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 process of desiccation starts due to the pressure on the spinal arteries. Case Description: A 56-year-old man presented with the left C8 T1 radiculopathy, left hand grip weakness, and ipsilateral Horner's syndrome.Magnetic resonance imaging of the spine showed a contrast-enhancing lesion in the left T1 . Informed consent to present the data concerning the case for publication was obtained by the patient. Case report. Kuzma SA, Doberstein ST, Rushlow DR. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler:A case report. 2012. Correspondence Address:Naser AsgariPars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran, How to cite this article: Abolfazl Rahimizadeh, Amir Hossein Zohrevand, Nima Mohseni Kabir, Naser Asgari. T1T2 disc herniation: Report of four cases and review of the literature. 1998. Accessibility Biousse V, Touboul PJ, D'Anglejan-Chatillon J, Levy C, Schaison M, Bousser MG: Ophthalmologic manifestations of internal carotid artery dissection. Carson J, Gumpert J, Jefferson A. Herniated discs affect 5 to 20 per 1000 adults annually. (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up. He completed that match and 1 additional match that day with mild symptoms. 1998. T1T2 myelopathy and/or radiculopathy, magnetic resonance (MR) localization (anterior/anterolateral/lateral posterior), and optimal surgical management. 28: 322-30, 14. 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. (e) Showing removal of the sequestrated disc fragment. 2. 2010. 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. By specifically examining these five muscles, one can differentiate between cubital tunnel syndrome, which leaves their motor strength intact, and C8-T1 radiculopathy. The most common symptom of a thoracic herniated disc is pain. Kanno H, Aizawa T, Tanaka Y, et al. Also, patients commonly feel a band of pain that goes around the front of the chest. sharing sensitive information, make sure youre on a federal J Neurosurg Spine. Use the Previous and Next buttons to navigate three slides at a time, or the slide dot buttons at the end to jump three slides at a time. Diagnosis and treatment of thoracic intervertebral disc protrusions. 2000. The authors certify that they have obtained all appropriate patient consent forms. 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. Wolters Kluwer Health J Neurosurg. Bransford R, Zhang F, Bellabarba C, Konodi M, Chapman JR. Approximately 75% of all thoracic disc herniations are seen below T8. Watch: Thoracic Herniated Disc Video Epub 2021 Nov 26. 2009. 16. (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. J Neurosurg. 2010 Feb;12(2):221-31. doi: 10.3171/2009.9.SPINE09476. 2017. Symptoms depend on where and how big the disc herniation is, where it is pressing, and whether the spinal cord has been damaged. There will be pain in the front side of Arm Pit. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. Upper back pain is usually attributed to minor injuries, such as muscle strain, sprain, poor posture, improper lifting, or twisting, but not often a herniated disc. The goal of surgery is to remove all or part of the herniated disc that is compressing a nerve root. Muscle weakness in certain muscles of one or both legs. Intervertebral thoracic disk herniation is rare. Caner H, Kilinoglu BF, Benli S, Altinrs N, Bavbek M. Magnetic resonance image findings and surgical considerations in T1-2 disc herniation. In this article, we reviewed these 32 prior cases of T1T2 disc herniations and added our four cases. Asian Spine Journal, 2012 (evidence level 3A) T2 radiculopathy: A differential screen for upper extremity radicular pain. 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. Int J Spine Surg. 7: 189-92, 30. The levels affected are often T11 and T12, with 75% occurring below T8comparatively closer to the more flexible lumbar spine. Despite having a long learning curve, the surgical technique described herein can be even used in patients with complex and calcified thoracic disc herniations. Also Check: Symptoms Of Heartworm In Dogs. There are several treatment options for thoracic herniated discs. 1956;6:110. PMC The details of 36 cases with T1T2 disc herniation. Horner syndrome or oculosympathetic paresis is caused by interruption of the sympathetic nerve supply to the face and eye that manifests as facial anhidrosis, blepharoptosis, and miosis. Osteoarthritis appeared to be the predominant cause of the disc herniation in both patients. Federal government websites often end in .gov or .mil. Therefore, once muscles and ligaments are relaxed around the T1-T2, we start working on the kyphotic curve of the spine. High thoracic disc herniation. posterolateral discs) and, in some cases, spontaneously resolved (2 of 36 cases). 6: 199-202. The https:// ensures that you are connecting to the Epub 2013 Aug 16. 