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. Am J Ophthalmol 1980;90:394-402. A standard posterior approach with laminoforaminotomy and diskectomy was done. 2014 Oct;21(4):568-76. doi: 10.3171/2014.6.SPINE13682. 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. 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 ]. Had a cervical epidural injection last Thursday and so far no relief. Federal government websites often end in .gov or .mil. Neurosurgery. Disc herniation; T1T2 disc space; spontaneous resolution; sternal splitting approach; thoracic disc; upper thoracic disc herniation. The further down the spine the injury occurs, the greater chance for at least partial recovery. 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. There is no medicine or procedure to reverse the process of ageing. 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. Thoracic spinal cord injuries are rare and only account for 10 15 percent of all spinal cord injuries. GUIDE: Physical Therapy Guide to Herniated Disk. Choose PT, August 26, 2021. A, Right parasagittal T1-, T2-, and STIR-weighted images that demonstrate a discrete fracture line through the pedicles of L4 bilaterally without pedicle marrow signal intensity changes (long arrow) and a less obvious fracture line on T1 images through the L5 pedicle with concomitant type 1 pedicle marrow changes (short arrows). Report of four cases and literature review. 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. Background:Symptomatic T1T2 disc herniations are rare and, in most cases, are located posterolaterally. With age, the soft disks that act as cushions between your spines vertebrae wear down, dry out and/or shrink. The man was treated surgically and the woman medically. 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). Your email address will not be published. J Glob Spine J. 17: 418-30, 4. We present a patient with thoracic disk herniation and Horner syndrome who was treated surgically. 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. Symptoms depend on where and how big the disc herniation is, where it is pressing, and whether the spinal cord has been damaged. 28: 322-30, 14. A herniation here may cause pain at the back or chest around the first rib, or pain in the ring and/or pinky fingers. An official website of the United States government. The symptoms began as dull back pain, which the patient initially attributed to a muscle strain, but progressively worsened throughout a 24-hour period. and transmitted securely. Spine (Phila Pa 1976) 1991;16(10 suppl):S542-S547. 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. 1968. 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. The rest of the postganglionic fibers travel along the internal carotid artery and enter the cavernous sinus. HHS Vulnerability Disclosure, Help Am J Ophthalmol 1998;126:565-577. Asian Spine J 2012;6:199-202. Bethesda, MD 20894, Web Policies 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 . (h) Postoperative T2-weighted MRI: showing appropriate decompression of the spinal cord at T1T2 level. 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. Anterior approach to the cervicothoracic junction by unilateral or bilateral manubriotomy. She underwent T1-T2 anterior discectomy and fusion. Herniated Discs: When Is Surgery Necessary?. 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. Because this nerve root is the part of the brachial plexus. Gokcen HB, Erdogan S, Gumussuyu G, Ozturk S, Ozturk C. A rare case of T1-2 thoracic disc herniation mimicking cervical radiculopathy. Arts MP, Bartels RH: Anterior or posterior approach of thoracic disc herniation? (a) T2-weighted sagittal magnetic resonance imaging (MRI) of the second case showing a hard disc at T1T2 level. T1-T2 Pinched Nerve: The T1 spinal nerve is responsible for the ring and pinky fingers and the area at the first rib. (a) T2-weighted sagittal image demonstrating, (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable, (a) T2-weighted sagittal magnetic resonance, (a) T2-weighted sagittal magnetic resonance imaging (MRI) of the second case showing a, (a) T2-weighted sagittal magnetic resonance imaging (MRI) shows T1T2 disc herniation. Caner H, Kilinoglu BF, Benli S, Altinrs N, Bavbek M. Magnetic resonance image findings and surgical considerations in T1-2 disc herniation. Data is temporarily unavailable. 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. 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 ]. 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. MeSH Some common signs and symptoms of a cervical herniated disc include: Neck pain. 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. (g) Plain CT radiograph showing that the cage is located at bicalvicular line. Patients with upper extremity radicular pain/paresthesias are often sent for radiographs and MRI. 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. Required fields are marked *. Experience with ruptured T1-T2 discs. i have a t1-2 herniated disc pinching a nerve, possible thoracic outlet. 1991. 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. MRI provides the diagnosis. Diagnostic testing for herniated disk includes MRI, CT, myelography, and plain radiography, either alone or in different combinations, as the occasion demands. Report of four cases and literature review. When there is some problem in the T1-T2 diss, it gives similar symptoms to cervical problem. A disc herniation is a significant cause or contributor of neck pain. We added our cases (four cases) of T1T2 disc herniations to those 32 cases found in the literature. Over-the-counter or prescription meds such as acetaminophen and NSAIDs like ibuprofen are common medicinal treatments. A magnetic resonance imaging scan revealed a large focal paracentral herniated disc at the T2-3 level. Svien HJ, Karavitis AL. (e) Showing removal of the sequestrated disc fragment. 