6: s-0036, 28. 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. Neurosurgery. It can also occur with ligamentous laxity in response to loading. (b) Sagittal cervical fat saturated MRI shows the same. 1998. (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable cord compression. Herniated discs in the thoracic spine have a tendency to become calcified, also known as hard disc herniation. Degenerative changes of the spine is the same condition as spinal osteoarthritis, spondylosis and degenerative disk disease. (e) Showing removal of the sequestrated disc fragment. Because in this case, a patient might get back all those symptoms of T1-T2 slip disc come back again. Anto M, Manuel A, Jayachandran A, Thomas SG, Joseph A, Thankachan A, Bahuleyan B. Surg Neurol Int. Intervertebral thoracic disk herniation is rare. Symptomatic thoracic disc herniation is uncommon and has been estimated to less than 0.75% of all symptomatic spinal disc herniations. The goal of surgery is to remove all or part of the herniated disc that is compressing a nerve root. J Glob Spine J. Myelopathy is rare. The clinical signs and symptoms of T-1 radiculopathy are similar to those of C-8 radiculopathy; however, distinguishing features can frequently be found on neurological examination. Summary of background data: Thoracolumbar junction disc herniations show a variety of signs and symptoms because of . This is a rarest condition in case of all thoracic discs, but can appear in this reason due to trauma. official website and that any information you provide is encrypted 1998. Background: So there is no difference in T1-T2 and D1-D2 discs. Radiation of pain in the upper arm on the front side. 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. Croat Med J. 6: 199-202. Diagnostic testing for herniated disk includes MRI, CT, myelography, and plain radiography, either alone or in different combinations, as the occasion demands. They can help rule out other conditions and give you a referral to a specialist. 15: 227-41, 20. 1983. Neurosurgery. 9. Nakahara S, Sato T. First thoracic disc herniation with myelopathy. (f) After placement of peek cage, note brachiocephalic vein at lower border of the scene. (d) Three-dimensional cervical computed tomography (CT) scan shows T1T2 and T3 screw rod fixation on the left side. GUIDE: Physical Therapy Guide to Herniated Disk. Choose PT, August 26, 2021. 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 ]. Hoffman's sign was negative. For more information, please refer to our Privacy Policy. government site. The symptoms began as dull back pain, which the patient initially attributed to a muscle strain, but progressively worsened throughout a 24-hour period. Follow-up magnetic resonance studies documented full resolution for the patient with radiculopathy and a posterolateral disc. C8 and T1 nerve roots compromise both the ulnar and median nerve root; therefore, precise examination of these roots is necessary. Patients demographic data and common clinical features of the corresponding location at which they generate. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. Bulge is a term for an image and can be a normal variant . She underwent T1-T2 anterior discectomy and fusion. (b) Axial view shows the posterolaterally located disc is on the left side. -, Bransford R, Zhang F, Bellabarba C, Konodi M, Chapman JR. eCollection 2022. Case description: 1995. Symptoms such as these are primarily determined by the location of the cervical herniated disc. In this condition we work on the posture of the shoulders and neck all together. This impingement typically produces neck and radiating arm pain or. Outcomes were based on the modified JOA scores for the three patients with thoracic myelopathy and their scores were 10, 11, and 11, respectively, while the visual analog scale for the fourth patient was 0. Maloney WF, Younge BR, Moyer NJ: Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. Reflex examination was 2/4 in C 6, 7, and 8 roots. 4. 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. There will be pain in the front side of Arm Pit. 2010. The annular tear can be confirmed with a discogram followed with a CT scan. Generally speaking, most neurosurgeons will advise against surgery if you are not experiencing pain or symptoms. Am J Ophthalmol 1980;90:394-402. We added our cases (four cases) of T1T2 disc herniations to those 32 cases found in the literature. See All About Neck Pain Radicular pain. [ 15 ] Patients with thoracic discs typically present with neck pain (i.e. 1960;17:41830. 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. (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. Due to high occurrence of complications from open surgery, minimally invasive approaches are desirable. The exception to this is for a giant herniated thoracic disc, which almost always requires surgery. 