Study design: A retrospective clinical review of patients with thoracolumbar junction disc herniation. Patients with upper extremity radicular pain/paresthesias are often sent for radiographs and MRI. Anterior surgery can be achieved without sternotomy. (e) Showing removal of the sequestrated disc fragment. Nonsurgical treatments are usually tried first to treat CTJ injuries. Upper thoracic spine arthroplasty via the anterior approach. Summary of background data: Thoracolumbar junction disc herniations show a variety of signs and symptoms because of . It can also occur with ligamentous laxity in response to loading. The physician explained that you have a Bulging Disc, but you may still have questions that have been unanswered. 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. 17. 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. The pain may be centered over the injured disc but may spread to one or both sides of the mid-back. 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. Surg Neurol. Nakahara S, Sato T. First thoracic disc herniation with myelopathy. -, Alberico AM, Sahni KS, Hall JA, Jr, Young HF. 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. Unauthorized use of these marks is strictly prohibited. (Ayurveda) doctor. 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. Court, C., E. Mansour, and C. Bouthors. T1-T2 slip disc or disc protrusion is a common word for all these conditions. 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. Background: Symptomatic T1-T2 disc herniations are rare and, in most cases, are located posterolaterally. Biousse V, Touboul PJ, D'Anglejan-Chatillon J, Levy C, Schaison M, Bousser MG: Ophthalmologic manifestations of internal carotid artery dissection. Case description: In this condition we work on the posture of the shoulders and neck all together. Disc herniation; T1T2 disc space; spontaneous resolution; sternal splitting approach; thoracic disc; upper thoracic disc herniation. A cervical herniated disc may cause a number of symptoms in different parts of the body. Introduction. (b) Sagittal cervical fat saturated MRI shows the same. Would you like email updates of new search results? 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. Thoracic disc herniations make up 0.25%0.75% of all disc ruptures. Love JG, Kiefer EJ: Root pain and paraplegia due to protrusions of thoracic intervertebral disks. 1998. This typically breaks down as such: Herniated discs are very common, but they usually occur in the lumbar spine as opposed to the thoracic region. When there is some problem in the T1-T2 diss, it gives similar symptoms to cervical problem. Spine (Phila Pa 1976). It is causing burning/tingling up my neck to my ear and jaw area. Pain is usually the first symptom. 1995. When we discuss about D1-D2 disc problem or T1-T2 disc problem, symptoms are more like- cervical disc herniation. If the lower thoracic region is involved, a patient may encounter pain . The symptoms often follow a dermatomal distribution, . So when we provideAyurvedic treatment of T1-T2 slip disc we are careful about providing a proper solution. 1980. 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). Can J Neurol Sci. Herniated Discs: When Is Surgery Necessary?. Symptomatic Lumbar Disc Herniation MadanMohanSahoo,MSOrth1,SudhirKumarMahapatra,DNBOrth1, Sheetal Kaur, MD1, Jitendra Sarangi, . Specially in case of T1-T2 disc problem, age plays an important role. 30: E305-10, 24. Surgery was done 8 days from the onset of symptoms. 1978. Yale J Biol Med. Natalie Evenson MSN, BSN, RN is a health content writer. PMC sharing sensitive information, make sure youre on a federal 33. (a) T2-weighted sagittal magnetic resonance imaging (MRI) of the second case showing a hard disc at T1T2 level. J Neurosurg. 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. Bulge is a term for an image and can be a normal variant . Good office ergonomics, such as a supportive chair, can reduce the risk of thoracic herniated discs, which are already rare. The symptoms of a herniated disc in the thoracic area usually include: Pain that travels around the body and into one or both legs. 2013. In one case, a central disc fragment extended through the dura. Diagnostic testing for herniated disk includes MRI, CT, myelography, and plain radiography, either alone or in different combinations, as the occasion demands. may email you for journal alerts and information, but is committed 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). Approximately 90% of herniated discs occur at L4-L5 and L5-S1, causing pain in the L5 or S1 nerve that radiates down the sciatic nerve. Differentiating motor function from the C8-T1 nerve roots and ulnar nerve pathology can be assessed with motor testing. Most people respond well to non-operative or conservative treatment. To keep your spine neutral and avoid putting pressure on any herniated discs, place a small pillow under your head and knees. Movement the blood supply to the disc is interrupted it causes the desiccation of the disc. The symptoms of T1-T2 slip disc are- Pain just below the spine of the scapula. Magnetic resonance imaging revealed a left-sided T1-T2 herniated disc compressing the T1 nerve root. A disc herniation is a significant cause or contributor of neck pain. Save my name, email, and website in this browser for the next time I comment. 