After talking about your symptoms and . All surgically treated patients recovered fully. 2003. 1960. 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. (Ayurveda) doctor. The exception to this is for a giant herniated thoracic disc, which almost always requires surgery. You May Like: Parvo Symptoms In Older Dogs. J Neurosurg. The .gov means its official. (d) Axial T2-weighted axial view also confirms disappearance of the disc. Evid Based Spine Care J 2010;1:21-28. by the American Academy of Orthopaedic Surgeons. (b) Axial view showing the central location of the disc. Bethesda, MD 20894, Web Policies Background: Herniated discs in the thoracic spine have a tendency to become calcified, also known as hard disc herniation. Follow-up magnetic resonance studies documented full resolution for the patient with radiculopathy and a posterolateral disc. Surgical options will vary based on the size, type, and location of the injury, but the most common are. Federal government websites often end in .gov or .mil. J Neurosurg. T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. J Glob Spine J. Numbness or tingling. Specifically, T1 nerve root compression presents with specific signs and symptoms. Wolters Kluwer Health 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. Delineating the location of nerve compression begins with assessing sites of peripheral compression with physical examination. If youre between the ages of 30 and 50, youre more likely to be affected. This is the least common location for radiculopathy. Sekhar LN, Jannetta PJ. Because in this case, a patient might get back all those symptoms of T1-T2 slip disc come back again. : T1 radiculopathy caused by intervertebral disc herniation: Symptomatic and neurological features. 13: 240-5, 16. 2). A spine surgeon or spinal neurosurgeon can assess your herniated thoracic disc and help you decide if it would be best to have surgery or to try conservative treatment. The patient was then discharged from the emergency center with oral methylprednisolone and follow-up with an orthopaedic spine surgeon. 2014 Oct;21(4):568-76. doi: 10.3171/2014.6.SPINE13682. This sympathetic pathway begins in the hypothalamus and synapses in the intermediolateral gray substance of the spinal cord at C8-T2 levels making it susceptible to disruption via a high thoracic intervertebral disk herniation. Muscle weakness in certain muscles of one or both legs. 25: 910-6, 32. 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. 1998. There are several treatment options for thoracic herniated discs. At 9 months postoperatively, the patient continued to be pain free with full strength and intact sensation. Adults, 2019. NCHS Data Brief, Number 415,July 2021, July 2021. You may be trying to access this site from a secured browser on the server. The most commonly affected levels are C5-C6, C6-C7, and C4-C5. 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. (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable cord compression. HHS Vulnerability Disclosure, Help So the treatment is dependent on the following parameters-. Hagerstown, MD, Harper & Row, 1978. AJR Am J Roentgenol. 7. J Neurol Neurosurg Psychiatry. The .gov means its official. (b) Axial view shows the posterolaterally located disc is on the left side. 19: 449-51, 3. Transthoracic excision and fusion, case report with 4-year follow-up. You May Like: Symptoms Of Hpa Axis Dysfunction. All surgically treated patients recovered fully. Anterior surgery can be achieved without sternotomy. 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. We present a patient with thoracic disk herniation and Horner syndrome who was treated surgically. Abbott KH, Retter RH. Spine (Phila Pa 1976) 1991;16(10 suppl):S542-S547. 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. 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. J Athl Train. By specifically examining these five muscles, one can differentiate between cubital tunnel syndrome, which leaves their motor strength intact, and C8-T1 radiculopathy. This is possible through panchakarma procedures and Rasyana therapies later on. 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. 6: 1-10, 2. C8 and T1 nerve roots compound both ulnar and median nerves.3 Therefore C8 and T1 radiculopathies . Myelopathy is rare. Can J Neurol Sci. Proc Staff Meet Mayo Clin. Bethesda, MD 20894, Web Policies Arbit E. A surgical approach through the pedicle to protruded thoracic discs. 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. Cases 3 and 4, respectively exhibited, a Brown-Sequard syndrome and radiculopathy alone. FOIA -, Alberico AM, Sahni KS, Hall JA, Jr, Young HF. Even if it is not causing pain or symptoms, a giant disc herniation will usually require surgical treatment. Horner syndrome with associated T1 weakness and paresthesias is representative of many etiologies (Table 2). 30: 152-4, 6. 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. 1986;19:44951. BMJ Case Rep. 2014. Symptomatic Lumbar Disc Herniation MadanMohanSahoo,MSOrth1,SudhirKumarMahapatra,DNBOrth1, Sheetal Kaur, MD1, Jitendra Sarangi, . sharing sensitive information, make sure youre on a federal Follow-up magnetic resonance studies documented full resolution for the patient with radiculopathy and a posterolateral disc. 