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. (f) After placement of a large cage. Patients with upper extremity radicular pain/paresthesias are often sent for radiographs and MRI. Shortly after the postganglionic fibers leave the superior cervical ganglion, vasomotor and sudomotor fibers branch off to travel along external carotid artery to innervate the blood vessels and sweat glands of the face. 134: 184-5, 19. Glaser J. Neuro-Ophthalmology, ed 1. (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable cord compression. J Neurosurg. Kurz LT, Pursel SE, Herkowitz HN. 2006. BMJ Case Rep. 2014. The patient was then discharged from the emergency center with oral methylprednisolone and follow-up with an orthopaedic spine surgeon. 12. 2010;12:22131. Most people respond well to non-operative or conservative treatment. Protrusion of the first thoracic disk. Rahimizadeh A, Sami SH, Rahimizadeh S, Williamson WL, Amirzadeh M. Surg Neurol Int. 1986;19:44951. Numbness or tingling. Nonsurgical treatments are usually tried first to treat CTJ injuries. 7. 8600 Rockville Pike 1993. 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. doi: 10.1097/00007632-200111150-00021. 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. Gille O, Razafimahandry HJ, Sderlund C, Gangnet N, Vital JM. (c) T2-weighted sagittal image shows complete resolution of the disc at 5-month follow-up. Disc herniation at T1-2. 84-A: 1013-7, 21. T1 and T2 - These lead into nerves that go into the top of your chest and into the arms and hands. Thoracic spinal cord injuries are rare and only account for 10 15 percent of all spinal cord injuries. 30: E305-10, 24. The levels affected are often T11 and T12, with 75% occurring below T8comparatively closer to the more flexible lumbar spine. 25: 910-6, 32. Biousse V, Touboul PJ, D'Anglejan-Chatillon J, Levy C, Schaison M, Bousser MG: Ophthalmologic manifestations of internal carotid artery dissection. 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. Avoid lifting, twisting, or straining the back. A disc herniation is a significant cause or contributor of neck pain. (a) T2-weighted sagittal magnetic resonance imaging (MRI) of the second case showing a hard disc at T1T2 level. 24/36 patients). J Neurosurg Spine. Claude-Bernard-Horner syndrome is not constant but highly suggestive. Federal government websites often end in .gov or .mil. doi: 10.1136/bcr-2014-204820. 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. Epub 2021 Nov 26. Read Also: Attention Deficit Hyperactivity Disorder Symptoms, Neck Pain, Cervical Disc Herniation & Radiculopathy-Everything You Need To Know Dr. Nabil Ebraheim, Herniated Disc Symptoms, (All You Need To Know To Cure), L3 Herniated Disc/Nerve Root Compression Evaluation, Attention Deficit Hyperactivity Disorder Symptoms, Symptoms Of Ovarian Cysts After Hysterectomy, Magnetic resonance imaging is the best tool for observing and diagnosing problems with intervertebral discs, Other Imaging tests, such as X-ray or computed tomography may be used, but are not as accurate as MRI in diagnosing a herniated thoracic disc, Myelography, which involves injecting dye into the space around your spinal cord and taking X-ray or CT images to identify any narrowing in the spinal canal, Medical history to identify any accidents, pre-existing conditions, or trauma that may have caused an injury to your spine, Physical examination to record the type, severity, and location of your pain or other symptoms and draw conclusions about their cause, Sacrum, where the spine connects to the hips. The same decay can be age related too. The symptoms of a herniated disc depends on either the size and position of the disc. Movement the blood supply to the disc is interrupted it causes the desiccation of the disc. Pain just below the spine of the scapula. In simple terms, a disc bulge refers to an apparent generalized extension of disc tissues beyond the edges of the edge of vertebrae, usually less than 3mm. Rossitti S, Stephensen H, Ekholm S, von Essen C: The anterior approach to high thoracic (T1-T2) disc herniation. Hamlyn PJ, Zeital T, King TT. 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. Rahimizadeh A, Zohrevand AH, Kabir NM, Asgari N. Surg Neurol Int. First thoracic disc protrusion. Specially in case of T1-T2 disc problem, age plays an important role. Symptoms of thoracolumbar junction disc herniation. Mulpuri K, LeBlanc JG, Reilly CW, Poskitt KJ, Choit RL, Sahajpal V. Sternal split approach to the cervicothoracic junction in children. For example, you may feel pain in your neck, arms, hands, fingers, or parts of the shoulder. Surgery for T1T2 posterolateral herniated discs may require transfacet pedicle-sparing decompression with pedicle screw fixation. 2016. (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. It can result from advanced disc degeneration or from vertebral body remodeling . The man was treated surgically and the woman medically. When there is a change in the consistency of the jelly of disc, this falls under condition of slip disc or disc protrusion. The majority of herniated thoracic discs are diagnosed and treated before they progress to even partial paralysis. (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. High thoracic disc herniation. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. Evid Based Spine Care J 2010;1:21-28. JAMA 1965;191:627-631. 