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Svien HJ, Karavitis AL: Multiple protrusions of intervertebral disks in the upper thoracic region: Report of case. If we just suppress the pain and associated discomfort due to T1-T2 slip disc, that wont be a permanent solution of the problem. Following adjustment for the localisation, shots were taken with the patient positioned supine, with a routine protocol for the lumbar spine with the measurement level between L3-S1 at the center of the disc (Fig. Here, we reviewed four cases of symptomatic T1-T2 disc herniations; two patients were paraparetic due to central discs and underwent anterior surgery utilizing a cage construct. According to Dr. Good, here are some healthy habits you can build that will help keep your discs healthy. Spine (Phila Pa 1976). 2005. The fibers ascend and synapse at the superior cervical ganglia at the level of the bifurcation of the common carotid artery (C3-C4). Kurz LT, Pursel SE, Herkowitz HN. Negoveti L, Cerina V, Sajko T, Glavi Z. Intradural disc herniation at the T1-T2 level. 1. 1952. 2022 Sep 9;13:412. doi: 10.25259/SNI_580_2022. An official website of the United States government. Rahimizadeh A, Zohrevand AH, Kabir NM, Asgari N. Surg Neurol Int. They occur when a vertebra in your spine collapses, which can lead to severe pain, deformity and loss of height. Back, Lower Limb, and Upper Limb Pain among U.S. Surg Neurol. Bulge is a term for an image and can be a normal variant . Sharan AD, Przybylski GJ, Tartaglino L. Approaching the upper thoracic vertebrae without sternotomy or thoracotomy:A radiographic analysis with clinical application. Required fields are marked *. Some common signs and symptoms of a cervical herniated disc include: Neck pain. This fact is most likely explained by the restricted mobility and facet orientation of the thoracic spine. T1 motor root innervates the flexor digitorum superficialis, flexor pollicis longus, flexor pollicis longus, flexor digitorum profundus, lumbricals, interossei, and the pectoralis major. [ 3 , 6 , 19 , 28 , 30 , 34 ] T1T2 discs account for only approximately 13% of all thoracic discs. According to Christopher Good, MD, FACS President of Virginia Spine Institute, often the most optimal treatment is to allow the body to heal naturally with time. 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. This was excised utilizing a transfacet pedicle-sparing left-sided approach with left-sided T1T3 pedicle screw fixation to avoid instability [ Figure 3 ]. [ 1 , 2 , 4 , 5 , 7 - 9 , 11 - 15 , 17 , 18 , 21 , 24 - 26 , 29 , 31 - 33 , 35 - 37 ]. (f) Postoperative T1-weighted MRI, at 3-year follow-up, note clearance of the cord. If you begin to experience symptoms, or if your mild symptoms like pain, radiculopathy, myelopathy become worse, it may be time to consider surgery. If any of the thoracic nerves become inflamed, such as from a thoracic herniated disc or a narrowing of the foramen, thoracic radiculopathy can develop with symptoms of pain, tingling, numbness, and/or weakness radiating along the nerve root. Causes of T1 nerve root compression has been summarized in the literature (Table 2). High thoracic disc herniation. 73: 598-9, 13. Physical examination revealed pain in the left upper paraspinal and scapular region radiating to the left shoulder with mild improvement of the pain with abduction of the left shoulder above the head. Herniated discs in the thoracic region account for less than 1% overall. The thoracic spine is surrounded by the rib cage and it is much harder to damage the spinal cord in this area. C8 and T1 nerve roots compromise both the ulnar and median nerve root; therefore, precise examination of these roots is necessary. The support that the rib cage provides to the thoracic spine means it experiences less wear and tear than the other segments of the spine, making it less likely for the thoracic segment to develop thoracic herniated discs and other conditions. Protrusions of thoracic intervertebral disks. 15. 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. (b) Axial view shows the posterolaterally located disc is on the left side. 17. Avoid lifting, twisting, or straining the back. 1995. Symptoms of a herniated thoracic disc may include: A vertebral, rib, and/or disc injury at the C7-T1 level may cause moderate to severe neck pain and/or upper back pain. MeSH Symptomatic thoracic disc herniation is uncommon and has been estimated to less than 0.75% of all symptomatic spinal disc herniations. Calcific discitis with giant thoracic disc herniations in adults. Among these diseases To set the slipped disc to normal is one. (a) T2-weighted sagittal magnetic resonance imaging (MRI) of the second case showing a hard disc at T1T2 level. 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 large herniated disc can compress the spinal cord within the spinal canala condition called myelopathyresulting in numbness, tingling, and or weakness in one or both lower extremities, and sometimes bowel and bladder dysfunction, and in extreme cases, paralysis. Results: The patient's symptoms resolved completely. This is disc herniation. Furthermore, more than 75% of thoracic protrusions are located below T8, and only approximately 3% occur at the T1-T2 level, as in our patient. