After confirming the diagnosis with MRI, the patient was treated with standard posterior approach with laminoforaminotomy and diskectomy. [ 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. Rahimizadeh A, Zohrevand AH, Kabir NM, Asgari N. Surg Neurol Int. BMJ Case Rep. 2014. Because in this case, a patient might get back all those symptoms of T1-T2 slip disc come back again. 35: 329-31, 11. (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. Posted by mlerin @mlerin, Nov 4, 2019. J Bone Joint Surg Am. Weakness with finger abduction results from C8 radiculopathy and/or peripheral ulnar nerve entrapment. J Neurol Neurosurg Psychiatry. J Neurosurg Spine. 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. On postoperative day 1, the patient reported improvement in his left-sided radiating back pains, partial return of sensation along the left medial forearm, and hand with some mild persistent paresthesias. C8 and T1 nerve roots compromise both the ulnar and median nerve root; therefore, precise examination of these roots is necessary. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. 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. Spine (Phila Pa 1976). 2). (e) Axial CT scan shows a pedicle screw in an upper thoracic vertebra. Horner syndrome with associated T1 weakness and paresthesias is representative of many etiologies (Table 2). We added our cases (four cases) of T1T2 disc herniations to those 32 cases found in the literature. The first reported case was in 1945; since then, only 31 additional cases have been published. This is disc herniation. The number one prevention is not smoking. Lloyd TV, Johnson JC, Paul DJ, Hunt W: Horner's syndrome secondary to herniated disc at T1-T2. (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. Diagnosis and treatment of thoracic intervertebral disc protrusions. With cervical disc herniations, the nerve affected by the condition is the one that exits at that specific level of the spine. (d) Axial T2-weighted axial view also confirms disappearance of the disc. [ 1 , 2 , 4 , 5 , 7 - 9 , 11 - 15 , 17 , 18 , 21 , 24 - 26 , 29 , 31 - 33 , 35 - 37 ]. There are several treatment options for thoracic herniated discs. National Library of Medicine This pain is typically felt toward the back or side of the neck. 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. Horner's syndrome secondary to intervertebral disc herniation at the level of T1-2. Signs and Symptoms of a T1-T2 Herniated Nucleus Pulposis in the Literature (n = 21). Acute traumatic sequestrated thoracic disc herniation: A case report and review. The location of the pain depends on the location of the herniated disc. 13: 240-5, 16. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. 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. (b) Sagittal, (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up., MeSH 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 ]. T1-T2 slip disc or disc protrusion is a common word for all these conditions. 1998. 48: 768-72, 27. This site needs JavaScript to work properly. In one case, a central disc fragment extended through the dura. 9. 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. The symptoms of a herniated disc in the thoracic area usually include: Pain that travels around the body and into one or both legs. (b) The disc space is a little bit above the manubrium line and cervicothoracic (CT) angle is 27. 1993. The rest of the postganglionic fibers travel along the internal carotid artery and enter the cavernous sinus. Spine (Phila Pa 1976). (b) Axial view showing the central location of the disc. The rest of the postganglionic fibers travel along the internal carotid artery and enter the cavernous sinus. Herniated discs happen when the soft, jellylike inner layer of a shock-absorbing intervertebral disc bulges into or breaks through the discs tough outer layer. by the American Academy of Orthopaedic Surgeons. Careful radiographic analysis is needed preoperatively to identify the upper limit of the sternum. 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. 2017. 1956. A report of five cases. 1. 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 symptoms began as dull back pain, which the patient initially attributed to a muscle strain, but progressively worsened throughout a 24-hour period. 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. (c) T2-weighted sagittal image shows complete resolution of the disc at 5-month follow-up. 2003. Bethesda, MD 20894, Web Policies Differentiating motor function from the C8-T1 nerve roots and ulnar nerve pathology can be assessed with motor testing. 