doi: 10.1097/00007632-200111150-00021. Hoffman's sign was negative. 18: 782-4, Your email address will not be published. Degenerative disease and trauma are the most common causes of herniated discs in the thoracic spine. (h) Postoperative T2-weighted MRI: showing appropriate decompression of the spinal cord at T1T2 level. Morgan H, Abood C. Disc herniation at T1-2. Dont Miss: Hsv-2 Low Positive No Symptoms, A 65-year-old female patient underwent a transthoracicendoscopic approach to remove a calcified thoracic disc herniation that caused spinal cord compression. Some common signs and symptoms of a cervical herniated disc include: Neck pain. Available from: http://surgicalneurologyint.com/surgicalint-articles/9301/. This clinical condition can commonly be a consequence of cervical sympathetic chain injury, which runs along the lateral aspect of the vertebral body. A very subtle ptosis and miosis remained. 6: 1-10, 2. Thus if there are some brachial plexus injuries on lower side there will be impact on the same nerve root and its supply too. 28: 322-30, 14. 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. Symptoms Thoracic disc degeneration can be a cause of upper or mid back pain. The patient underwent successful T2-3 anterior discectomy with T2-3 rib autograft fusion. Sharan AD, Przybylski GJ, Tartaglino L. Approaching the upper thoracic vertebrae without sternotomy or thoracotomy:A radiographic analysis with clinical application. 2022 Jan;212:107062. doi: 10.1016/j.clineuro.2021.107062. 18. Negoveti L, Cerina V, Sajko T, Glavi Z. Intradural disc herniation at the T1-T2 level. Possley, Daniel DO; Luczak, S. Brandon MD; Angus, Andrew MD; Montgomery, David MD. The symptoms of a herniated disc in the thoracic area usually include: Pain that travels around the body and into one or both legs. 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. Anterior approaches are useful, but more involved. The symptoms of a herniated disc depends on either the size and position of the disc. Your email address will not be published. Symptoms can also include numbness, tingling, or muscle weakness in one or both lower extremities. 6 Approximately more than 70 . In this article, we reviewed these 32 prior cases of T1T2 disc herniations and added our four cases. Even if it is not causing pain or symptoms, a giant disc herniation will usually require surgical treatment. This process of desiccation starts due to the pressure on the spinal arteries. Rossitti S, Stephensen H, Ekholm S, von Essen C: The anterior approach to high thoracic (T1-T2) disc herniation. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Opioids are most useful in the acute phase and generally not recommended for long-term use. Both of these signs were absent in our patients. J Bone Joint Surg Am 1983;65:992-997. Numbness or tingling. Posted by mlerin @mlerin, Nov 4, 2019. Unlike the usual calcification in the medioposterior position for middle or lower thoracic spine herniations, a soft posterolateral herniation was observed here. posterolateral discs) and, in some cases, spontaneously resolved (2 of 36 cases). Herniated discs affect 5 to 20 per 1000 adults annually. (e) Intraoperative clearance of the disc space from both hard disc and osteophytes. Spine J 2014;14:1654-1662. 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. -, Alberico AM, Sahni KS, Hall JA, Jr, Young HF. Thoracic spinal cord injuries are rare and only account for 10 15 percent of all spinal cord injuries. J Neurosurg. 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. After confirming the diagnosis with MRI, the patient was treated with standard posterior approach with laminoforaminotomy and diskectomy. 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. In cases where instability of the CTJ occurs or when nonsurgical treatments do not provide relief, surgery may be considered. Results: The patient's symptoms resolved completely. Tests such as Tinel sign at carpal/cubital tunnel, elbow flexion test, ulnar nerve compression test, Phalen test, and/or Durkan test are helpful. Neurosurgery. T1-T2 Herniation: The T1 spinal nerve is responsible for the ring and pinky fingers and the area around the first rib. There was a decreased sensation noted along the left medial forearm and hypothenar region. official website and that any information you provide is encrypted We added our cases (four cases) of T1T2 disc herniations to those 32 cases found in the literature. 19: 449-51, 3. Gelch MM. Alberico AM, Sahni KS, Hall JA, Young HF. When Natalie is not working, you can find her gardening and taking care of her animals on her mini farm. JAMA 1965;191:627-631. 2010. Follow-up magnetic resonance studies documented full resolution for the patient with radiculopathy and a posterolateral disc. 13: 240-5, 16. 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. Local MD says he is not fimilar with T1-2. Anterior approach to the cervicothoracic junction by unilateral or bilateral manubriotomy. Love JG, Kiefer EJ: Root pain and paraplegia due to protrusions of thoracic intervertebral disks. (a) T2-weighted sagittal magnetic resonance imaging (MRI) shows T1T2 disc herniation. 7: 189-92, 30. Carr DA, Volkov AA, Rhoiney DL, Setty P, Barrett RJ, Claybrooks R, Bono PL, Tong D, Soo TM. There might be some other reasons like- some addiction or something like this, that causes the desiccation of the T1-T2 disc. Because thoracic disc herniation can be caused by an injury, it can affect anyone. 