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. Surgery for T1T2 posterolateral herniated discs may require transfacet pedicle-sparing decompression with pedicle screw fixation. With cervical disc herniations, the nerve affected by the condition is the one that exits at that specific level of the spine. Calcific discitis with giant thoracic disc herniations in adults. In one case, a central disc fragment extended through the dura. When there is a change in the consistency of the jelly of disc, this falls under condition of slip disc or disc protrusion. Surgery was done 8 days from the onset of symptoms. 2002. 2014 Oct;21(4):568-76. doi: 10.3171/2014.6.SPINE13682. official website and that any information you provide is encrypted 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. Gelch MM. J Neurosurg Spine. Patients with cervical radiculopathy symptoms and physical examination findings consistent with Horner syndrome should be evaluated with a MRI that includes the upper thoracic spine. (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. Conclusions: We reviewed 4 cervical T1-T2 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. 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. There is no charge to read or download any SNI content, but registering for a free membership will provide you with additional special features. Before sharing sensitive information, make sure youre on a federal 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. 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. 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. Morgan H, Abood C. Disc herniation at T1-2. -, Arseni C, Nash F. Thoracic intervertebral disc protrusion:A clinical study. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler: a case report. J Neurosurg 1978;48:128-130. 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. Thoracic herniated discs are less common than herniated discs in the neck or low back, but they do happen. So that we can give the proper space to the disc and it can breathe normally and can remain its space. 7: 189-92, 30. To keep your spine neutral and avoid putting pressure on any herniated discs, place a small pillow under your head and knees. by the American Academy of Orthopaedic Surgeons. Sharan AD, Przybylski GJ, Tartaglino L. Approaching the upper thoracic vertebrae without sternotomy or thoracotomy:A radiographic analysis with clinical application. Preganglionic sympathetic neurons exit the spinal cord and ascend up the carotid sheath to the superior cervical ganglion at the level of the bifurcation of the common carotid artery. 6. 30: 152-4, 6. Non-surgical treatment options for symptoms of a thoracic herniated disc will typically include one or a combination of the following: A short period of rest (e.g. If the lower thoracic region is involved, a patient may encounter pain . Gokcen HB, Erdogan S, Gumussuyu G, Ozturk S, Ozturk C. A rare case of T1-2 thoracic disc herniation mimicking cervical radiculopathy. This may be evident by sensory disturbances below the level of compression, difficulty with balance and walking, lower extremity weakness, or bowel or bladder dysfunction. Non-Contained Discs: The inner gel-like material has broken through the outer wall of the intervertebral disc. to maintaining your privacy and will not share your personal information without Yoon, Wai Weng, and Jonathan Koch. (f) After placement of a large cage. [ 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. 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 ]. There are many different condition with T1-T2 disc and these are as follows-. Please try again soon. Disc herniation can occur in the cervical, thoracic, or lumbar 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). 1960;17:41830. (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. 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. (i) Postoperative T2-weighted MRI demonstrates the cage in T1T2 interspace. Asian Spine Journal, 2012 (evidence level 3A) T2 radiculopathy: A differential screen for upper extremity radicular pain. For the fourth patient, the sequestrated disc disappeared 5 months later [Figures 4c and d ]. This fact is most likely explained by the restricted mobility and facet orientation of the thoracic spine. Neurosurgery. This site needs JavaScript to work properly. Am J Ophthalmol 1998;126:565-577. C8 and T1 nerve roots compound both ulnar and median nerves.3 Therefore C8 and T1 radiculopathies . Apply an ice pack or cold compress to the affected area for 15- to 20-minute intervals every two hours. 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. Hagerstown, MD, Harper & Row, 1978. 88: 623-33, 35. Yale J Biol Med. 17: 418-30, 4. Clipboard, Search History, and several other advanced features are temporarily unavailable. The details of 36 cases with T1T2 disc herniation. All the discs in the spine, have an inner soft part with harder shell outside. Patients demographic data and common clinical features of the corresponding location at which they generate. Disc herniation at T1-2. Biousse V, Touboul PJ, D'Anglejan-Chatillon J, Levy C, Schaison M, Bousser MG: Ophthalmologic manifestations of internal carotid artery dissection. 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. Find out how, and what you can do to treat them. It can also occur with ligamentous laxity in response to loading. For the former patient, cervicothoracic MRI showed a left centro-laterally disc at the T1T2 level. (a) T2-weighted sagittal magnetic resonance imaging (MRI) of the second case showing a hard disc at T1T2 level. Asian Spine J. Disc herniation at T1-2. All but five intrinsic hand muscles are innervated by the ulnar nerve; abductor pollicus brevis, flexor pollicis brevis, opponens pollicis, and lateral lumbricals. 2. By specifically examining these five muscles, one can differentiate between cubital tunnel syndrome, which leaves their motor strength intact, and C8-T1 radiculopathy. 1980. Would you like email updates of new search results? If the disc herniates into the spinal cord area, the thoracic herniated disk may also present with myelopathy . A case of the patient with severe neurological deficits, caused by intradural thoracic disc herniation at T1-T2 interspace, which required surgical treatment and the symptoms were relieved immediately after surgery. If youre between the ages of 30 and 50, youre more likely to be affected. Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. MRI provides the diagnosis. The physician explained that you have a Bulging Disc, but you may still have questions that have been unanswered. Claude-Bernard-Horner syndrome is not constant but highly suggestive. Thoracic discectomy by posterior pedicle-sparing, transfacet approach with real-time intraoperative ultrasonography: Clinical article. 4 ' 5 The first T1-2 disc herniation case was reported in 1954 by Sivien and Karavitis. Can J Neurol Sci. (b) Sagittal cervical fat saturated MRI shows the same. The rest of the postganglionic fibers travel along the internal carotid artery and enter the cavernous sinus. . 2010;12:22131. The main concept ofAyurvedic treatment of T1-T2 slip disc problem is based on the cause of the problem. Overall outcomes for T1 disk herniations treated surgically are favorable. The man was treated surgically and the woman medically. Acute traumatic sequestrated thoracic disc herniation: A case report and review. In cases where instability of the CTJ occurs or when nonsurgical treatments do not provide relief, surgery may be considered. Summary of background data: Thoracolumbar junction disc herniations show a variety of signs and symptoms because of . You May Like: Parvo Symptoms In Older Dogs. (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. CT can be used to complement MRI in cases of thoracic disk herniations. 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. (d) Axial T2-weighted axial view also confirms disappearance of the disc. 2016. 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. If the C8 nerve is compressed or irritated, additional symptoms may occur, such as: If the spinal cord is injured, the upper and/or lower limbs and the torso may be completely or partially paralyzed.2 There may also be changes in bowel and/or bladder functions. She underwent T1-T2 anterior discectomy and fusion. Approximately 75% of all thoracic disc herniations are seen below T8. Thoracic disc herniation:Operative approaches and results. Svien HJ, Karavitis AL: Multiple protrusions of intervertebral disks in the upper thoracic region: Report of case. T1T2 myelopathy and/or radiculopathy, magnetic resonance (MR) localization (anterior/anterolateral/lateral posterior), and optimal surgical management. 1956. (b) Sagittal, (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up., MeSH The main reason behind this is the inappropriate process of ageing. The 2023 edition of ICD-10-CM M51.24 became effective on October 1, 2022. 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. Outcomes were based on the modified JOA scores for the three patients with thoracic myelopathy and their scores were 10, 11, and 11, respectively, while the visual analog scale for the fourth patient was 0. Shortly after the postganglionic fibers leave the superior cervical ganglion, vasomotor and sudomotor fibers branch off to travel along the external carotid artery to innervate the blood vessels and sweat glands of the face. 24-Apr-2019;10:56, How to cite this URL: Abolfazl Rahimizadeh, Amir Hossein Zohrevand, Nima Mohseni Kabir, Naser Asgari. J Neurosurg. Bransford RJ, Zhang F, Bellabarba C, Lee MJ. Protrusions of thoracic intervertebral disks. The symptoms began as dull back pain, which the patient initially attributed to a muscle strain, but progressively worsened throughout a 24-hour period. The most common symptom of a thoracic herniated disc is pain. The T-1 radiculopathy usually involves weakness of the intrinsic muscles of the hand. It can range from a mild pain that feels tender when touched to a sharp or burning pain. The site is secure. 1. may email you for journal alerts and information, but is committed He is an M.D. Diagnosis and treatment of thoracic intervertebral disc protrusions. Sebastian . Most people dont need surgery for a thoracic herniated disc. According to Dr. Good, here are some healthy habits you can build that will help keep your discs healthy. 92: 715-8, 9. Diagnostic testing for herniated disk includes MRI, CT, myelography, and plain radiography, either alone or in different combinations, as the occasion demands. Symptoms such as these are primarily determined by the location of the cervical herniated disc. If there is some deformity behind T1-T2 slip disc than we aim to restore the kyphotic changes. 1998. eCollection 2021. (c) T2-weighted sagittal image shows complete resolution of the disc at 5-month follow-up. Follow-up magnetic resonance studies documented full resolution for the patient with radiculopathy and a posterolateral disc. 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. . Smoking wrecks your discs along with everything else, weakening and drying them out (in case you needed another reason to quit). Love JG, Kiefer EJ: Root pain and paraplegia due to protrusions of thoracic intervertebral disks. (f) After placement of peek cage, note brachiocephalic vein at lower border of the scene. Along with this when we work with pronated shoulders and fixed neck- chances of problem with D1-D2 disc increases in same frequency. Anterior approach to the cervicothoracic junction by unilateral or bilateral manubriotomy. They can help rule out other conditions and give you a referral to a specialist. 2001. J Athl Train. 