7. Excruciating pain from cervical (C7/T1) radiculopathy. Radiation of pain in the upper arm on the front side. Generally speaking, most neurosurgeons will advise against surgery if you are not experiencing pain or symptoms. (e) Intraoperative clearance of the disc space from both hard disc and osteophytes. Herniated discs in the thoracic region account for less than 1 percent of all herniated discs. 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. 8600 Rockville Pike Intradural disc herniations comprise 0.26-0.30% of all herniated discs. 88: 148-50, 22. JAMA 1965;191:627-631. An accurate diagnosis and timely surgical intervention may provide the patient the best chance for regression of symptoms and a satisfactory outcome. Numbness or tingling in areas of one or both legs. There are many different condition with T1-T2 disc and these are as follows-. 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. In cases where instability of the CTJ occurs or when nonsurgical treatments do not provide relief, surgery may be considered. Five percent are found in the thoracic, 3% in the cervical, and 92% in the lumbar region. J Neurosurg Spine. A large herniated disc can compress the spinal cord within the spinal canala condition called myelopathyresulting in numbness, tingling, and or weakness in one or both lower extremities, and sometimes bowel and bladder dysfunction, and in extreme cases, paralysis. Int J Spine Surg. (h) Postoperative T2-weighted MRI: showing appropriate decompression of the spinal cord at T1T2 level. When the pressure is increasing with the time and jelly starts moving towards the periphery of the disc, it causes several symptoms according the compression on the nerve roots. Arseni C, Nash F. Thoracic intervertebral disc protrusion:A clinical study. Where. A disc herniation is a significant cause or contributor of neck pain. This is the American ICD-10-CM version of M51.24 - other international versions of ICD-10 M51.24 may differ. The symptoms are limited, as observed in both patients, to a T1 radiculopathy, to be distinguished from C8 radicopathy. By specifically examining these five muscles, one can differentiate between cubital tunnel syndrome, which leaves their motor strength intact, and C8-T1 radiculopathy. 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. 14. Again, the specific symptoms of a cervical herniated disc will depend on the affected pinched nerves. Posterior approach surgery has most commonly been used for laminectomy and/or foraminotomy.1,5,11-13 Adequate disk access of more central disk herniations may not be accomplished without excessive facet resection leading to hypermobility. If you begin to experience symptoms, or if your mild symptoms like pain, radiculopathy, myelopathy become worse, it may be time to consider surgery. Kurz LT, Pursel SE, Herkowitz HN. Protrusions of thoracic intervertebral disks. The C8 nerve root innervates the extensor indicus and abductor pollicis brevis from the radial and median nerves, respectively, in addition to finger flexion (ulnar nerve). To complicate matters, sometimes fragments from the annulus may break away from the parent disc and drift into the spinal canal. Extruded upper thoracic disc causing horner's syndrome:Report of a case. 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). Symptomatic T1-T2 disc herniations are rare and, in most cases, are located posterolaterally. J Glob Spine J. 48: 128-30, 8. Approximately 75% of all thoracic disc herniations are seen below T8. Data is temporarily unavailable. The symptoms of T1-T2 slip disc are- Pain just below the spine of the scapula. J Neurosurg. Copyright Surgical Neurology International. 2002. Kumar R, Buckley TF. There will be pain in the front side of Arm Pit. If there is some deformity behind T1-T2 slip disc than we aim to restore the kyphotic changes. Thoracic discectomy by posterior pedicle-sparing, transfacet approach with real-time intraoperative ultrasonography: Clinical article. Natalie Evenson MSN, BSN, RN is a health content writer. (g) Post-operative CT AP X-ray: shows the cage in T1T2 disc space. Although posterior approach surgery is most commonly used for laminectomy and/or foraminotomy, successful anterior approaches to upper thoracic lesions are valid as well. 84-A: 1013-7, 21. 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). Bethesda, MD 20894, Web Policies (f) After placement of a large cage. T1T2 disc herniation: Report of four cases and review of the literature. 