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). (d) Three-dimensional cervical computed tomography (CT) scan shows T1T2 and T3 screw rod fixation on the left side. MR studies documented a soft central disc in one patient, and a calcified central disc in the second [Figures 1 and 2 ]. Keywords: Disc herniation, spontaneous resolution, sternal splitting approach, T1T2 disc space, thoracic disc, upper thoracic disc herniation. BMJ Case Rep. 2014 Jun 5;2014:bcr2014204820. Disclaimer. Sekhar LN, Jannetta PJ. Because this nerve root is the part of the brachial plexus. (b) Sagittal cervical fat saturated MRI shows the same. The same decay can be age related too. 2021 Mar 17;12:108. doi: 10.25259/SNI_941_2020. These are same. Multiple protrusions of intervertebral disks in the upper thoracic region:Report of case. 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. CT can be used to complement MRI in cases of thoracic disk herniations. 2003. 24-Apr-2019;10:56. Bransford R, Zhang F, Bellabarba C, Konodi M, Chapman JR. J Neurosurg Spine. 1960. 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. (e) Showing removal of the sequestrated disc fragment. 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. When there is some problem in the T1-T2 diss, it gives similar symptoms to cervical problem. J Neurosurg 1978;48:128-130. But not in case of T1-T2 slip disc. Br J Neurosurg 1993;7:189-192. Unauthorized use of these marks is strictly prohibited. T2 sagittal and axial MR images with T1-T2 disk herniation (arrows). Careful radiographic analysis is needed preoperatively to identify the upper limit of the sternum. She also works as an Adult and Pediatric Sexual Assault Nurse Examiner. Most people dont need surgery for a thoracic herniated disc. For more information, please refer to our Privacy Policy. You may have pain in your lower back, numbness or pain in your leg, or loss of bladder control. These symptoms typically follow a pattern as noted above, based on the affected nerve roots location and functions. This fact is most likely explained by the restricted mobility and facet orientation of the thoracic spine. A herniation here may cause pain at the back or chest around the first rib, or pain in the ring and/or pinky fingers. 6: 199-202. There are several treatment options for thoracic herniated discs. Takagi H, Kawaguchi Y, Kanamori M, Abe Y, Kimura T. T1-2 disc herniation following an en bloc cervical laminoplasty. A disc herniation is a significant cause or contributor of neck pain. The 2023 edition of ICD-10-CM M51.24 became effective on October 1, 2022. This is a rarest condition in case of all thoracic discs, but can appear in this reason due to trauma. If youre between the ages of 30 and 50, youre more likely to be affected. 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. 88: 623-33, 35. Disc herniation at T1-2. The annular tear can be confirmed with a discogram followed with a CT scan. Management of Thoracic Disc Herniations via Posterior Unilateral Modified Transfacet Pedicle-Sparing Decompression With Segmental Instrumentation and Interbody Fusion. Spine (Phila Pa 1976). (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. T1-T2 disc herniation: Report of four cases and review of the literature. Spine (Phila Pa 1976). The https:// ensures that you are connecting to the J Athl Train. 1998. 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. Case Description:Here, we reviewed four cases of symptomatic T1T2 disc herniations; two patients were paraparetic due to central discs and underwent anterior surgery utilizing a cage construct. Herniated discs in the thoracic region account for less than 1 percent of all herniated discs. may email you for journal alerts and information, but is committed (b) Axial view showing the central location of the disc. 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. Calcific discitis with giant thoracic disc herniations in adults. (b) Axial view showing the central location of the disc. 2003;30:1524. This was excised utilizing a transfacet pedicle-sparing left-sided approach with left-sided T1T3 pedicle screw fixation to avoid instability [ Figure 3 ]. 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. Thoracic Disc Herniation: Surgical Treatment.. 2016. Mulpuri K, LeBlanc JG, Reilly CW, Poskitt KJ, Choit RL, Sahajpal V. Sternal split approach to the cervicothoracic junction in children. Therefore, once muscles and ligaments are relaxed around the T1-T2, we start working on the kyphotic curve of the spine. A pinched nerve may cause pain in the back or chest at the first rib, or pain in the ring and/or pinky fingers. We report two cases of exceptional first thoracic disc herniation in a 60-year-old man and a 55-year-old woman. 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. J Neurosurg Spine. So just go to contact us and send all your reports so that we will be able to guide you in a better way for your problem and Ayurvedic treatment of T1-T2 slip disc problem. (b) The disc space is a little bit above the manubrium line and cervicothoracic (CT) angle is 27. 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. So when we provideAyurvedic treatment of T1-T2 slip disc we are careful about providing a proper solution. Avoid lifting, twisting, or straining the back. (b) The disc space is a little bit above the manubrium line and cervicothoracic (CT) angle is 27. Lloyd TV, Johnson JC, Paul DJ, Hunt W: Horner's syndrome secondary to herniated disc at T1-T2. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Neurosurgery. [ 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. But they can happen. The authors certify that they have obtained all appropriate patient consent forms.