2022 Jan;212:107062. doi: 10.1016/j.clineuro.2021.107062. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. Therefore, once muscles and ligaments are relaxed around the T1-T2, we start working on the kyphotic curve of the spine. Pain is often described as sharp or burning. [ 1 , 2 , 4 , 5 , 7 - 9 , 11 - 15 , 17 , 18 , 21 , 24 - 26 , 29 , 31 - 33 , 35 - 37 ]. 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. Massage and acupuncture can be useful in managing pain. 2010. (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. Morgan H, Abood C: Disc herniation at T1-2: Report of four cases and literature review. J Neurol Neurosurg Psychiatry. (d) Axial T2-weighted axial view also confirms disappearance of the disc. Horner's syndrome secondary to intervertebral disc herniation at the level of T1-2. Increased reflexes in one or both legs that can cause spasticity in the legs. Epub 2016 Jan 28. This is the American ICD-10-CM version of M51.24 - other international versions of ICD-10 M51.24 may differ. government site. Horner's syndrome secondary to T1-T2 intervertebral disc prolapse. 1978. 2001 Nov 15;26(22):E512-8. 2002. 49: 599-606, 23. The further down the spine the injury occurs, the greater chance for at least partial recovery. 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. Movement the inner soft part of the disc jelly- nucleus pulposus tears the annular ligament and starts coming out in the spinal canal or in lateral foramina. Treating thoracic-disc herniations: Do we always have to go anteriorly? This pain is typically felt toward the back or side of the neck. 2001. MRI provides the diagnosis. You may be trying to access this site from a secured browser on the server. 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. Left upper extremity motor was 5/5 in all myotomes except 4/5 finger abduction. 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. Magnetic resonance imaging revealed a left-sided T1-T2 herniated disc compressing the T1 nerve root. If the disc herniates into the spinal cord area, the thoracic herniated disk may also present with myelopathy . (b) The disc space is a little bit above the manubrium line and cervicothoracic (CT) angle is 27. We present a patient with thoracic disk herniation and Horner syndrome who was treated surgically. Symptoms can also include numbness, tingling, or muscle weakness in one or both lower extremities. Unlike the usual calcification in the medioposterior position for middle or lower thoracic spine herniations, a soft posterolateral herniation was observed here. 2021 Mar 17;12:108. doi: 10.25259/SNI_941_2020. If you have a thoracic herniated disc, you may feel these symptoms circumferentially around your rib cage or upper abdominal area. Disc herniation at T1-2. 1, 3, 4, 5 Although uncommon, T1-T2 disk herniation should be suspected if a patient presents with Horner syndrome and upper extremity pain. This was excised utilizing a transfacet pedicle-sparing left-sided approach with left-sided T1T3 pedicle screw fixation to avoid instability [ Figure 3 ]. J Orthop Sci 2009;14:103-106. Upper thoracic spine arthroplasty via the anterior approach. Gelch MM: Herniated thoracic disc at T1-2 level associated with Horner's syndrome: Case report. 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. 1986. An official website of the United States government. eCollection 2021. Symptoms Thoracic disc degeneration can be a cause of upper or mid back pain. Bethesda, MD 20894, Web Policies Please enable it to take advantage of the complete set of features! 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. Cases 3 and 4, respectively exhibited, a Brown-Sequard syndrome and radiculopathy alone. The location of the pain depends on the location of the herniated disc. Acute traumatic sequestrated thoracic disc herniation: A case report and review. Hann EC. Contained Discs: The disc has not broken through the outer wall of the intervertebral disc, which means the inner gel-like material remains contained. After talking about your symptoms and . This pain might shoot into your arm or leg when you cough, sneeze or move into certain positions. These symptoms typically follow a pattern as noted above, based on the affected nerve roots location and functions. 1986. Recommended Reading: Heart Disease Symptoms In Dogs. 1980. The presence of an accurate and reproducible radiologic description is essential for the success of any interventional therapy, in addition to disc removal. The .gov means its official. Anterior approaches are useful, but more involved. 