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. Therefore, once muscles and ligaments are relaxed around the T1-T2, we start working on the kyphotic curve of the spine. In this condition we work on the posture of the shoulders and neck all together. Gokcen HB, Erdogan S, Gumussuyu G, Ozturk S, Ozturk C. A rare case of T1-2 thoracic disc herniation mimicking cervical radiculopathy. The T-1 radiculopathy usually involves weakness of the intrinsic muscles of the hand. 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. Epub 2017 Apr 6. (b) Axial view shows the posterolaterally located disc is on the left side. On which side the compression is more symptoms will be according to that. But they can happen. Under his, Cost effective alternative for spinal surgery. Unauthorized use of these marks is strictly prohibited. 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. Spacey K, Zaidan A, Khazim R, Dannawi Z. Horner's syndrome secondary to intervertebral disc herniation at the level of T1-2. All surgically treated patients recovered fully. Cervical radiographs are not usually clinically useful because of the difficulty in visualizing through the shoulders. In one case, a central disc fragment extended through the dura. Br J Neurosurg. Evid Based Spine Care J 2010;1:21-28. Thanks to the rigidity of the thoracic spine and the size of thoracic vertebrae, a thoracic herniated disc is a lot less likely to happen than a lumbar (lower back) or cervical (neck) herniated disc. doi: 10.1136/bcr-2014-204820. Careful radiographic analysis is needed preoperatively to identify the upper limit of the sternum. Clin Neurol Neurosurg. So there is no difference in T1-T2 and D1-D2 discs. 2001 Nov 15;26(22):E512-8. 7: 495-7, 37. When there is a change in the consistency of the jelly of disc, this falls under condition of slip disc or disc protrusion. A disc bulge is not a disc herniation. Symptoms depend on where and how big the disc herniation is, where it is pressing, and whether the spinal cord has been damaged. Practice short intervals of gentle exercise. Modified anterior approach to the cervicothoracic junction. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. If the herniation compresses a thoracic spinal nerve, it can cause radiculopathypain that radiates down the nerve and away from the spinewith pain, numbness, and tingling. 1993. (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. and transmitted securely. Although . 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. official website and that any information you provide is encrypted Symptomatic disc herniation in the upper thoracic spine from T1 to T4 is rare, with most occurring at T1T2 levels[ 3 , 6 , 19 , 28 , 30 , 34 ] [ Table 1 ]. 6: s-0036, 29. 2019 Apr 24;10:56. doi: 10.25259/SNI-34-2019. Degenerative changes of the spine is the same condition as spinal osteoarthritis, spondylosis and degenerative disk disease. Kanno H, Aizawa T, Tanaka Y, et al. 1-3 The most affected area in the thoracic region is the T11-12 level. 2014 Oct;21(4):568-76. doi: 10.3171/2014.6.SPINE13682. Objectives: To evaluate the clinical features of thoracolumbar junction disc herniation and to prepare a chart for the level diagnosis in the neurologic findings and symptoms. Also Check: Symptoms Of Heartworm In Dogs. Proc Staff Meet Mayo Clin 1954;29:375-378. The most commonly affected levels are C5-C6, C6-C7, and C4-C5. (b) Axial view showing the central location of the disc. A herniation here may cause pain at the back or chest around the first rib, or pain in the ring and/or pinky fingers. 2016. (d) Three-dimensional cervical computed tomography (CT) scan shows T1T2 and T3 screw rod fixation on the left side. Due to high occurrence of complications from open surgery, minimally invasive approaches are desirable. Disc herniation can occur in the cervical, thoracic, or lumbar spine. (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable cord compression. 13. 33. Hoffman's sign was negative. 12. Most T1T2 discs were posterolateral in location (25 cases); only 11 were purely central or centrolateral. Treating thoracic-disc herniations: Do we always have to go anteriorly? The T1-T2 interspace is not fully visualized on a cervical MRI; therefore, a thoracic MRI scan can be helpful. 2003. T1-T2 slip disc or disc protrusion is a common word for all these conditions. A disc herniation is a significant cause or contributor of neck pain. Kanno H, Aizawa T, Tanaka Y, Hoshikawa T, Ozawa H, Itoi E. T1 radiculopathy caused by intervertebral disc herniation:Symptomatic and neurological features. (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. T1-T2 disc herniation: Report of four cases and review of the literature. Son ES, Lee SH, Park SY, Kim KT, Kang CH, Cho SW: Surgical treatment of t1-2 disc herniation with t1 radiculopathy: A case report with review of the literature. 12: 221-31, 5. Rahimizadeh A. Thoracic disc herniation:20 years experience in 82 cases. This study can distinguish calcified disk herniations, which may lead to modified treatment strategies and surgical approach.3 The T1 nerve root supplies the ulnar nerve with C8 at a root level, the medial pectoral, medial brachial cutaneous, the medial antebrachial cutaneous nerves at a cord level, and the first intercostal nerve. T1T2 disc herniation: Report of four cases and review of the literature. Thoracic Disc Herniation: Surgical Treatment.. Fortschr Neurol Psychiatr 2001;69:236-241. 