title: Adjacent segment degeneration at T1-T2 presenting as chest pain: case report.
abstract: METHODS
  A case report of a T1-T2 herniated disc adjacent to a cervical spine fusion.
  
  
  OBJECTIVE
  To describe the clinical presentation and treatment of a symptomatic T1-T2 disc herniation adjacent to an anterior cervical spine arthrodesis.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  The patient's symptoms resolved completely.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Tripler Army Medical Center, Honolulu, HI 96859-5000, USA. dfreccero@aol.com
authors.forename: David
authors.initials: D
authors.lastname: Freccero
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Donovan
mesh_terms: D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D003937:Diagnosis, Differential; D017586:Diskectomy; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications; D011843:Radiculopathy / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D013123:Spinal Fusion / Q000009:adverse effects*; D013904:Thoracic Vertebrae / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome