and transmitted securely. Winter RB, Siebert R. Herniated thoracic disc at T1-T2 with paraparesis. The same decay can be age related too. 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. See this image and copyright information in PMC. 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. 8. 13: 240-5, 16. A cervical herniated disc may cause a number of symptoms in different parts of the body. 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. 16. Withawin Kesornsak, Kanthika Wasinpongwanich & Verapan Kuansongtham, Teresa Plancha da Silva, Marta Amaral Silva, Ftima Carvalho, Guillermo Alejandro Ricciardi, Ignacio Gabriel Garfinkel, Daniel Oscar Ricciardi, Kalyan Kumar Varma Kalidindi, Mayank Gupta & Harvinder Singh Chhabra, Lance L. Goetz, Sean McAvoy & Kate Zakrzewski, Kevin Hines, Karim Hafazalla, Jack Jallo. Thoracic disc herniations make up 0.25%0.75% of all disc ruptures. Thoracic back pain may be exacerbated when coughing or sneezing. This is the reason in few reports it is mentioned as D1-D2 region also. Symptoms such as these are primarily determined by the location of the cervical herniated disc. 7: 189-92, 30. 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. The video can be found here1). A standard posterior approach with laminoforaminotomy and diskectomy was done. (g) Post-operative CT AP X-ray: shows the cage in T1T2 disc space. 12. Thus if there are some brachial plexus injuries on lower side there will be impact on the same nerve root and its supply too. They occur when a vertebra in your spine collapses, which can lead to severe pain, deformity and loss of height. New left-sided partial ptosis and pupillary miosis were found on facial examination (Figure 1, A). Pain just below the spine of the scapula. There are several treatment options for thoracic herniated discs. Tokuhashi Y, Matsuzaki H, Uematsu Y, Oda H. Spine (Phila Pa 1976). one or two days) and activity modification (eliminating the activities and positions that worsen or cause the thoracic back pain). The https:// ensures that you are connecting to the (e) Showing removal of the sequestrated disc fragment. (Ayurveda) doctor. Horwitz NH, Whitcomb BB, Reilly FG. National Library of Medicine J Neurosurg. Specifically, T1 nerve root compression presents with specific signs and symptoms. This pain is typically felt toward the back or side of the neck. Neurosurgery. Patients with upper extremity radicular pain/paresthesias are often sent for radiographs and MRI. He completed that match and 1 additional match that day with mild symptoms. Your doctor may use the following to diagnose a thoracic herniated disc: Sometimes other tests may be ordered because herniated thoracic disc pain and symptoms can mimic heart, lung, and stomach conditions. . Caner H, Kilinoglu BF, Benli S, Altinrs N, Bavbek M. Magnetic resonance image findings and surgical considerations in T1-2 disc herniation. Radiation of pain in the upper arm on the front side. Excruciating pain from cervical (C7/T1) radiculopathy. 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. The most common symptom of a thoracic herniated disc is pain. Diagnosis and treatment of thoracic intervertebral disc protrusions. Horner syndrome with associated T1 weakness and paresthesias is representative of many etiologies (Table 2). 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. Anterior approaches are useful, but more involved. Keywords: Disc herniation, spontaneous resolution, sternal splitting approach, T1T2 disc space, thoracic disc, upper thoracic disc herniation. 3. 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. Kuzma SA, Doberstein ST, Rushlow DR. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler:A case report. Stillerman CB, Chen TC, Couldwell WT, Zhang W, Weiss MH. Hoffman's sign was negative. 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. 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. Carousel with three slides shown at a time. Myeloradiculopathy: C8 and T1 radiculopathy - ScienceDirect What are the symptoms of a t2-t3 disc problem? - Answers Anterior surgery can be achieved without sternotomy. 