2022 Jan;212:107062. doi: 10.1016/j.clineuro.2021.107062. Lloyd TV, Johnson JC, Paul DJ, Hunt W. Horner's syndrome secondary to herniated disc at T1--T2. routine T1 and T2 sequences were used to study the status of the endplate (1.5-T Optima GEM MRI, GE Healthcare, Buck- . (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. 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. (d) Three-dimensional cervical computed tomography (CT) scan shows T1T2 and T3 screw rod fixation on the left side. A very subtle ptosis and miosis remained. Herniated discs in the thoracic region account for less than 1 percent of all herniated discs. Patterson RH. The .gov means its official. 10. Careers. Herniated discs affect 5 to 20 per 1000 adults annually. Spine (Phila Pa 1976) 1991;16(10 suppl):S542-S547. When the inner core of the disc when stops getting proper nutrition, than it starts decaying further. Most people respond well to non-operative or conservative treatment. Read Also: Attention Deficit Hyperactivity Disorder Symptoms, Neck Pain, Cervical Disc Herniation & Radiculopathy-Everything You Need To Know Dr. Nabil Ebraheim, Herniated Disc Symptoms, (All You Need To Know To Cure), L3 Herniated Disc/Nerve Root Compression Evaluation, Attention Deficit Hyperactivity Disorder Symptoms, Symptoms Of Ovarian Cysts After Hysterectomy, Magnetic resonance imaging is the best tool for observing and diagnosing problems with intervertebral discs, Other Imaging tests, such as X-ray or computed tomography may be used, but are not as accurate as MRI in diagnosing a herniated thoracic disc, Myelography, which involves injecting dye into the space around your spinal cord and taking X-ray or CT images to identify any narrowing in the spinal canal, Medical history to identify any accidents, pre-existing conditions, or trauma that may have caused an injury to your spine, Physical examination to record the type, severity, and location of your pain or other symptoms and draw conclusions about their cause, Sacrum, where the spine connects to the hips. Herniated Disc Symptoms in the Lumbar Spine The most common symptom associated with a herniated disc in the lumbar spine is leg pain (also known as sciatica). Informed consent to present the data concerning the case for publication was obtained by the patient. Barrow Neurological Institute. [ 15 ] Patients with thoracic discs typically present with neck pain (i.e. Arseni C, Nash F. Thoracic intervertebral disc protrusion:A clinical study. Rev Chir Orthop Reparatrice Appar Mot. 1983. T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. This the next process of degenerative disc disease is- disc bulge. Reflex examination was 2/4 in C 6, 7, and 8 roots. People who have a herniated disk often have radiating numbness or tingling in the body part served by the affected nerves. 1998 Jan;88(1):148-50. doi: 10.3171/jns.1998.88.1.0148. The video can be found here1). When we discuss about D1-D2 disc problem or T1-T2 disc problem, symptoms are more like- cervical disc herniation. 2013 Sep-Oct;48(5):710-5. doi: 10.4085/1062-6050-48.5.03. PMC 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. Please enable scripts and reload this page. Again, the specific symptoms of a cervical herniated disc will depend on the affected pinched nerves. Rossitti S, Stephensen H, Ekholm S, von Essen C: The anterior approach to high thoracic (T1-T2) disc herniation. Horner's syndrome secondary to intervertebral disc herniation at the level of T1-2. J Neurosurg. Background:Symptomatic T1T2 disc herniations are rare and, in most cases, are located posterolaterally. Pain is often described as sharp or burning. 1991. Signal . 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. Five percent are found in the thoracic, 3% in the cervical, and 92% in the lumbar region. Spine (Phila Pa 1976). Tokuhashi Y, Matsuzaki H, Uematsu Y, Oda H. Spine (Phila Pa 1976). MRI best documents soft T1T2 thoracic discs, while computed tomography is typically optimal for calcified herniations. There will be pain in the front side of Arm Pit. 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. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. This is disc herniation. The presence of an accurate and reproducible radiologic description is essential for the success of any interventional therapy, in addition to disc removal. Can J Neurol Sci. J Neurosurg Spine. Background: T1-T2 intervertebral disc prolapse (IVDP) is a rare clinical condition.Horner's syndrome is an extremely rare clinical finding in these patients. Morgan H, Abood C: Disc herniation at T1-2: Report of four cases and literature review. It is important to understand the symptoms, causes, and treatments for a bulging disc to prevent the condition from worsening. Disclaimer. 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). 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. [ 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). For example, you may feel pain in your neck, arms, hands, fingers, or parts of the shoulder. Thoracic Disc Herniation: Surgical Treatment.. Introduction. We report two cases of exceptional first thoracic disc herniation in a 60-year-old man and a 55-year-old woman. This process of desiccation starts due to the pressure on the spinal arteries. Thoracic Herniated Disc Symptoms. This narrows the space between your vertebrae, causing certain issues. This clinical condition can commonly be a consequence of cervical sympathetic chain injury, which runs along the lateral aspect of the vertebral body. (e) Showing removal of the sequestrated disc fragment. Unauthorized use of these marks is strictly prohibited. Where. Avoid lifting, twisting, or straining the back. The first reported case was in 1945; since then, only 31 additional cases have been published. Herniated Thoracic Disc. Barrow Neurological Institute, August 3, 2022.