88: 623-33, 35. 1960;17:41830. 1-3 The most affected area in the thoracic region is the T11-12 level. Would you like email updates of new search results? 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. Br J Neurosurg. Intervertebral thoracic disk herniation is rare. All surgically treated patients recovered fully. We report two cases of exceptional first thoracic disc herniation in a 60-year-old man and a 55-year-old woman. (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. The pain may be centered over the injured disc but may spread to one or both sides of the mid-back. to maintaining your privacy and will not share your personal information without Patients demographic data and common clinical features of the corresponding location at which they generate. All but five intrinsic hand muscles are innervated by the ulnar nerve; abductor pollicus brevis, flexor pollicis brevis, opponens pollicis, and lateral lumbricals. M51.24 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Regular exercise and strengthening the core abdominal muscles will help stabilize the spine. Nakahara S, Sato T. First thoracic disc herniation with myelopathy. Numbness or tingling. You will not be suddenly and completely paralyzed by a herniated thoracic disc. Signal . In this condition we work on the posture of the shoulders and neck all together. symptoms with longer duration or unrelieved by conservative The thickening and buckle of the vertebrae in the lower back are referred to as Ligamentum flavum hypertrophy or infolding. Anterior surgery can be achieved without sternotomy. BMJ Case Rep. 2014 Jun 5;2014:bcr2014204820. Results: The patient's symptoms resolved completely. Signs and Symptoms of a T1-T2 Herniated Nucleus Pulposis in the Literature (n = 21). In cases where instability of the CTJ occurs or when nonsurgical treatments do not provide relief, surgery may be considered. Epub 2014 Jul 18. Before Krasnianski M, Georgiadis D, Grehl H, Lindner A: Correlation of clinical and magnetic resonance imaging findings in patients with brainstem infarction. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. 12: 221-31, 5. Kumar R, Buckley TF. MRI diagnosis is C7/T1 and C6-C7 severe foraminal narrowing and stenosis. 37: 541-2, 12. Clipboard, Search History, and several other advanced features are temporarily unavailable. The 2023 edition of ICD-10-CM M51.24 became effective on October 1, 2022. Mulier S, Debois V. Thoracic disc herniations:Transthoracic, lateral, or posterolateral approach?A review. FOIA The rib cage adds extra protection, support, and stabilization to the spine, making it less susceptible to damage in general and disc trouble in particular. Diagnosis and treatment of thoracic intervertebral disc protrusions. 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). 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. A working differential diagnosis can guide management. This is the American ICD-10-CM version of M51.24 - other international versions of ICD-10 M51.24 may differ. 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. See All About Neck Pain Radicular pain. There is no charge to read or download any SNI content, but registering for a free membership will provide you with additional special features. Background: Symptomatic T1-T2 disc herniations are rare and, in most cases, are located posterolaterally. 11: 30-, 10. J Athl Train. Save my name, email, and website in this browser for the next time I comment. Thoracic Herniated Disc Symptoms. T1-T2 disc herniation:Two cases. (f) Postoperative T1-weighted MRI, at 3-year follow-up, note clearance of the cord. Back, Lower Limb, and Upper Limb Pain among U.S. Nowadays, endoscopic techniques have become increasingly popular and full-endoscopic surgery can be performed in the thoracic spine . As we all know there are only few chances of the disc problems in dorsal spine, because this area is fixed in comparison to the cervical spine and lumbar spine. 12. 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. Band-like pain travelling from the back to the abdomen/chest on one or both sides of the body Headaches when you sit or lie in certain positions Numbness, tingling, or a burning feeling in your legs Trouble walking or moving your legs Weakness in your arms or legs Trouble urinating or having a bowel movement (e) Showing removal of the sequestrated disc fragment. Biousse V, Touboul PJ, D'Anglejan-Chatillon J, Levy C, Schaison M, Bousser MG: Ophthalmologic manifestations of internal carotid artery dissection. 34: 68-77, 7. Med Ann Dist Columbia. 1998. J Neurosurg. Can J Neurol Sci. When there is a compression on the disc, it starts decaying. See this image and copyright information in PMC. For example, you may feel pain in your neck, arms, hands, fingers, or parts of the shoulder. 13. Posterior-only approach for the treatment of symptomatic central thoracic disc herniation regardless of calcification: A consecutive case series of 30 cases over five years. Central disk herniations or those that compromise up to 50% across the disk space are often approached through an anterior approach as effective decompression cannot be completed from a posterior only approach. [ 15 ] Patients with thoracic discs typically present with neck pain (i.e. (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable cord compression. This site needs JavaScript to work properly. Cervical radiographs are not usually clinically useful because of the difficulty in visualizing through the shoulders. 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. AJR Am J Roentgenol. 1. 2006. 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. 