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. A herniated thoracic disc is considered giant if it obstructs more than 50% of the central canal of the spine . Within the spine itself there are also many other disorders that can have similar presenting symptoms of upper back pain and/or radiating pain, such as a spine fracture , infection, tumor, and certain metabolic disorders. 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. 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). 2000. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. Yale J Biol Med. 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. 1986. You will not be suddenly and completely paralyzed by a herniated thoracic disc. They can help rule out other conditions and give you a referral to a specialist. The T-1 radiculopathy usually involves weakness of the intrinsic muscles of the hand. Thoracic herniated discs are less common than herniated discs in the neck or low back, but they do happen. 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. Thoracic region is the first segment of the thoracic or dorsal spine. But not in case of T1-T2 slip disc. 48: 128-30, 8. But they can happen. First thoracic disc protrusion. Morgan H, Abood C: Disc herniation at T1-2: Report of four cases and literature review. Protrusions of thoracic intervertebral disks. MRI provides the diagnosis. 2. Causes of T1 nerve root compression has been summarized in the literature (Table 2). So when we provideAyurvedic treatment of T1-T2 slip disc we are careful about providing a proper solution. 9. Anterior approach to the cervicothoracic junction by unilateral or bilateral manubriotomy. Approximately 75% of all thoracic disc herniations are seen below T8. Its not easy figuring out how to sleep with a herniated disc. Symptoms of thoracolumbar junction disc herniation. PMC 1978. Experience with ruptured T1-T2 discs. (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable cord compression. Management of Thoracic Disc Herniations via Posterior Unilateral Modified Transfacet Pedicle-Sparing Decompression With Segmental Instrumentation and Interbody Fusion. Winter RB, Siebert R. Herniated thoracic disc at T1-T2 with paraparesis. J Neurosurg. J Neurosurg. 1955. and transmitted securely. 12. [ 3 , 6 , 19 , 28 , 30 , 34 ] Most thoracic disc herniations occur below the T8 level, and the majority are found at T11T12. Thoracic disc herniations are rare conditions compared with other disc herniations seen at cervical and lumbar spine levels. J Neurosurg. The most common symptom of a thoracic herniated disc is pain. 17: 418-30, 4. (c) T2-weighted sagittal image shows complete resolution of the disc at 5-month follow-up. -. There are some simple things that you can do at home to help alleviate the pain. Because this nerve root is the part of the brachial plexus. The rest of the postganglionic fibers travel along the internal carotid artery and enter the cavernous sinus. (h) Postoperative T2-weighted MRI: showing appropriate decompression of the spinal cord at T1T2 level. 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. Horner's syndrome secondary to intervertebral disc herniation at the level of T1-2. We added our cases (four cases) of T1T2 disc herniations to those 32 cases found in the literature. Five percent are found in the thoracic, 3% in the cervical, and 92% in the lumbar region. Horner syndrome or oculosympathetic paresis is evident because of interruption of sympathetic nerve supply to the eye, which consists of a 3-neuron pathway. FOIA Signs and Symptoms of a T1-T2 Herniated Nucleus Pulposis in the Literature (n = 21). To keep your spine neutral and avoid putting pressure on any herniated discs, place a small pillow under your head and knees. Spine (Phila Pa 1976). 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. (b) Sagittal, (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up., MeSH Svien HJ, Karavitis AL: Multiple protrusions of intervertebral disks in the upper thoracic region: Report of case. Left upper extremity motor was 5/5 in all myotomes except 4/5 finger abduction. When the inner core of the disc when stops getting proper nutrition, than it starts decaying further. Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. Herniated discs in the thoracic region account for less than 1% overall. Some common signs and symptoms of a cervical herniated disc include: Neck pain. She also works as an Adult and Pediatric Sexual Assault Nurse Examiner. Report of four cases and literature review. Unable to load your collection due to an error, Unable to load your delegates due to an error. 8. JAAOS Global Research & Reviews2(11):e016, November 2018. There was a decreased sensation noted along the left medial forearm and hypothenar region. 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. The annular tear can be confirmed with a discogram followed with a CT scan. 1978. Your message has been successfully sent to your colleague. (a) T2-weighted sagittal magnetic resonance imaging (MRI) of the second case showing a hard disc at T1T2 level. 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 ]. Surgery for T1T2 posterolateral herniated discs may require transfacet pedicle-sparing decompression with pedicle screw fixation. 