: Approaching the upper thoracic vertebrae without sternotomy or thoracotomy: a radiographic analysis with clinical application. Spine 25:9109162000

    • Search Google Scholar
    • Export Citation
  • 53

    Steinmetz MPMiller JWarbel AKrishnaney AABingaman WBenzel EC: Regional instability following cervicothoracic junction surgery. J Neurosurg Spine 4:2782842006

    • Search Google Scholar
    • Export Citation
  • 54

    Stillerman CBChen TCCouldwell WTZhang WWeiss MH: Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. J Neurosurg 88:6236331998

    • Search Google Scholar
    • Export Citation
  • 55

    Vollmer DGSimmons NE: Transthoracic approaches to thoracic disc herniations. Neurosurg Focus 9:4e82000

  • 56

    Wakefield AESteinmetz MPBenzel EC: Biomechanics of thoracic discectomy. Neurosurg Focus 11:3E62001

  • 57

    Wigfield CGill SNelson RLangdon IMetcalf NRobertson J: Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg 96:1 Suppl17212002

    • Search Google Scholar
    • Export Citation
  • 58

    Wigfield CCGill SSNelson RJMetcalf NHRobertson JT: The new Frenchay artificial cervical joint: results from a twoyear pilot study. Spine 27:244624522002

    • Search Google Scholar
    • Export Citation
  • 59

    Xu RGrabow REbraheim NADurham SJYeasting RA: Anatomic considerations of a modified anterior approach to the cervicothoracic junction. Am J Orthop 29:37402000

    • Search Google Scholar
    • Export Citation
  • 60

    Zigler JDelamarter RSpivak JMLinovitz RJDanielson GO 3rdHaider TT: Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease. Spine 32:115511632007

    • Search Google Scholar
    • Export Citation
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