1995. Proc Staff Meet Mayo Clin. (f) Postoperative T1-weighted MRI, at 3-year follow-up, note clearance of the cord. MRI best documents soft T1T2 thoracic discs, while computed tomography is typically optimal for calcified herniations. BecauseAyurvedic treatment of T1-T2 slip disc problem is not about suppression of signs and symptoms alone. posterolateral discs) and, in some cases, spontaneously resolved (2 of 36 cases). Global Spine J. The levels affected are often T11 and T12, with 75% occurring below T8comparatively closer to the more flexible lumbar spine. routine T1 and T2 sequences were used to study the status of the endplate (1.5-T Optima GEM MRI, GE Healthcare, Buck- . Anterior surgery can be achieved without sternotomy. This is the condition, which is more common than other conditions in the T1-T2 disc. Kanno H, Aizawa T, Tanaka Y, et al. [ 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). So the treatment is dependent on the following parameters-. (e) Axial CT scan shows a pedicle screw in an upper thoracic vertebra. 2013 Sep-Oct;48(5):710-5. doi: 10.4085/1062-6050-48.5.03. Symptomatic thoracic disc herniation is uncommon and has been estimated to less than 0.75% of all symptomatic spinal disc herniations. Left upper extremity motor was 5/5 in all myotomes except 4/5 finger abduction. 2. There will be pain in the front side of Arm Pit. Disclaimer. We focused on the clinical presentation, e.g. C8 root pathology will result in weakness in all three of these muscles with manual muscle testing. Conservative treatments are appropriate for T1T2 discs resulting in just mild radiculopathy (e.g. 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. Both of these signs were absent in our patients. The symptoms of a herniated disc depends on either the size and position of the disc. Would you like email updates of new search results? It can range from a mild pain that feels tender when touched to a sharp or burning pain. 2009. Bransford R, Zhang F, Bellabarba C, Konodi M, Chapman JR. Disclaimer. 4: 366-7, 25. 2002. In this article, we reviewed these 32 prior cases of T1T2 disc herniations and added our four cases. J Neurosurg. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. Surgical options will vary based on the size, type, and location of the injury, but the most common are. 2021 Mar 17;12:108. doi: 10.25259/SNI_941_2020. Excruciating pain from cervical (C7/T1) radiculopathy. When the inner core of the disc when stops getting proper nutrition, than it starts decaying further. He completed that match and 1 additional match that day with mild symptoms. If the lower thoracic region is involved, a patient may encounter pain . It can result from advanced disc degeneration or from vertebral body remodeling . (b) Sagittal cervical fat saturated MRI shows the same. 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. We present a rare case of a patient with T1-T2 intervertebral disk herniation and Horner syndrome who was treated surgically. (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. 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. It can also occur with ligamentous laxity in response to loading. Neurology. I've been in excruciating pain in the right shoulder and throughout the arm and hand for months. 2010. Carr DA, Volkov AA, Rhoiney DL, Setty P, Barrett RJ, Claybrooks R, Bono PL, Tong D, Soo TM. If youve been having intolerable pain that fails to respond to conservative treatments and or causes neurological deficits. 10. If you have a thoracic herniated disc, you may feel these symptoms circumferentially around your rib cage or upper abdominal area. The preganglionic fibers then exit the spinal cord and enter the cervical sympathetic chain. Despite having a long learning curve, the surgical technique described herein can be even used in patients with complex and calcified thoracic disc herniations. 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). Anterior approaches are useful, but more involved. Under his, Cost effective alternative for spinal surgery. J Orthop Sci. Acute traumatic sequestrated thoracic disc herniation: A case report and review. Maintaining a healthy weight will put less pressure on the discs and minimizes wear and tear to the spine. (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable cord compression. Nonsurgical treatments are usually tried first to treat CTJ injuries. (g) Post-operative CT AP X-ray: shows the cage in T1T2 disc space. 7: 495-7, 37. Opioids are most useful in the acute phase and generally not recommended for long-term use. Rahimizadeh A. Thoracic disc herniation:20 years experience in 82 cases. J Neurosurg Spine. T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. A pinched nerve may cause pain in the back or chest at the first rib, or pain in the ring and/or pinky fingers. For the former patient, cervicothoracic MRI showed a left centro-laterally disc at the T1T2 level. Five percent are found in the thoracic, 3% in the cervical, and 92% in the lumbar region. Symptoms such as these are primarily determined by the location of the cervical herniated disc. Therefore an MRI scan is important to find our the proper cause behind the problem. 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. Remember, the cervical spine is composed of 7 bones stacked one on top of each other. The same decay can be age related too. This is disc herniation. BMJ Case Rep. 2014. Gelch MM: Herniated thoracic disc at T1-2 level associated with Horner's syndrome: Case report. [ 3 , 6 , 19 , 28 , 30 , 34 ] Most thoracic disc herniations occur below the T8 level, and the majority are found at T11T12. 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. Bransford RJ, Zhang F, Bellabarba C, Lee MJ. Lucas, Jacqueline W, Eric M Connor, and Jonaki Bose.