T1-T2 disc herniation:Two cases. If the herniation compresses a thoracic spinal nerve, it can cause radiculopathypain that radiates down the nerve and away from the spinewith pain, numbness, and tingling. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. Epub 2016 Jan 28. eCollection 2021. Gelch MM. 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. If the disc herniates into the spinal cord area, the thoracic herniated disk may also present with myelopathy . Although . Weakness. New left-sided partial ptosis and pupillary miosis were found on facial examination (Figure 1, A). Summary of background data: Thoracolumbar junction disc herniations show a variety of signs and symptoms because of . This is the T1 nerve root which originates from the T1-T2 region. Careful radiographic analysis is needed preoperatively to identify the upper limit of the sternum. Surg Neurol. Spine (Phila Pa 1976). Evid Based Spine Care J 2010;1:21-28. The thoracic spine is surrounded by the rib cage and it is much harder to damage the spinal cord in this area. Avoid lifting, twisting, or straining the back. (b) Sagittal cervical fat saturated MRI shows the same. On which side the compression is more symptoms will be according to that. Luk KD, Cheung KM, Leong JC. 2001. It can range from a mild pain that feels tender when touched to a sharp or burning pain. 13. The video can be found here1). If you are experiencing pain or others symptoms of a herniated thoracic disc, you should make an appointment to see your primary care doctor. 2002. 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. 48: 768-72, 27. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. The most common symptom of a thoracic herniated disc is pain. We focused on the clinical presentation, e.g. Publication types Case Reports 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. Disc herniation; T1T2 disc space; spontaneous resolution; sternal splitting approach; thoracic disc; upper thoracic disc herniation. Doctors order these vertebrae from C1 to C7, starting at the base of the skull and extending downward. Report of four cases and literature review. Modified anterior approach to the cervicothoracic junction. GUIDE: Physical Therapy Guide to Herniated Disk. Choose PT, August 26, 2021. As people age, their thoracic intervertebral discs may lose their cushioning ability and become more likely to rupture. Disclaimer. Dont Miss: Group B Strep Pregnancy Symptoms. This is a rarest condition in case of all thoracic discs, but can appear in this reason due to trauma. They can help rule out other conditions and give you a referral to a specialist. J Neurosurg. Anterior surgery can be achieved without sternotomy. The patient was then discharged from the emergency center with oral methylprednisolone and follow-up with an orthopaedic spine surgeon. At 9 months postoperatively, the patient continued to be pain free with full strength and intact sensation. Barrow Neurological Institute. Some common signs and symptoms of a cervical herniated disc include: Neck pain. Most people respond well to non-operative or conservative treatment. This site needs JavaScript to work properly. Patterson RH. Biousse V, Touboul PJ, D'Anglejan-Chatillon J, Levy C, Schaison M, Bousser MG: Ophthalmologic manifestations of internal carotid artery dissection. A magnetic resonance imaging scan revealed a large focal paracentral herniated disc at the T2-3 level. (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. This clinical condition can commonly be a consequence of cervical sympathetic chain injury, which runs along the lateral aspect of the vertebral body. Before Wolters Kluwer Health T1T2 myelopathy and/or radiculopathy, magnetic resonance (MR) localization (anterior/anterolateral/lateral posterior), and optimal surgical management. Micheli LJ, Hood RW: Anterior exposure of the cervicothoracic spine using a combined cervical and thoracic approach. (b) Axial view showing the central location of the disc. Where. MRI best documents soft T1T2 thoracic discs, while computed tomography is typically optimal for calcified herniations. J Neurosurg. It is important to understand the symptoms, causes, and treatments for a bulging disc to prevent the condition from worsening. FOIA The third patient undergoing a transfacet pedicle-sparing left-sided approach had a postoperative three-dimensional computed tomography scans showing adequate root decompression and screw placement screws [Figures 3e and d ]. In this condition we work on the posture of the shoulders and neck all together. Asian Spine Journal, 2012 (evidence level 3A) T2 radiculopathy: A differential screen for upper extremity radicular pain. Epub 2021 Nov 26. J Neurosurg 1998;88:623-633. Despite having a long learning curve, the surgical technique described herein can be even used in patients with complex and calcified thoracic disc herniations. (f) After placement of a large cage. J Athl Train. Careers. 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. Unlike the usual calcification in the medioposterior position for middle or lower thoracic spine herniations, a soft posterolateral herniation was observed here. 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. Also, patients commonly feel a band of pain that goes around the front of the chest. 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. 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. 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. Love JG, Schorn VG: Thoracic-disk protrusions. Magnetic resonance imaging revealed a left-sided T1-T2 herniated disc compressing the T1 nerve root. T1 and T2 - These lead into nerves that go into the top of your chest and into the arms and hands. The symptoms of T1-T2 slip disc are-. MRI provides the diagnosis. (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. Follow-up magnetic resonance studies documented full resolution for the patient with . 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. She has 24 years of experience in various areas, including Trauma, Neuro, Orthopedics, Critical Care, Emergency and Perioperative nursing. 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. Hamlyn PJ, Zeital T, King TT. 1980. Claude-Bernard-Horner syndrome is not constant but highly suggestive. 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. Surgical Treatment of T1-2 Disc Herniation with T1 Radiculopathy: A Case Report with Review . Thoracic Herniated Disc Symptoms. 24/36 patients). When there is a change in the consistency of the jelly of disc, this falls under condition of slip disc or disc protrusion. 12: 303-5, 31. Even if it is not causing pain or symptoms, a giant disc herniation will usually require surgical treatment. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. National Library of Medicine The site is secure. Anterior approach to the cervicothoracic junction by unilateral or bilateral manubriotomy. Krasnianski M, Georgiadis D, Grehl H, Lindner A: Correlation of clinical and magnetic resonance imaging findings in patients with brainstem infarction. (d) Axial T2-weighted axial view also confirms disappearance of the disc. There is no medicine or procedure to reverse the process of ageing. Disc Herniation - Statpearls - NCBI Bookshelf. National Library of Medicine, January 18, 2022. J Neurosurg. 6 Approximately more than 70 . Neurology. may email you for journal alerts and information, but is committed 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. The number one prevention is not smoking. Mulpuri K, LeBlanc JG, Reilly CW, Poskitt KJ, Choit RL, Sahajpal V. Sternal split approach to the cervicothoracic junction in children. 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. T1-T2 Pinched Nerve: The T1 spinal nerve is responsible for the ring and pinky fingers and the area at the first rib. This narrows the space between your vertebrae, causing certain issues. Lloyd TV, Johnson JC, Paul DJ, Hunt W. Horner's syndrome secondary to herniated disc at T1--T2. The authors certify that they have obtained all appropriate patient consent forms. Hann EC. Some error has occurred while processing your request. However, it is most common in men between the ages of 40 and 60. J Athl Train. After literature review, 39 cases of T1-2 disk herniation were discovered.1 Only seven of these cases presented with an associated Horner syndrome (Table 1). If the lower thoracic region is involved, a patient may encounter pain . Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. Follow-up magnetic resonance studies documented full resolution for the patient with radiculopathy and a posterolateral disc. Symptoms Thoracic disc degeneration can be a cause of upper or mid back pain. First thoracic disc protrusion. Surgical repair carries a risk of complications, including worsening neurological outcomes due to the close proximity to the spinal cord. (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. A standard posterior approach with laminoforaminotomy and diskectomy was done. Keywords: Spine J 2014;14:1654-1662. See this image and copyright information in PMC. Thus if there are some brachial plexus injuries on lower side there will be impact on the same nerve root and its supply too. 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.