(a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable cord compression. 4 ' 5 The first T1-2 disc herniation case was reported in 1954 by Sivien and Karavitis. A Rare Case of T1-2 Thoracic Disc Herniation Mimicking Cervical T1T2 disc herniation: Report of four cases and review of the literature. Informed consent to present the data concerning the case for publication was obtained by the patient. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. 2021 Mar 17;12:108. doi: 10.25259/SNI_941_2020. New left-sided partial ptosis and pupillary miosis were found on facial examination (Figure 1, A). Some error has occurred while processing your request. Myelopathy is rare. Please try again soon. They can help rule out other conditions and give you a referral to a specialist. A cervical herniated disc may cause a number of symptoms in different parts of the body. This sympathetic pathway begins in the hypothalamus and synapses in the intermediolateral gray substance of the spinal cord at C8-T2 levels making it susceptible to disruption via a high thoracic intervertebral disk herniation. Extruded upper thoracic disc causing horner's syndrome:Report of a case. Some common signs and symptoms of a cervical herniated disc include: Neck pain. (h) Postoperative T2-weighted MRI: showing appropriate decompression of the spinal cord at T1T2 level. Patients with cervical radiculopathy symptoms and physical examination findings consistent with Horner syndrome should be evaluated with a MRI that includes the upper thoracic spine. Where. If the lower thoracic region is involved, a patient may encounter pain radiating to one or both lower extremities. official website and that any information you provide is encrypted (i) Postoperative T2-weighted MRI demonstrates the cage in T1T2 interspace. It can result from advanced disc degeneration or from vertebral body remodeling . 42: 193-5, 26. Thoracic Herniated Disc: Symptoms and Treatment There are several treatment options for thoracic herniated discs. 48: 128-30, 8. This is disc herniation. Report of four cases and literature review. Federal government websites often end in .gov or .mil. A 29-year-old surgical resident presented to the emergency department complaining of acute onset left periscapular back pain, along with progressive left medial forearm and fourth and fifth digit numbness with grip weakness of the left hand. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler: a case report. FOIA This impingement typically produces neck and radiating arm pain or. It can range from a mild pain that feels tender when touched to a sharp or burning pain. Radiating pain may be perceived to be in the chest or belly, and this leads to a quite different diagnosis that will need to include an assessment of heart, lung, kidney and gastrointestinal disorders as well as other non-spine musculoskeletal causes. 1986. Thoracic spinal cord injuries are typically less severe than injuries to the cervical spinal cord. (e) Showing removal of the sequestrated disc fragment. Svien HJ, Karavitis AL. The C8 nerve root innervates the extensor indicus and abductor pollicis brevis from the radial and median nerves, respectively, in addition to finger flexion (ulnar nerve). While the anterior approach tends to be a more familiar approach to most spine surgeons, certain anatomic restrictions may limit its use for T1-T2. Background: Symptomatic T1-T2 disc herniations are rare and, in most cases, are located posterolaterally. Lumbar diskectomy is a common procedure for the management of lumbar radiculopathy, but recurrent lumbar disk herniation is one of the most common complications of the procedure, sometimes necessitating repeat surgery. JAMA 1965;191:627-631. The rib cage adds extra protection, support, and stabilization to the spine, making it less susceptible to damage in general and disc trouble in particular. 2016 May;25 Suppl 1:204-8. doi: 10.1007/s00586-016-4402-y. Medications, traction, dry needling, and epidural spinal injections can be used with physical therapy to help manage pain and allow the body to heal on its own, says Dr. Good. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Possley, Dr. Luczak, Dr. Angus, and Dr. Montgomery. The 2023 edition of ICD-10-CM M51.24 became effective on October 1, 2022. Before 2010. Winter RB, Siebert R. Herniated thoracic disc at T1-T2 with paraparesis. Background: A 23-year-old male collegiate wrestler injured his neck in a wrestling tournament match and experienced pain, weakness, and numbness in his left upper extremity. sharing sensitive information, make sure youre on a federal In the form the patient has given her consent for her images and other clinical information to be reported in the journal. i have a t1-2 herniated disc pinching a nerve, possible thoracic outlet. A herniation here may cause pain at the back or chest around the first rib, or pain in the ring and/or pinky fingers. [ 4 , 6 , 27 , 30 , 34 ] However, for central T1T2 disc herniations, resulting in significant myelopathy, anterior surgery may be warranted (e.g., the low cervical-manubrium method and/or limited sternal splitting procedures). The four cases of T1T2 discs included two females and two males who ranged in the age group from 36 to 67 years (average: 47 years). However, it is most common in men between the ages of 40 and 60. Intradural disc herniations comprise 0.26-0.30% of all herniated discs. (d) Axial T2-weighted axial view also confirms disappearance of the disc. Myeloradiculopathy: C8 and T1 radiculopathy - ScienceDirect Nowadays, endoscopic techniques have become increasingly popular and full-endoscopic surgery can be performed in the thoracic spine . 13. Bulge is a term for an image and can be a normal variant . 2022 Jan;212:107062. doi: 10.1016/j.clineuro.2021.107062. This is the T1 nerve root which originates from the T1-T2 region. Well tell you how, why, and what you can do to treat a thoracic herniated disc if you have one and prevent them in the future. The details of 36 cases with T1T2 disc herniation. The authors certify that they have obtained all appropriate patient consent forms. PMC 2000. T1-T2 Herniation: The T1 spinal nerve is responsible for the ring and pinky fingers and the area around the first rib. Experiencing pain in your thoracic region could be due to many conditions that can affect these tissues, including: More common causes of thoracic spine pain that directly involve your spinal column include: Conditions that specifically affect your vertebrae, spinal cord and/or nerve roots in your thoracic spine, include: Other conditions that can affect any region of your spine, including your thoracic region, include: You may have had a medical exam that revealed an underlying health problem. People who have a herniated disk often have radiating numbness or tingling in the body part served by the affected nerves. 34: 68-77, 7. All the discs in the spine, have an inner soft part with harder shell outside. CT can be used to complement MRI in cases of thoracic disk herniations. Follow-up magnetic resonance studies documented full resolution for the patient with . 6. MRI diagnosis is C7/T1 and C6-C7 severe foraminal narrowing and stenosis. Osteoarthritis appeared to be the predominant cause of the disc herniation in both patients. But they can also happen after more severe trauma in the absence of osteoporosis or as a result of tumors on your spine. (d) Axial T2-weighted axial view also confirms disappearance of the disc. A report of five cases. We reviewed 4 cervical T1-T2 disc herniations; two central/anterolateral lesions warranting anterior surgical approaches/cages, and 2 lateral discs treated with a posterolateral transfacet, pedicle-sparing procedure and no surgery respectively. So when we provideAyurvedic treatment of T1-T2 slip disc we are careful about providing a proper solution. Conclusions:We reviewed 4 cervical T1T2 disc herniations; two central/anterolateral lesions warranting anterior surgical approaches/cages, and 2 lateral discs treated with a posterolateral transfacet, pedicle-sparing procedure and no surgery respectively. J Orthop Sci. (h) Postoperative T2-weighted MRI: showing appropriate decompression of the spinal cord at T1T2 level. There are some simple things that you can do at home to help alleviate the pain. (g) Post-operative CT AP X-ray: shows the cage in T1T2 disc space. 2). Publication types Case Reports One of the main differences between thoracic vertebrae and vertebrae in other levels of the spine is that each thoracic vertebra has joints that connect it to the rib bone on each side of the spine. 