2001. 18. Please enable it to take advantage of the complete set of features! Mulier S, Debois V. Thoracic disc herniations:Transthoracic, lateral, or posterolateral approach?A review. Where. Asian Spine J 2012;6:199-202. Informed consent to present the data concerning the case for publication was obtained by the patient. The symptoms of a herniated disc in the thoracic area usually include: Pain that travels around the body and into one or both legs. 1993. Surgery should occur only when objective findings of structural defects are correlated with the patients symptoms and signs. J Orthop Sci 2009;14:103-106. This narrows the space between your vertebrae, causing certain issues. one or two days) and activity modification (eliminating the activities and positions that worsen or cause the thoracic back pain). Successful Smith-Robinson approaches to T1-T2 have been achieved, whereas partial sternotomy has been used in others.9,14 Thoracic disk herniations can be approached posteriorly when little to no retraction of the spinal cord is necessary for disk access. Svien HJ, Karavitis AL. (f) Postoperative T1-weighted MRI, at 3-year follow-up, note clearance of the cord. Although posterior approach surgery is most commonly used for laminectomy and/or foraminotomy, successful anterior approaches to upper thoracic lesions are valid as well. 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. A standard posterior approach with laminoforaminotomy and diskectomy was done. T1-T2 Herniation: The T1 spinal nerve is responsible for the ring and pinky fingers and the area around the first rib. Historically, symptomatic thoracic disk herniation occurred with a frequency of 2 to 3/1,000 cases of disk herniation.2 This is likely even less frequent with the advent of MRI use in diagnosis. Rahimizadeh A, Zohrevand AH, Kabir NM, Asgari N. Surg Neurol Int. Good office ergonomics, such as a supportive chair, can reduce the risk of thoracic herniated discs, which are already rare. (f) After placement of a large cage. 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). Hoffman's sign was negative. 42: 193-5, 26. This impingement typically produces neck and radiating arm pain or. C8 root pathology will result in weakness in all three of these muscles with manual muscle testing. (f) After placement of a large cage. Disclaimer. . (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. This study can distinguish calcified disk herniations, which may lead to modified treatment strategies and surgical approach.3 The T1 nerve root supplies the ulnar nerve with C8 at a root level, the medial pectoral, medial brachial cutaneous, the medial antebrachial cutaneous nerves at a cord level, and the first intercostal nerve. The location of the pain depends on the location of the herniated disc. Nonsurgical treatments are usually tried first to treat CTJ injuries. 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. The symptoms began as dull back pain, which the patient initially attributed to a muscle strain, but progressively worsened throughout a 24-hour period. Intervertebral thoracic disk herniation is rare. 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. Gelch MM: Herniated thoracic disc at T1-2 level associated with Horner's syndrome: Case report. Because thoracic disc herniation can be caused by an injury, it can affect anyone. (b) Axial view shows the posterolaterally located disc is on the left side. The fourth patient had an MR left-sided laterally located extruded disc at the T1T2 level managed nonsurgically [ Figure 4a and b ]. An official website of the United States government. MeSH (e) Showing removal of the sequestrated disc fragment. 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. (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. 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. Watch: Thoracic Herniated Disc Video J Neurosurg Spine. 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 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. A pinched nerve may cause pain in the back or chest at the first rib, or pain in the ring and/or pinky fingers. A report of five cases. 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). J Neurosurg Spine. 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. Therefore, once muscles and ligaments are relaxed around the T1-T2, we start working on the kyphotic curve of the spine. Recommended Reading: Chronic Bronchitis Signs And Symptoms, A limited description of the specific lumbar spinal nerves includes: L1 innervates the abdominal internal obliques via the ilioinguinal nerve L2-4 innervates iliopsoas, a hip flexor, and other muscles via the femoral nerve L2-4 innervates adductor longus, a hip adductor, and other muscles via the obturator nerve L5. 13. 4 ' 5 The first T1-2 disc herniation case was reported in 1954 by Sivien and Karavitis. Report of four cases and literature review. Case report. They occur when a vertebra in your spine collapses, which can lead to severe pain, deformity and loss of height. 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. Pain just below the spine of the scapula. Careers. Therefore an MRI scan is important to find our the proper cause behind the problem.