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. (b) Axial view showing the central location of the disc. 6: 199-202. The symptoms began as dull back pain, which the patient initially attributed to a muscle strain, but progressively worsened throughout a 24-hour period. T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. Horner's syndrome secondary to intervertebral disc herniation at the level of T1-2. By specifically examining these five muscles, one can differentiate between cubital tunnel syndrome, which leaves their motor strength intact, and C8-T1 radiculopathy. J Glob Spine J. 6: s-0036, 29. Adults, 2019. NCHS Data Brief, Number 415,July 2021, July 2021. This is the T1 nerve root which originates from the T1-T2 region. A report of five cases. J Athl Train. 14. Diagnostic testing for herniated disk includes MRI, CT, myelography, and plain radiography, either alone or in different combinations, as the occasion demands. There is no charge to read or download any SNI content, but registering for a free membership will provide you with additional special features. Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. The symptoms of T1-T2 slip disc are-. 14: 103-6, 15. It can range from a mild pain that feels tender when touched to a sharp or burning pain. There are many different condition with T1-T2 disc and these are as follows-. There is no medicine or procedure to reverse the process of ageing. Follow-up magnetic resonance studies documented full resolution for the patient with radiculopathy and a posterolateral disc. 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). Biousse V, Touboul PJ, D'Anglejan-Chatillon J, Levy C, Schaison M, Bousser MG: Ophthalmologic manifestations of internal carotid artery dissection. 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. (b) The disc space is a little bit above the manubrium line and cervicothoracic (CT) angle is 27. National Library of Medicine [ 1 , 2 , 4 , 5 , 7 , 8 , 10 - 17 , 21 , 24 - 26 , 29 , 31 - 33 , 35 - 37 ] There were 24 males and 12 females averaging 49.1 years of age (range 2372 years of age) [ Table 2 ]. Surgical approaches to thoracic disk herniations correlate with patient anatomy, location of nerve root compression, and surgeon familiarity. Thoracic Radiculopathy - Physiopedia J Neurosurg. official website and that any information you provide is encrypted If we just suppress the pain and associated discomfort due to T1-T2 slip disc, that wont be a permanent solution of the problem. (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up. Pain is often described as sharp or burning. Available from: http://surgicalneurologyint.com/surgicalint-articles/9301/. 2016 May;25 Suppl 1:204-8. doi: 10.1007/s00586-016-4402-y. Herniated Disc (Cervical, Thoracic, Lumbar) - Columbia Neurosurgery in Spine (Phila Pa 1976) 1991;16(10 suppl):S542-S547. Causes of T1 nerve root compression has been summarized in the literature (Table 2). When Natalie is not working, you can find her gardening and taking care of her animals on her mini farm. The thoracic spine is surrounded by the rib cage and it is much harder to damage the spinal cord in this area. T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. Glaser J. Neuro-Ophthalmology, ed 1. Rahimizadeh A, Sami SH, Rahimizadeh S, Williamson WL, Amirzadeh M. Surg Neurol Int. The most commonly affected levels are C5-C6, C6-C7, and C4-C5. Despite having a long learning curve, the surgical technique described herein can be even used in patients with complex and calcified thoracic disc herniations. Neurosurgery. AJR Am J Roentgenol. Gelch MM. The T1-T2 interspace is not fully visualized on a cervical MRI; therefore, a thoracic MRI scan can be helpful. 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. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. Accessibility Surgical options will vary based on the size, type, and location of the injury, but the most common are. Clipboard, Search History, and several other advanced features are temporarily unavailable. Luk KD, Cheung KM, Leong JC. MRI best documents soft T1T2 thoracic discs, while computed tomography is typically optimal for calcified herniations. Management of Thoracic Disc Herniations via Posterior Unilateral Modified Transfacet Pedicle-Sparing Decompression With Segmental Instrumentation and Interbody Fusion. Bethesda, MD 20894, Web Policies (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. PMC Accessibility The most common areas to have a herniated disc are the cervical and lumbar areas of the spine. Informed consent to present the data concerning the case for publication was obtained by the patient. J Neurosurg Spine. 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 ]. Federal government websites often end in .gov or .mil. Avoid lifting, twisting, or straining the back. J Neurosurg. J Glob Spine J. 7: 495-7, 37. 