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. 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. Conclusions: Multiple protrusions of intervertebral disks in the upper thoracic region:Report of case. 2010;12:22131. Conservative treatments are appropriate for T1T2 discs resulting in just mild radiculopathy (e.g. At 9 months postoperatively, the patient continued to be pain free with full strength and intact sensation. This is the reason in few reports it is mentioned as D1-D2 region also. Causes of T1 nerve root compression has been summarized in the literature (Table 2). . Arseni C, Nash F. Thoracic intervertebral disc protrusion:A clinical study. Sekhar LN, Jannetta PJ. He is the founder of the Sukhayu Ayurved and working with patients clinically since last 15 years. 6 Approximately more than 70 . Keachie K, Shahlaie K, Muizelaar JP. 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. As people age, their thoracic intervertebral discs may lose their cushioning ability and become more likely to rupture. When there is a change in the consistency of the jelly of disc, this falls under condition of slip disc or disc protrusion. Along with this when we work with pronated shoulders and fixed neck- chances of problem with D1-D2 disc increases in same frequency. Herniated Thoracic Disc. Barrow Neurological Institute, August 3, 2022. Alberico AM, Sahni KS, Hall JA, Young HF. Contained Discs: The disc has not broken through the outer wall of the intervertebral disc, which means the inner gel-like material remains contained. -, Arseni C, Nash F. Thoracic intervertebral disc protrusion:A clinical study. Sharan AD, Przybylski GJ, Tartaglino L. Approaching the upper thoracic vertebrae without sternotomy or thoracotomy:A radiographic analysis with clinical application. To complicate matters, sometimes fragments from the annulus may break away from the parent disc and drift into the spinal canal. (a) T2-weighted sagittal magnetic resonance imaging (MRI) of the second case showing a hard disc at T1T2 level. Rev Chir Orthop Reparatrice Appar Mot. Barrow Neurological Institute. 8600 Rockville Pike The patient underwent successful T2-3 anterior discectomy with T2-3 rib autograft fusion. GUIDE: Physical Therapy Guide to Herniated Disk. Choose PT, August 26, 2021. 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. With this technique, there is no retraction of the neural elements, no sacrifice of the nerve roots, and the pedicles are spared.15 When considering anterior surgery, identify the level of the clavicles, sternum, and breast tissue in relation to the upper thoracic levels for adequate preoperative planning. Opioids are most useful in the acute phase and generally not recommended for long-term use. Symptomatic thoracic disc herniation is uncommon and has been estimated to less than 0.75% of all symptomatic spinal disc herniations. 10. (i) Postoperative T2-weighted MRI demonstrates the cage in T1T2 interspace. This condition can happen to anyone at any age but is more prevalent in older populations or with those who are involved in strenuous physical activity for extended periods of time. 4. J Neurosurg Spine. Introduction Surgical intervention is the treatment of choice in patients with thoracic disc herniation with refractory symptoms and progressive myelopathy. For example, T3 radiculopathy could radiate pain and other symptoms into the chest via the branch of the nerve root that becomes an intercostal nerve traveling along the route between the third and fourth ribs. 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. Pain is often described as sharp or burning. Stillerman CB, Chen TC, Couldwell WT, Zhang W, Weiss MH: Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. Unauthorized use of these marks is strictly prohibited. Surgical approaches to thoracic disk herniations correlate with patient anatomy, location of nerve root compression, and surgeon familiarity. When there is a compression on the disc, it starts decaying. (c) Reconstructed sagittal computed tomography (CT) scan of the CT region showing T1T2 hard disc, indicating that the compression, also note that CT angle is 10. Non-surgical treatment options for symptoms of a thoracic herniated disc will typically include one or a combination of the following: A short period of rest (e.g. J Neurosurg 1998;88:623-633. Again, the specific symptoms of a cervical herniated disc will depend on the affected pinched nerves. Due to high occurrence of complications from open surgery, minimally invasive approaches are desirable. Disc herniation; T1T2 disc space; spontaneous resolution; sternal splitting approach; thoracic disc; upper thoracic disc herniation. Methods: The visual analogue scale (VAS), Oswestry disability index (ODI), and MacNab scale were used to analyze the results collected during the . 