10. Surgical approaches to thoracic disk herniations correlate with patient anatomy, location of nerve root compression, and surgeon familiarity. Thoracic discectomy by posterior pedicle-sparing, transfacet approach with real-time intraoperative ultrasonography: Clinical article. Bethesda, MD 20894, Web Policies eCollection 2022. Due to the location of the thoracic spine, a herniated disc can cause pain to the mid-back, unilateral or bilateral chest wall, or abdominal areas around the affected vertebrae. The T1-T2 interspace is not fully visualized on a cervical MRI; therefore, a thoracic MRI scan can be helpful. In this condition we work on the posture of the shoulders and neck all together. T1T2 disc herniation: Report of four cases and review of the literature. Copyright Surgical Neurology International. Kuzma SA, Doberstein ST, Rushlow DR. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler:A case report. Rossitti S, Stephensen H, Ekholm S, von Essen C. The anterior approach to high thoracic (T1-T2) disc herniation. An MRI showing a herniated thoracic disc compressing the spinal cord.An MRI from the same patient shown above after minimally invasive lateral thoracic discectomy and fusion. (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up. T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. J Athl Train. Surg Neurol. Conclusions: We reviewed 4 cervical T1-T2 disc herniations; two central/anterolateral lesions warranting anterior surgical approaches/cages, and 2 lateral discs treated with a posterolateral transfacet, pedicle-sparing procedure and no surgery respectively. 2002. Protrusion of the first thoracic disk. The patient underwent successful T2-3 anterior discectomy with T2-3 rib autograft fusion. 7: 495-7, 37. Spine J 2014;14:1654-1662. 48: 768-72, 27. 6: 199-202. Oral steroids can also decrease inflammation, which will help alleviate pain. Compression fractures are especially common in the lower thoracic area, and they often result from osteoporosis and mild trauma. Careful radiographic analysis is needed preoperatively to identify the upper limit of the sternum. 29: 375-8, 36. Keywords: Unable to load your collection due to an error, Unable to load your delegates due to an error. Within the spine itself there are also many other disorders that can have similar presenting symptoms of upper back pain and/or radiating pain, such as a spine fracture , infection, tumor, and certain metabolic disorders. At his follow-up appointment, there was no improvement of his symptoms; therefore, the decision was made to intervene surgically given his persistent pain, weakness, and Horner syndrome. Doctors order these vertebrae from C1 to C7, starting at the base of the skull and extending downward. 6: s-0036, 29. The most common symptom of a thoracic herniated disc is pain. 1980. Maloney WF, Younge BR, Moyer NJ: Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. J Neurosurg. T1-T2 Disk Herniation Presenting With Horner Syndrome: A Cas - LWW When there is a compression on the disc, it starts decaying. Surgery should occur only when objective findings of structural defects are correlated with the patients symptoms and signs. (c) Manubrium line and cervicothoracic (CT) angle on T2-weight magnetic resonance imaging (MRI): manubrium line intersects T2 vertebral body near to T2T3 disc, CT angle is about 38. Rev Chir Orthop Reparatrice Appar Mot. J Neurol Neurosurg Psychiatry. Most people respond well to non-operative or conservative treatment. Takagi H, Kawaguchi Y, Kanamori M, Abe Y, Kimura T. T1-2 disc herniation following an en bloc cervical laminoplasty. Transthoracic excision and fusion, case report with 4-year follow-up. Thoracic Disc Herniation - What You Need to Know - Drugs.com 1956;6:110. Clinical Reasoning: Partial Horner syndrome and upper right limb At 1-week postoperatively, he had near complete improvement in his left-hand strength with mild forearm paresthesias and persistent ptosis and miosis of the left eye. [ 3 , 6 , 19 , 28 , 30 , 34 ] Most thoracic disc herniations occur below the T8 level, and the majority are found at T11T12. The oculosympathetic pathway then joins the ophthalmic division of the fifth cranial nerve (V1) and travels into the orbit through the superior orbital fissure to provide innervation to the iris dilator muscle and Mueller's muscle; a small smooth muscle in the eyelid responsible for a minor portion of upper lid elevation and lower lid retraction. Christopher Good, MD, FACS President of Virginia Spine