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. Watch: Thoracic Herniated Disc Video eCollection 2019. (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. T1-T2 slip disc or disc protrusion is a common word for all these conditions. Thoracic spinal cord injuries are typically less severe than injuries to the cervical spinal cord. Patients demographic data and common clinical features of the corresponding location at which they generate. These degenerative changes are more likely to happen in your neck and lower back than your upper and middle back . 30: E305-10, 24. 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. Thoracic disc herniations are rare conditions compared with other disc herniations seen at cervical and lumbar spine levels. Management of Thoracic Disc Herniations via Posterior Unilateral Modified Transfacet Pedicle-Sparing Decompression With Segmental Instrumentation and Interbody Fusion. For example, you may feel pain in your neck, arms, hands, fingers, or parts of the shoulder. 1983. 17. (f) Postoperative T1-weighted MRI, at 3-year follow-up, note clearance of the cord. 88: 623-33, 35. government site. For more information, please refer to our Privacy Policy. (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up. C8 root pathology will result in weakness in all three of these muscles with manual muscle testing. 2010 Feb;12(2):221-31. doi: 10.3171/2009.9.SPINE09476. 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. Negoveti L, Cerina V, Sajko T, Glavi Z. Intradural disc herniation at the T1-T2 level. A working differential diagnosis can guide management. According to the American Association of Neurological Surgeons, about 75 - 85% of people in the U.S. suffer from back pain at some point in their lifetime. 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. 35: 329-31, 11. The same decay can be age related too. Morgan H, Abood C: Disc herniation at T1-2: Report of four cases and literature review. Conclusions: The man was treated surgically and the woman medically. All but five intrinsic hand muscles are innervated by the ulnar nerve; abductor pollicus brevis, flexor pollicis brevis, opponens pollicis, and lateral lumbricals. 1971. 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. T2 sagittal and axial MR images with T1-T2 disk herniation (arrows). This is the least common location for radiculopathy. BMJ Case Rep. 2014 Jun 5;2014:bcr2014204820. 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. 14: 103-6, 15. (f) After placement of a large cage. Weakness with finger abduction results from C8 radiculopathy and/or peripheral ulnar nerve entrapment. 18: 782-4, Your email address will not be published. A pinched nerve may cause pain in the back or chest at the first rib, or pain in the ring and/or pinky fingers. T1-T2 Herniation: The T1 spinal nerve is responsible for the ring and pinky fingers and the area around the first rib. People who have a herniated disk often have radiating numbness or tingling in the body part served by the affected nerves. (b) Sagittal, (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up., MeSH Symptomatic thoracic disc herniation is uncommon and has been estimated to less than 0.75% of all symptomatic spinal disc herniations. 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. T1-T2 disc herniation:Two cases. Most people respond well to non-operative or conservative treatment. (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. 29: 375-8, 36. T1 motor root innervates the flexor digitorum superficialis, flexor pollicis longus, flexor pollicis longus, flexor digitorum profundus, lumbricals, interossei, and the pectoralis major. 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. Glaser J. Neuro-Ophthalmology, ed 1. Spine (Phila Pa 1976). 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. Neurology. Opioids are most useful in the acute phase and generally not recommended for long-term use. 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. Winter RB, Siebert R. Herniated thoracic disc at T1-T2 with paraparesis. 12: 303-5, 31. 1952. A standard posterior approach with laminoforaminotomy and diskectomy was done. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Informed consent to present the data concerning the case for publication was obtained by the patient. Biousse V, Touboul PJ, D'Anglejan-Chatillon J, Levy C, Schaison M, Bousser MG: Ophthalmologic manifestations of internal carotid artery dissection. 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. Svien HJ, Karavitis AL. Sebastian . (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. Increased reflexes in one or both legs that can cause spasticity in the legs. Federal government websites often end in .gov or .mil. If the lower thoracic region is involved, a patient may encounter pain . [ 3 , 6 , 19 , 28 , 30 , 34 ] T1T2 discs account for only approximately 13% of all thoracic discs. I have a severe pressure senstation in the area of the bulge and when I lay down I have the burning in my neck and also in my (L)arm. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. 24/36 patients). 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). 2001 Nov 15;26(22):E512-8. Available from: http://surgicalneurologyint.com/surgicalint-articles/9301/. (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up. 4 ' 5 The first T1-2 disc herniation case was reported in 1954 by Sivien and Karavitis. (f) After placement of a large cage. Symptoms of thoracolumbar junction disc herniation. 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. Proc Staff Meet Mayo Clin. This clinical condition can commonly be a consequence of cervical sympathetic chain injury, which runs along the lateral aspect of the vertebral body. Logue V. Thoracic intervertebral disc prolapse with spinal cord compression. Maloney WF, Younge BR, Moyer NJ: Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. Disc herniation; T1T2 disc space; spontaneous resolution; sternal splitting approach; thoracic disc; upper thoracic disc herniation. Apply an ice pack or cold compress to the affected area for 15- to 20-minute intervals every two hours. 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. 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. J Glob Spine J. Rossitti S, Stephensen H, Ekholm S, von Essen C. The anterior approach to high thoracic (T1-T2) disc herniation. Study design: A retrospective clinical review of patients with thoracolumbar junction disc herniation. may email you for journal alerts and information, but is committed Thoracic back pain may be exacerbated when coughing or sneezing. 