2010. Specifically, T1 nerve root compression presents with specific signs and symptoms. Symptoms of thoracolumbar junction disc herniation. 1956;6:110. government site. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. If youve been having intolerable pain that fails to respond to conservative treatments and or causes neurological deficits. The further down the spine the injury occurs, the greater chance for at least partial recovery. Clipboard, Search History, and several other advanced features are temporarily unavailable. This narrows the space between your vertebrae, causing certain issues. If the C8 nerve is compressed or irritated, additional symptoms may occur, such as: If the spinal cord is injured, the upper and/or lower limbs and the torso may be completely or partially paralyzed.2 There may also be changes in bowel and/or bladder functions. These all symptoms always confuse before the proper diagnosis of slip disc in D1-D2. Get new journal Tables of Contents sent right to your email inbox, Creative Commons Attribution License 4.0 (CCBY), T1-T2 Disk Herniation Presenting With Horner Syndrome: A Case Report With Literary Review, Articles in Google Scholar by Daniel Possley, DO, Other articles in this journal by Daniel Possley, DO, Privacy Policy (Updated December 15, 2022). Croat Med J. Despite having a long learning curve, the surgical technique described herein can be even used in patients with complex and calcified thoracic disc herniations. 25: 910-6, 32. When there is some problem in the T1-T2 diss, it gives similar symptoms to cervical problem. 4 ' 5 The first T1-2 disc herniation case was reported in 1954 by Sivien and Karavitis. (e) Axial CT scan shows a pedicle screw in an upper thoracic vertebra. Given the neurologic findings on examination, a cervical and thoracic MRI was obtained which revealed T1-T2 left paracentral disk extrusion with mild superior migration and left intraforaminal extension causing moderate left lateral recess stenosis and abutment of the left T1 nerve root (Figure 2). (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. J Bone Joint Surg Am 1983;65:992-997. Possley, Daniel DO; Luczak, S. Brandon MD; Angus, Andrew MD; Montgomery, David MD. But not in case of T1-T2 slip disc. 7. 35: 329-31, 11. Postoperative MR imaging (MRI) studies in the first two patients showed adequate cord decompression following placement of T1T2 anterior interbody cages [Figures 1 and 2 ]. 2003;30:1524. On examination, she had lower extremity hyperreflexia, an abnormal gait, and lower lumbar pain but lacked any radicular findings. Thus if there are some brachial plexus injuries on lower side there will be impact on the same nerve root and its supply too. Pain is the most common symptom of a thoracic herniated disc and may be isolated to the upper back or radiate in a dermatomal (single nerve root) pattern. 16. Carr DA, Volkov AA, Rhoiney DL, Setty P, Barrett RJ, Claybrooks R, Bono PL, Tong D, Soo TM. Approximately 75% of all thoracic disc herniations are seen below T8. Kumar R, Buckley TF. Some research has shown that herniated discs run in families, suggesting that your genes can make it more likely that you will develop a herniated thoracic disc. (e) Axial CT scan shows a pedicle screw in an upper thoracic vertebra. Eur Spine J. It can also occur with ligamentous laxity in response to loading. Bethesda, MD 20894, Web Policies The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). If the lower thoracic region is involved, a patient may encounter pain radiating to one or both lower extremities. T1T2 thoracic disc herniations are an extremely rare, and optimal results depend on the central and centrolateral location of the discs and the operative/nonoperative choices were made based on the clinical presentation. Please try after some time. BecauseAyurvedic treatment of T1-T2 slip disc problem is not about suppression of signs and symptoms alone. J Neurosurg Spine. For example, you may feel pain in your neck, arms, hands, fingers, or parts of the shoulder. Med Ann Dist Columbia. The reason, why T1-T2 disc problem- bulge or herniation mimics the cervical disc problems is- the nerve root from D1-D2 disc is- T1 and this is part of the brachial plexus. J Neurol Neurosurg Psychiatry. Horner syndrome with associated T1 weakness and paresthesias is representative of many etiologies (Table 2). 1991. Love JG, Schorn VG: Thoracic-disk protrusions. Historically, symptomatic thoracic disk herniation occurred with a frequency of 2 to 3/1,000 cases of disk herniation.2 This is likely even less frequent with the advent of MRI use in diagnosis. 