Institute, https://www.barrowneuro.org/condition/thoracic-disc-herniation/, https://doi.org/10.1016/j.otsr.2017.04.022, https://www.ncbi.nlm.nih.gov/books/NBK441822/, https://www.choosept.com/guide/physical-therapy-guide-herniated-disk, https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Low-Back-Pain, https://www.cdc.gov/nchs/data/databriefs/db415-H.pdf, https://doi.org/10.1302/2058-5241.6.210020, Upper Back Pain Causes, Risk Factors, Diagnosis and Treatment, Spondylosis Symptoms, Causes, Diagnosis and Treatment, 7 Lower Back Pain Causes That Affect Women, Muscle Relaxants for Back Pain and Neck Pain, Herniated Disc: Symptoms, Causes, Diagnosis, and Treatment. This displacement can cause inflammation and compression to the spinal nerves or spinal cord, resulting in pain and possible neurological deficits like tingling, numbness, or weakness somewhere down the nerve. See this image and copyright information in PMC. Background:Symptomatic T1T2 disc herniations are rare and, in most cases, are located posterolaterally. Thoracic region is the first segment of the thoracic or dorsal spine. Horner syndrome or oculosympathetic paresis is evident because of interruption of sympathetic nerve supply to the eye, which consists of a 3-neuron pathway. Management of Thoracic Disc Herniations via Posterior Unilateral Modified Transfacet Pedicle-Sparing Decompression With Segmental Instrumentation and Interbody Fusion. Because your thoracic spine is much more rigid and stable, your thoracic spinal area is much less frequently injured than your lumbar and cervical spine. T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. sharing sensitive information, make sure youre on a federal Neurosurgery. The symptoms of T1-T2 slip disc depends on the severity of the problem. Both of these signs were absent in our patients. 1954. There was a decreased sensation noted along the left medial forearm and hypothenar region. Kumar R, Buckley TF. Eur Spine J. Signal . 18: 782-4, Your email address will not be published. The symptoms began as dull back pain, which the patient initially attributed to a muscle strain, but progressively worsened throughout a 24-hour period. 1960. Spine (Phila Pa 1976). Thoracic Disc Degeneration - Spine Care | UCLA Health -, Alberico AM, Sahni KS, Hall JA, Jr, Young HF. A modified anterior approach to the cervicothoracic junction with clavicle resection16 or combined cervicothoracic approach for diskectomy has proven useful as well.14,17. Wolters Kluwer Health The most common symptom of a thoracic herniated disc is pain. Along with this when we work with pronated shoulders and fixed neck- chances of problem with D1-D2 disc increases in same frequency. This process of desiccation starts due to the pressure on the spinal arteries. T1T2 myelopathy and/or radiculopathy, magnetic resonance (MR) localization (anterior/anterolateral/lateral posterior), and optimal surgical management. 1 Far less common is C7-T1 or T1-T2 pathology, causing a C8 or T1 radiculopathy, with a prevalence of 6.2% of affected nerve roots in one series. (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up. An official website of the United States government. A case of the patient with severe neurological deficits, caused by intradural thoracic disc herniation at T1-T2 interspace, which required surgical treatment and the symptoms were relieved immediately after surgery. Increased reflexes in one or both legs that can cause spasticity in the legs. Weakness. Sitting in chairs with a firm back to support the spine will help alleviate back pain. (b) Sagittal cervical fat saturated MRI shows the same. When Natalie is not working, you can find her gardening and taking care of her animals on her mini farm. Gelch MM. The patient understand that her name and initial will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Yoon, Wai Weng, and Jonathan Koch. We report two cases of exceptional first thoracic disc herniation in a 60-year-old man and a 55-year-old woman. Disclaimer. 1993. When the inner core of the disc when stops getting proper nutrition, than it starts decaying further. The thoracic region, which has more vertebrae than any other part of the spine, is the least-mobile region of the spine and therefore the least susceptible to disc herniation. (b) Axial view shows the posterolaterally located disc is on the left side. Natalie Evenson MSN, BSN, RN is a health content writer. Herniated disk - Symptoms and causes - Mayo Clinic
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