15. If the herniation occurs in the neck, for example, it can cause pain that radiates into the shoulder and arm; if it occurs in the lower back, the pain produced can radiate down into the hip and leg. Conclusion: Adjacent-segment degeneration after cervical spine fusion may rarely occur even at T1-T2, and the unusual symptoms of a T1 . Surg Neurol. The further down the spine the injury occurs, the greater chance for at least partial recovery. Multiple protrusions of intervertebral disks in the upper thoracic region:Report of case. (e) Axial CT scan shows a pedicle screw in an upper thoracic vertebra. This fact is most likely explained by the restricted mobility and facet orientation of the thoracic spine. Rossitti S, Stephensen H, Ekholm S, von Essen C: The anterior approach to high thoracic (T1-T2) disc herniation. (e) Intraoperative clearance of the disc space from both hard disc and osteophytes. 33. Protrusion of the first thoracic disk. A magnetic resonance imaging scan revealed a large focal paracentral herniated disc at the T2-3 level. 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. This is the T1 nerve root which originates from the T1-T2 region. J Neurosurg. A disc bulge is not a disc herniation. Objective: To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1-T2 disc herniation. 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. Ruptured thoracic discs. 6. Back, Lower Limb, and Upper Limb Pain among U.S. 1986;19:44951. J Neurol Neurosurg Psychiatry. (b) Sagittal cervical fat saturated MRI shows the same. Neurosurgical Developments on the Horizon, Leksell Gamma Knife Society Meeting Series, Dubai, 2018, Mayo Clinic Neuroscience Neurosurgery Lecture Series, http://surgicalneurologyint.com/surgicalint-articles/9301/, Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran. 15: 227-41, 20. 134: 184-5, 19. 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. There are several treatment options for thoracic herniated discs. Case report. (c) T2-weighted sagittal image shows complete resolution of the disc at 5-month follow-up. Due to high occurrence of complications from open surgery, minimally invasive approaches are desirable. 1991. Thoracic disc herniation:Operative approaches and results. Neurosurgery. The patient underwent successful T2-3 anterior discectomy with T2-3 rib autograft fusion. Disclaimer. Herniated thoracic discs can cause paralysis. The third patient undergoing a transfacet pedicle-sparing left-sided approach had a postoperative three-dimensional computed tomography scans showing adequate root decompression and screw placement screws [Figures 3e and d ]. The https:// ensures that you are connecting to the Anterior approach to the cervicothoracic junction by unilateral or bilateral manubriotomy. There was a decreased sensation noted along the left medial forearm and hypothenar region. Bethesda, MD 20894, Web Policies Disclaimer. sharing sensitive information, make sure youre on a federal Drawing showing the anatomy of the oculosympathetic pathway. 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 ]. J Neurosurg 1950;7:62-69. The thickening and buckle of the vertebrae in the lower back are referred to as Ligamentum flavum hypertrophy or infolding. 2017 Sep;7(6):506-513. doi: 10.1177/2192568217694140. 3. Caner H, Kilinoglu BF, Benli S, Altinrs N, Bavbek M. Magnetic resonance image findings and surgical considerations in T1-2 disc herniation. J Neurol Neurosurg Psychiatry. In cases where instability of the CTJ occurs or when nonsurgical treatments do not provide relief, surgery may be considered. We present a rare case of a patient with T1-T2 intervertebral disk herniation and Horner syndrome who was treated surgically. 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. Spine J 2014;14:1654-1662. Required fields are marked *. FOIA If you have a thoracic herniated disc, you may feel these symptoms circumferentially around your rib cage or upper abdominal area. Although anhydrosis was not explicitly tested, Horner syndrome was strongly suspected. T1T2 disc herniation: Report of four cases and review of the literature. 12: 221-31, 5. 92: 715-8, 9. 8. Background:Symptomatic T1T2 disc herniations are rare and, in most cases, are located posterolaterally. Movement the blood supply to the disc is interrupted it causes the desiccation of the disc. 2022 Sep 9;13:412. doi: 10.25259/SNI_580_2022. JAMA 1965;191:627-631. The .gov means its official. Bransford R, Zhang F, Bellabarba C, Konodi M, Chapman JR. Gelch MM: Herniated thoracic disc at T1-2 level associated with Horner's syndrome: Case report. 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. Data is temporarily unavailable. Lucas, Jacqueline W, Eric M Connor, and Jonaki Bose. Surgical approaches to thoracic disk herniations correlate with patient anatomy, location of nerve root compression, and surgeon familiarity. See this image and copyright information in PMC. Please try after some time. Thoracic herniated discs are less common than herniated discs in the neck or low back, but they do happen. The symptoms of T1-T2 slip disc depends on the severity of the problem. a = artery, n = nerve. 2010. Thoracic discectomy by posterior pedicle-sparing, transfacet approach with real-time intraoperative ultrasonography: Clinical article. Gelch MM. 11. Claude-Bernard-Horner syndrome is not constant but highly suggestive. 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 rest of the postganglionic fibers travel along the internal carotid artery and enter the cavernous sinus. Osteoarthritis appeared to be the predominant cause of the disc herniation in both patients. 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. J Neurosurg Spine. Vaidya Dr. Pardeep does it according to the scientific principles of Ayurveda. This impingement typically produces neck and radiating arm pain or. Yoon, Wai Weng, and Jonathan Koch. Am J Ophthalmol 1998;126:565-577. The symptoms of T1-T2 slip disc are- Pain just below the spine of the scapula. (d) Axial T2-weighted axial view also confirms disappearance of the disc. The fibers ascend and synapse at the superior cervical ganglia at the level of the bifurcation of the common carotid artery (C3-C4). 2000. AJR Am J Roentgenol. 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. Cervical radiographs are not usually clinically useful because of the difficulty in visualizing through the shoulders.