1978. Trauma, such as a motor vehicle crash or fall can also cause a thoracic herniated disc. Also, if the branch of the thoracic nerve going toward the back becomes inflamed, pain and other symptoms could be felt in the back at or near the location of the inflammation. 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. Good office ergonomics, such as a supportive chair, can reduce the risk of thoracic herniated discs, which are already rare. Hann EC. 88: 623-33, 35. Br J Neurosurg 1993;7:189-192. Arbit E. A surgical approach through the pedicle to protruded thoracic discs. 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. On examination, she had lower extremity hyperreflexia, an abnormal gait, and lower lumbar pain but lacked any radicular findings. (b) Axial view shows the posterolaterally located disc is on the left side. Report of four cases and literature review. Rossitti S, Stephensen H, Ekholm S, von Essen C. The anterior approach to high thoracic (T1-T2) disc herniation. J Neurosurg 1998;88:623-633. 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 ]. Introduction Surgical intervention is the treatment of choice in patients with thoracic disc herniation with refractory symptoms and progressive myelopathy. Epub 2017 Apr 6. J Orthop Sci. doi: 10.1136/bcr-2014-204820. Tokuhashi Y, Matsuzaki H, Uematsu Y, Oda H. Spine (Phila Pa 1976). (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. 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. one or two days) and activity modification (eliminating the activities and positions that worsen or cause the thoracic back pain). Careful radiographic analysis is needed preoperatively to identify the upper limit of the sternum. Specially in case of T1-T2 disc problem, age plays an important role. The main reason behind this is the inappropriate process of ageing. Regular exercise and strengthening the core abdominal muscles will help stabilize the spine. 6: 1-10, 2. 2016 May;25 Suppl 1:204-8. doi: 10.1007/s00586-016-4402-y. The https:// ensures that you are connecting to the (a) T2-weighted sagittal magnetic resonance imaging (MRI) of the second case showing a hard disc at T1T2 level. Along with this when we work with pronated shoulders and fixed neck- chances of problem with D1-D2 disc increases in same frequency. A pinched nerve may cause pain in the back or chest at the first rib, or pain in the ring and/or pinky fingers. 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. A spine specialist determines if surgery is the best option. Over-the-counter or prescription meds such as acetaminophen and NSAIDs like ibuprofen are common medicinal treatments. (b) The disc space is a little bit above the manubrium line and cervicothoracic (CT) angle is 27. Gille O, Razafimahandry HJ, Sderlund C, Gangnet N, Vital JM. to maintaining your privacy and will not share your personal information without The incidence of a herniated disc may disrupt activities of daily living and sleep. Informed consent to present the data concerning the case for publication was obtained by the patient. Unlike the usual calcification in the medioposterior position for middle or lower thoracic spine herniations, a soft posterolateral herniation was observed here. There is no charge to read or download any SNI content, but registering for a free membership will provide you with additional special features. Even if it is not causing pain or symptoms, a giant disc herniation will usually require surgical treatment. BMJ Case Rep. 2014 Jun 5;2014:bcr2014204820. Numbness or tingling. 1978. -, Arseni C, Nash F. Thoracic intervertebral disc protrusion:A clinical study. (e) Showing removal of the sequestrated disc fragment. (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. In this article, we reviewed these 32 prior cases of T1T2 disc herniations and added our four cases. The video can be found here1). Therefore, once muscles and ligaments are relaxed around the T1-T2, we start working on the kyphotic curve of the spine. 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. Symptoms can also include numbness, tingling, or muscle weakness in one or both lower extremities. 2003;30:1524. When Natalie is not working, you can find her gardening and taking care of her animals on her mini farm. The most common areas to have a herniated disc are the cervical and lumbar areas of the spine. The symptoms often follow a dermatomal distribution, . If the disc herniates into the spinal cord area, the thoracic herniated disk may also present with myelopathy . 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). The thickening and buckle of the vertebrae in the lower back are referred to as Ligamentum flavum hypertrophy or infolding.
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