2001 Nov 15;26(22):E512-8. Your back has many interconnected bones, nerves, muscles, ligaments and tendons that protect your spinal cord. I've been in excruciating pain in the right shoulder and throughout the arm and hand for months. People who have a herniated disk often have radiating numbness or tingling in the body part served by the affected nerves. She has 24 years of experience in various areas, including Trauma, Neuro, Orthopedics, Critical Care, Emergency and Perioperative nursing. There will be pain in the front side of Arm Pit. The main reason behind this is the inappropriate process of ageing. Thoracic herniated discs are less common than herniated discs in the neck or low back, but they do happen. sharing sensitive information, make sure youre on a federal Svien HJ, Karavitis AL: Multiple protrusions of intervertebral disks in the upper thoracic region: Report of case. The first reported case was in 1945; since then, only 31 additional cases have been published. Rahimizadeh A, Sami SH, Rahimizadeh S, Williamson WL, Amirzadeh M. Surg Neurol Int. Asian Spine Journal, 2012 (evidence level 3A) T2 radiculopathy: A differential screen for upper extremity radicular pain. The location of the pain depends on the location of the herniated disc. 6: s-0036, 29. official website and that any information you provide is encrypted Kumar R, Buckley TF. Dont Miss: Group B Strep Pregnancy Symptoms. 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 report two cases of exceptional first thoracic disc herniation in a 60-year-old man and a 55-year-old woman. This clinical condition can commonly be a consequence of cervical sympathetic chain injury, which runs along the lateral aspect of the vertebral body. Surg Neurol. Although . Recommended Reading: Heart Disease Symptoms In Dogs. 6: 1-10, 2. Conclusions: Background: T1-T2 intervertebral disc prolapse (IVDP) is a rare clinical condition.Horner's syndrome is an extremely rare clinical finding in these patients. This process of desiccation starts due to the pressure on the spinal arteries. Dydyk, Alexander M, Ruben Ngnitewe Massa, and Fassil B Mesfin. 1. 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. 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. Please enable scripts and reload this page. 6 Approximately more than 70 . 1993. Although posterior approach surgery is most commonly used for laminectomy and/or foraminotomy, successful anterior approaches to upper thoracic lesions are valid as well. Fortschr Neurol Psychiatr 2001;69:236-241. 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. 13. 11: 499-501, 17. Vaidya Ji is well known for his specialisation in Ayurvedic treatment of different ailments. 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. Dermatomal patterns for C8 and T1 radiculopathy can be difficult to discern on examination because they can mimic peripheral nerve pathology such as cubital and/or Guyon tunnel syndrome.7 Motor deficits of C8 compression are reflected as weakness in hand intrinsic muscles, finger flexion, and some finger abduction. Rev Chir Orthop Reparatrice Appar Mot. Barrow Neurological Institute. doi: 10.1136/bcr-2014-204820. Opioids are most useful in the acute phase and generally not recommended for long-term use. An orthopedic or neurologic physical therapist can customize a treatment plan of safe herniated disc exercises to help decrease pain, improve strength and posture, and increase mobility. Sekhar LN, Jannetta PJ. Experience with ruptured T1-T2 discs. Despite having a long learning curve, the surgical technique described herein can be even used in patients with complex and calcified thoracic disc herniations. Vaidya Dr. Pardeep does it according to the scientific principles of Ayurveda. Thus if there are some brachial plexus injuries on lower side there will be impact on the same nerve root and its supply too. If you are experiencing pain or others symptoms of a herniated thoracic disc, you should make an appointment to see your primary care doctor. 8. [ 3 , 6 , 19 , 28 , 30 , 34 ] T1T2 discs account for only approximately 13% of all thoracic discs. Morgan H, Abood C. Disc herniation at T1-2. Would you like email updates of new search results? (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. Radiation of pain in the upper arm on the front side. Remember, the cervical spine is composed of 7 bones stacked one on top of each other. 