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. (d) Three-dimensional cervical computed tomography (CT) scan shows T1T2 and T3 screw rod fixation on the left side. Bookshelf Report of four cases and literature review. Because thoracic disc herniation can be caused by an injury, it can affect anyone. Bransford RJ, Zhang F, Bellabarba C, Lee MJ. Rarely, C8 nerve injury may cause Horners syndrome characterized by drooping eyelids, small pupils, and sunken eyeballs usually affecting one side of the face.7. J Neurosurg Spine. J Neurosurg 1978;48:128-130. However, it is most common in men between the ages of 40 and 60. Herniated thoracic disc at T1-2 level associated with horner's syndrome. Your back has many interconnected bones, nerves, muscles, ligaments and tendons that protect your spinal cord. (b) Axial view shows the posterolaterally located disc is on the left side. Degenerative disease and trauma are the most common causes of herniated discs in the thoracic spine. Trauma, such as a motor vehicle crash or fall can also cause a thoracic herniated disc. 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. T1-2 disk herniation diagnosis is often delayed because of its prevalence and misdiagnosis. In this article, we reviewed these 32 prior cases of T1T2 disc herniations and added our four cases. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. Kuzma SA, Doberstein ST, Rushlow DR. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler:A case report. Symptomatic T1-T2 disc herniations are rare and, in most cases, are located posterolaterally. 18. 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. If the disc is severely degenerated, bone spurs can form and limit the mobility of the thoracic spine. On which side the compression is more symptoms will be according to that. [ 3 , 6 , 19 , 28 , 30 , 34 ] Most thoracic disc herniations occur below the T8 level, and the majority are found at T11T12. Good office ergonomics, such as a supportive chair, can reduce the risk of thoracic herniated discs, which are already rare. Two females aged 67 and 48 years presented with acute cord infarction and paraparesis, respectively; the modified Japanese Orthopaedic Association (JOA) score for thoracic myelopathy (maximum 11) was 6 and the second patient was 7 [ Table 1 ]. Wolters Kluwer Health 1998 Jan;88(1):148-50. doi: 10.3171/jns.1998.88.1.0148. 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). Herniated Thoracic Disc. Barrow Neurological Institute, August 3, 2022. Surgical options will vary based on the size, type, and location of the injury, but the most common are. : T1 radiculopathy caused by intervertebral disc herniation: Symptomatic and neurological features. See this image and copyright information in PMC. Arbit E. A surgical approach through the pedicle to protruded thoracic discs. 17. 2003;30:1524. When there is a compression on the disc, it starts decaying. Spine (Phila Pa 1976). Anterior surgery can be achieved without sternotomy. If youre between the ages of 30 and 50, youre more likely to be affected. 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. 12: 303-5, 31. Thoracic Disc Herniation: Surgical Treatment.. MRI diagnosis is C7/T1 and C6-C7 severe foraminal narrowing and stenosis. Luk KD, Cheung KM, Leong JC. Disc herniation can occur in the cervical, thoracic, or lumbar spine. On examination, she had lower extremity hyperreflexia, an abnormal gait, and lower lumbar pain but lacked any radicular findings. But they can also happen after more severe trauma in the absence of osteoporosis or as a result of tumors on your spine. Conclusion: Adjacent-segment degeneration after cervical spine fusion may rarely occur even at T1-T2, and the unusual symptoms of a T1 . Along with this when we work with pronated shoulders and fixed neck- chances of problem with D1-D2 disc increases in same frequency. Anterior approach to the cervicothoracic junction by unilateral or bilateral manubriotomy. 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. 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. Thoracic disc herniations make up 0.25%0.75% of all disc ruptures. Therefore an MRI scan is important to find our the proper cause behind the problem. sharing sensitive information, make sure youre on a federal may email you for journal alerts and information, but is committed The video can be found here1). 1 Cervical pathologies causing these radiculopathies include herniated nucleus pulposus and cervical spondylosis. official website and that any information you provide is encrypted Court, C., E. Mansour, and C. Bouthors. 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. Oral steroids can also decrease inflammation, which will help alleviate pain. Surgical approaches to thoracic disk herniations correlate with patient anatomy, location of nerve root compression, and surgeon familiarity. 1971. [ 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). (i) Postoperative T2-weighted MRI demonstrates the cage in T1T2 interspace. Surgery was done 8 days from the onset of symptoms. 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. Five percent are found in the thoracic, 3% in the cervical, and 92% in the lumbar region. Am J Ophthalmol 1998;126:565-577. We present a rare case of a patient with T1-T2 intervertebral disk herniation and Horner syndrome who was treated surgically. New left-sided partial ptosis and pupillary miosis were found on facial examination (Figure 1, A). If we just suppress the pain and associated discomfort due to T1-T2 slip disc, that wont be a permanent solution of the problem.
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