15. Differentiating motor function from the C8-T1 nerve roots and ulnar nerve pathology can be assessed with motor testing. 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. . All surgically treated patients recovered fully. You may have pain in your lower back, numbness or pain in your leg, or loss of bladder control. When there is a change in the consistency of the jelly of disc, this falls under condition of slip disc or disc protrusion. These disc problems in thoracic region remains silent in most of the case. [ 3 , 6 , 19 , 28 , 30 , 34 ] T1T2 discs account for only approximately 13% of all thoracic discs. We present a patient with thoracic disk herniation and Horner syndrome who was treated surgically. Herniated discs affect 5 to 20 per 1000 adults annually. Intradural disc herniation at the T1-T2 level. | Semantic Scholar 24-Apr-2019;10:56, How to cite this URL: Abolfazl Rahimizadeh, Amir Hossein Zohrevand, Nima Mohseni Kabir, Naser Asgari. The discussion about a disc herniation is much more comprehensive and complicated since there are so many ways and places that a disc can herniate. Disc herniation at T1-2. 37: 541-2, 12. The thickening and buckle of the vertebrae in the lower back are referred to as Ligamentum flavum hypertrophy or infolding. [ 3 , 6 , 19 , 28 , 30 , 34 ] Most thoracic disc herniations occur below the T8 level, and the majority are found at T11T12. T1-T2 slip disc or disc protrusion is a common word for all these conditions. 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. Pain is usually the first symptom. Arts MP, Bartels RH: Anterior or posterior approach of thoracic disc herniation? When the inner core of the disc when stops getting proper nutrition, than it starts decaying further. There will be pain in the front side of Arm Pit. 2. Rev Chir Orthop Reparatrice Appar Mot. Am J Ophthalmol 1980;90:394-402. Herniated Thoracic Disc. Barrow Neurological Institute, August 3, 2022. (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. Bulge is a term for an image and can be a normal variant . Eur Spine J. Surgery was done 8 days from the onset of symptoms. Symptoms such as these are primarily determined by the location of the cervical herniated disc. 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. 2001. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. 2017 Sep;7(6):506-513. doi: 10.1177/2192568217694140. Radiation of pain in the upper arm on the front side. government site. If the lower thoracic region is involved, a patient may encounter pain radiating to one or both lower extremities. In cases where instability of the CTJ occurs or when nonsurgical treatments do not provide relief, surgery may be considered. Weakness. 1998. Most T1T2 discs were posterolateral in location (25 cases); only 11 were purely central or centrolateral. Sharan AD, Przybylski GJ, Tartaglino L. Approaching the upper thoracic vertebrae without sternotomy or thoracotomy:A radiographic analysis with clinical application. 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. Posted by mlerin @mlerin, Nov 4, 2019. 2006. Cervical Radiculopathy: Nonoperative Management of Neck Pain and - AAFP Protrusions of thoracic intervertebral disks. JAMA 1965;191:627-631. 34: 68-77, 7. 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. Specially in case of T1-T2 disc problem, age plays an important role. Carson J, Gumpert J, Jefferson A. Approximately 75% of all thoracic disc herniations are seen below T8. This fact is most likely explained by the restricted mobility and facet orientation of the thoracic spine. This is disc herniation. Transthoracic excision and fusion, case report with 4-year follow-up. Six weeks after surgery, the patient had complete resolution of his left-hand weakness and paresthesias, zero back pain, and some significant improvement in the ptosis and miosis (Figure 1, B). This is the condition, which is more common than other conditions in the T1-T2 disc. The one interesting aspect about a bulge is that it is an MRI finding that can correlate with an annular tear that causes deep midline low back pain. 2014: 34. The surgically treated patients all markedly recovered over an average of 3.87 years follow-up (range: 6 months7 years). Report of four cases and literature review. 2005. Morgan H, Abood C: Disc herniation at T1-2: Report of four cases and literature review.