14: 103-6, 15. Please try again soon. 48: 710-5, 18. A standard posterior approach with laminoforaminotomy and diskectomy was done. These symptoms typically follow a pattern as noted above, based on the affected nerve roots location and functions. Your spine is made up of 33 vertebrae divided into five different segments, which are listed below in order from your head to your legs: Thoracic herniated discs occur in the thoracic spine, which is made up of the 12 vertebrae that extend from the base of your neck to the bottom of your rib cage. MRI provides the diagnosis. If you have a thoracic herniated disc, you may feel these symptoms circumferentially around your rib cage or upper abdominal area. Careers. A herniated thoracic disc is considered giant if it obstructs more than 50% of the central canal of the spine . In a systematic review and meta-analysis by Brooks et al, disk height index, Modic changes, and sagittal range of motion were found to be significantly correlated with an increased rate of recurrent lumbar disk herniation. Dont Miss: Hsv-2 Low Positive No Symptoms, A 65-year-old female patient underwent a transthoracicendoscopic approach to remove a calcified thoracic disc herniation that caused spinal cord compression. Bransford R, Zhang F, Bellabarba C, Konodi M, Chapman JR. J Neurosurg Spine. 1983. A report of five cases. AJR Am J Roentgenol. T1-2 disk herniation diagnosis is often delayed because of its prevalence and misdiagnosis. Both were approached anteriorly with low cervical-suprasternal approaches and accompanied by cage application. Biousse V, Touboul PJ, D'Anglejan-Chatillon J, Levy C, Schaison M, Bousser MG: Ophthalmologic manifestations of internal carotid artery dissection. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. (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. This distinction is made by David F. Fardon, MD, and Pierre C. Milette, MD in their Combined Task Forces of the North American Spine Society. We report two cases of exceptional first thoracic disc herniation in a 60-year-old man and a 55-year-old woman. The physician explained that you have a Bulging Disc, but you may still have questions that have been unanswered. M51.24 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 12 thoracic vertebrae (T1 just below the neck down to T12 just above the lumbar spine) make up the largest and least flexible area of the spine. 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. Most people respond well to non-operative or conservative treatment. 8600 Rockville Pike Follow-up magnetic resonance studies documented full resolution for the patient with . The spurs may cause narrowing of the spinal canal and impinge on the spinal cord. This is the reason in few reports it is mentioned as D1-D2 region also. He completed that match and 1 additional match that day with mild symptoms. Muscle weakness in certain muscles of one or both legs. The pain may be centered over the injured disc but may spread to one or both sides of the mid-back. This pain is typically felt toward the back or side of the neck. When the inner core of the disc when stops getting proper nutrition, than it starts decaying further. Report of four cases and literature review. Disclaimer. Find out how, and what you can do to treat them. Objective: To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1-T2 disc herniation. Micheli LJ, Hood RW: Anterior exposure of the cervicothoracic spine using a combined cervical and thoracic approach. For more information, please refer to our Privacy Policy. After literature review, 39 cases of T1-2 disk herniation were discovered.1 Only seven of these cases presented with an associated Horner syndrome (Table 1). The symptoms began as dull back pain, which the patient initially attributed to a muscle strain, but progressively worsened throughout a 24-hour period. Thoracic herniated discs are less common than herniated discs in the neck or low back, but they do happen. Spine (Phila Pa 1976) 1991;16(10 suppl):S542-S547. Surgical approaches to thoracic disk herniations correlate with patient anatomy, location of nerve root compression, and surgeon familiarity. -, Arseni C, Nash F. Thoracic intervertebral disc protrusion:A clinical study. Most studies report improvement in pain and neurologic dysfunction, but Horner syndrome can be refractory to surgical decompression.12,18 Similarly, our patient at 6 weeks postoperative had resolution of his pain, motor, and sensory deficits but persistent Horner syndrome at nine months postoperatively. 1980. Numbness or tingling. Turbo spin-echo T1 and T2-weighted sagittal and turbo spin-echo T2 axial 4 mm sections parallel to the disc spaces were taken. 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 pupil dilator muscle and Mueller's muscles; small smooth muscles in the eyelid responsible for a minor portion of upper lid elevation and lower lid retraction. Asian Spine Journal, 2012 (evidence level 3A) T2 radiculopathy: A differential screen for upper extremity radicular pain. Proc Staff Meet Mayo Clin. Symptoms such as these are primarily determined by the location of the cervical herniated disc. eCollection 2022. Abbott KH, Retter RH. Signs and Symptoms of a T1-T2 Herniated Nucleus Pulposis in the Literature (n = 21). This the next process of degenerative disc disease is- disc bulge. 134: 184-5, 19. So when we provideAyurvedic treatment of T1-T2 slip disc we are careful about providing a proper solution. For example, you may feel pain in your neck, arms, hands, fingers, or parts of the shoulder. Correlating history, examination, and imaging will guide toward a successful diagnosis.