Adjacent Segment Degeneration at T1–T2 Presenting as Chest Pain

Abstract

A case report of a T1-T2 herniated disc adjacent to a cervical spine fusion. To describe the clinical presentation and treatment of a symptomatic T1-T2 disc herniation adjacent to an anterior cervical spine arthrodesis. Symptomatic adjacent segment disease after cervical spine arthrodesis occurs most commonly in the lower cervical spine motion segments and has not been previously reported at T1-T2. A 51-year-old female patient presented 4 years after three-level anterior cervical discectomy and fusion involving the C5-T1 levels. She complained of chronic chest pain and had undergone extensive medical evaluation before presentation. Magnetic resonance imaging revealed a left-sided T1-T2 herniated disc compressing the T1 nerve root. She underwent T1-T2 anterior discectomy and fusion. The patient's symptoms resolved completely. Adjacent-segment degeneration after cervical spine fusion may rarely occur even at T1-T2, and the unusual symptoms of a T1 radiculopathy may obscure the diagnosis. The combination of sharp anterior paramedian chest pain and numbness or weakness of the hand should prompt consideration of the diagnosis when cardiac ischemia or other more serious conditions have been ruled out.