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. C8 and T1 nerve roots compromise both the ulnar and median nerve root; therefore, precise examination of these roots is necessary. a = artery, n = nerve. may email you for journal alerts and information, but is committed your express consent. The site is secure. Our patient had resolution of his back pain, paresthesias, and grip weakness at 6 weeks postoperatively, but his Horner syndrome persisted at latest follow-up. Anterior approach to the cervicothoracic junction by unilateral or bilateral manubriotomy. Radiation of pain in the upper arm on the front side. -, Alberico AM, Sahni KS, Hall JA, Jr, Young HF. They can help rule out other conditions and give you a referral to a specialist. It can range from a mild pain that feels tender when touched to a sharp or burning pain. The surgically treated patients all markedly recovered over an average of 3.87 years follow-up (range: 6 months7 years). This impingement typically produces neck and radiating arm pain or. 2013 Sep-Oct;48(5):710-5. doi: 10.4085/1062-6050-48.5.03. 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. If you are experiencing pain or others symptoms of a herniated thoracic disc, you should make an appointment to see your primary care doctor. Correlating history, examination, and imaging will guide toward a successful diagnosis. T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. Thoracic spinal cord injuries are typically less severe than injuries to the cervical spinal cord. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. Objective: To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1-T2 disc herniation. 2003. Cases 3 and 4, respectively exhibited, a Brown-Sequard syndrome and radiculopathy alone. If youre between the ages of 30 and 50, youre more likely to be affected. Over-the-counter or prescription meds such as acetaminophen and NSAIDs like ibuprofen are common medicinal treatments. We present a rare case of a patient with T1-T2 intervertebral disk herniation and Horner syndrome who was treated surgically. Signal . . Disc herniation at T1-2. 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. 1980. People who have a herniated disk often have radiating numbness or tingling in the body part served by the affected nerves. Background: The authors conducted a 2-year retrospective follow-up to investigate the efficiency of an extraforaminal full-endoscopic approach with foraminoplasty used to treat lateral compressive diseases of the lumbar spine in 247 patients. The preganglionic fibers then exit the spinal cord and enter the cervical sympathetic chain. 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. See All About Neck Pain Radicular pain. According to Dr. Good, here are some healthy habits you can build that will help keep your discs healthy. T1-T2 Herniation: The T1 spinal nerve is responsible for the ring and pinky fingers and the area around the first rib. A very subtle ptosis and miosis remained. Arbit E. A surgical approach through the pedicle to protruded thoracic discs. The latter two cases had posterolateral discs contributing to a Brown-Sequard syndrome and radiculopathy, respectively; one patient required a transfacet pedicle-sparing procedure, while the second case was managed conservatively. Weakness with finger abduction results from C8 radiculopathy and/or peripheral ulnar nerve entrapment. Practice short intervals of gentle exercise. The annular tear can be confirmed with a discogram followed with a CT scan. Anterior approaches are useful, but more involved. C8 root pathology will result in weakness in all three of these muscles with manual muscle testing. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler: a case report. 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. Follow-up magnetic resonance studies documented full resolution for the patient with radiculopathy and a posterolateral disc. Global Spine J. Turbo spin-echo T1 and T2-weighted sagittal and turbo spin-echo T2 axial 4 mm sections parallel to the disc spaces were taken. While the diagnosed problems at the C7-T1 level are less common,2 research suggests that CTJ injuries may be missed during due to difficulties in visualizing this region on plain X-Ray films.3 A few conditions that may affect the CTJ are: In severe cases, CTJ injuries may affect the spinal cord or the C8 nerve roots. Signs and Symptoms of a T1-T2 Herniated Nucleus Pulposis in the Literature (n = 21) Case 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. A herniated thoracic disc is considered giant if it obstructs more than 50% of the central canal of the spine . Case Description:Here, we reviewed four cases of symptomatic T1T2 disc herniations; two patients were paraparetic due to central discs and underwent anterior surgery utilizing a cage construct. Horner's syndrome secondary to T1-T2 intervertebral disc prolapse. Krasnianski M, Georgiadis D, Grehl H, Lindner A: Correlation of clinical and magnetic resonance imaging findings in patients with brainstem infarction. You will not be suddenly and completely paralyzed by a herniated thoracic disc. 30: E305-10, 24. Neurology. Symptoms such as these are primarily determined by the location of the cervical herniated disc. Kanno H, Aizawa T, Tanaka Y, Hoshikawa T, Ozawa H, Itoi E. T1 radiculopathy caused by intervertebral disc herniation:Symptomatic and neurological features. When Natalie is not working, you can find her gardening and taking care of her animals on her mini farm. In this condition we work on the posture of the shoulders and neck all together. eCollection 2021. If we just suppress the pain and associated discomfort due to T1-T2 slip disc, that wont be a permanent solution of the problem. Would you like email updates of new search results? Mulpuri K, LeBlanc JG, Reilly CW, Poskitt KJ, Choit RL, Sahajpal V. Sternal split approach to the cervicothoracic junction in children. When the inner core of the disc when stops getting proper nutrition, than it starts decaying further. Ayurvedic treatment of T1-T2 slip disc problem due to process of ageing is all about slowing down the process of ageing and in deletion of the marks of age. 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. Gokcen HB, Erdogan S, Gumussuyu G, Ozturk S, Ozturk C. A rare case of T1-2 thoracic disc herniation mimicking cervical radiculopathy. A cervical herniated disc may cause a number of symptoms in different parts of the body. 7: 495-7, 37. With cervical disc herniations, the nerve affected by the condition is the one that exits at that specific level of the spine. 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. J Athl Train. Surgery was done 8 days from the onset of symptoms. Bransford RJ, Zhang F, Bellabarba C, Lee MJ. 2). sharing sensitive information, make sure youre on a federal (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. 1998 Jan;88(1):148-50. doi: 10.3171/jns.1998.88.1.0148. 42: 193-5, 26. Most people respond well to non-operative or conservative treatment. 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. This site needs JavaScript to work properly. (g) Post-operative CT AP X-ray: shows the cage in T1T2 disc space. But they can happen. Thoracic Disc Herniation Symptoms Watch: Thoracic Herniated Disc Video 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. 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). These disc problems in thoracic region remains silent in most of the case. 24-Apr-2019;10:56. Vaidya Ji is well known for his specialisation in Ayurvedic treatment of different ailments. J Orthop Sci. 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. The symptoms of a herniated disc in the thoracic area usually include: Pain that travels around the body and into one or both legs. 1 Cervical pathologies causing these radiculopathies include herniated nucleus pulposus and cervical spondylosis. You May Like: Parvo Symptoms In Older Dogs. Some error has occurred while processing your request. 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. Magnetic resonance imaging revealed a left-sided T1-T2 herniated disc compressing the T1 nerve root. (a) T2-weighted sagittal magnetic resonance imaging (MRI) shows T1T2 disc herniation. I've been in excruciating pain in the right shoulder and throughout the arm and hand for months. (d) Three-dimensional cervical computed tomography (CT) scan shows T1T2 and T3 screw rod fixation on the left side. The man was treated surgically and the woman medically. Gelch MM. 11. The tough outer layer (annulus fibrosus) loses elasticity with age, increasing the risk of tears that can result in herniation. 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. Carr DA, Volkov AA, Rhoiney DL, Setty P, Barrett RJ, Claybrooks R, Bono PL, Tong D, Soo TM. (i) Postoperative T2-weighted MRI demonstrates the cage in T1T2 interspace. There are some simple things that you can do at home to help alleviate the pain. 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 ]. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. Bransford R, Zhang F, Bellabarba C, Konodi M, Chapman JR. J Neurosurg Spine. Therefore, if the C6-C7 level has a herniation, then it is the C7 nerve that will be affected. These all symptoms always confuse before the proper diagnosis of slip disc in D1-D2. Differentiating motor function from the C8-T1 nerve roots and ulnar nerve pathology can be assessed with motor testing. The T-1 radiculopathy usually involves weakness of the intrinsic muscles of the hand. 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. Numbness or tingling in areas of one or both legs. Epub 2014 Jul 18. The further down the spine the injury occurs, the greater chance for at least partial recovery. 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.
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