15: 227-41, 20. Surgical approaches to thoracic disk herniations correlate with patient anatomy, location of nerve root compression, and surgeon familiarity. If the lower thoracic region is involved, a patient may encounter pain radiating to one or both lower extremities. A standard posterior approach with laminoforaminotomy and diskectomy was done. 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. Generally speaking, most neurosurgeons will advise against surgery if you are not experiencing pain or symptoms. For more information, please refer to our Privacy Policy. Numbness or tingling in areas of one or both legs. [ 1 , 2 , 4 , 5 , 7 , 8 , 11 - 15 , 17 , 18 , 25 , 26 , 29 , 32 , 33 , 35 - 37 ] T1T2 disc herniation can present with either radiculopathy or myelopathy. 1998 Jan;88(1):148-50. doi: 10.3171/jns.1998.88.1.0148. 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. 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. . 2022 Sep 9;13:412. doi: 10.25259/SNI_580_2022. Cases 3 and 4, respectively exhibited, a Brown-Sequard syndrome and radiculopathy alone. 1986. With age, the discs soft inner layer (nucleus pulposus) becomes less hydrated, making it less gelatinous and effective as a shock absorber. For the former patient, cervicothoracic MRI showed a left centro-laterally disc at the T1T2 level. T1T2 disc herniation: Report of four cases and review of the literature. An accurate diagnosis and timely surgical intervention may provide the patient the best chance for regression of symptoms and a satisfactory outcome. The site is secure. You may have pain in your lower back, numbness or pain in your leg, or loss of bladder control. 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 (Phila Pa 1976) 1991;16(10 suppl):S542-S547. Protrusions of thoracic intervertebral disks. J Neurosurg 1998;88:623-633. There was a decreased sensation noted along the left medial forearm and hypothenar region. your express consent. 37: 541-2, 12. MRI best documents soft T1T2 thoracic discs, while computed tomography is typically optimal for calcified herniations. Surgery for T1T2 posterolateral herniated discs may require transfacet pedicle-sparing decompression with pedicle screw fixation. If youve been having intolerable pain that fails to respond to conservative treatments and or causes neurological deficits. T1-T2 Pinched Nerve: The T1 spinal nerve is responsible for the ring and pinky fingers and the area at the first rib. 1998 Jan;88(1):148-50. doi: 10.3171/jns.1998.88.1.0148. Int J Spine Surg. (d) Axial T2-weighted axial view also confirms disappearance of the disc. Five percent are found in the thoracic, 3% in the cervical, and 92% in the lumbar region. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. 6. 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. Thoracic Disc Herniation: Surgical Treatment.. 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. For the fourth patient, the sequestrated disc disappeared 5 months later [Figures 4c and d ]. Herniated discs in the thoracic region account for less than 1 percent of all herniated discs. This site needs JavaScript to work properly. Thoracic spinal cord injuries are rare and only account for 10 15 percent of all spinal cord injuries. Svien HJ, Karavitis AL. (f) Postoperative T1-weighted MRI, at 3-year follow-up, note clearance of the cord. To report a rare thoracic intervertebral disc herniation followed by acutely progressing paraplegia. 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. 17: 418-30, 4. 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. 2017. Acute traumatic sequestrated thoracic disc herniation: A case report and review. There might be some other reasons like- some addiction or something like this, that causes the desiccation of the T1-T2 disc. It is important to understand the symptoms, causes, and treatments for a bulging disc to prevent the condition from worsening. The symptoms of T1-T2 slip disc are-. 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. For example, you may feel pain in your neck, arms, hands, fingers, or parts of the shoulder. The preganglionic fibers then exit the spinal cord and enter the cervical sympathetic chain. Takagi H, Kawaguchi Y, Kanamori M, Abe Y, Kimura T. T1-2 disc herniation following an en bloc cervical laminoplasty. The thickening and buckle of the vertebrae in the lower back are referred to as Ligamentum flavum hypertrophy or infolding. The levels affected are often T11 and T12, with 75% occurring below T8comparatively closer to the more flexible lumbar spine. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. 35: 329-31, 11. She underwent T1-T2 anterior discectomy and fusion. The majority of herniated thoracic discs are diagnosed and treated before they progress to even partial paralysis. To complicate matters, sometimes fragments from the annulus may break away from the parent disc and drift into the spinal canal. 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).
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