The physician explained that you have a Bulging Disc, but you may still have questions that have been unanswered. An accurate diagnosis and timely surgical intervention may provide the patient the best chance for regression of symptoms and a satisfactory outcome. Symptoms can also include numbness, tingling, or muscle weakness in one or both lower extremities. Osteoarthritis appeared to be the predominant cause of the disc herniation in both patients. Gelch MM: Herniated thoracic disc at T1-2 level associated with Horner's syndrome: Case report. The presence of an accurate and reproducible radiologic description is essential for the success of any interventional therapy, in addition to disc removal. This fact is most likely explained by the restricted mobility and facet orientation of the thoracic spine. The most common symptom of a thoracic herniated disc is pain. Before (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. 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. It can range from a mild pain that feels tender when touched to a sharp or burning pain. The spurs may cause narrowing of the spinal canal and impinge on the spinal cord. The main symptoms of lumbar disc herniation would radiate based on the location of the disc herniation . (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. 1998. The T-1 radiculopathy usually involves weakness of the intrinsic muscles of the hand. a = artery, n = nerve. 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. J Neurosurg 1998;88:623-633. Unlike the usual calcification in the medioposterior position for middle or lower thoracic spine herniations, a soft posterolateral herniation was observed here. Sometimes, there may be difficulty in breathing if the first rib or rib muscles are injured. Myelopathy is rare. If you are experiencing pain or others symptoms of a herniated thoracic disc, you should make an appointment to see your primary care doctor. 48: 128-30, 8. 2009. Patients demographic data and common clinical features of the corresponding location at which they generate. Lloyd TV, Johnson JC, Paul DJ, Hunt W: Horner's syndrome secondary to herniated disc at T1-T2. There is no charge to read or download any SNI content, but registering for a free membership will provide you with additional special features. Cervical radiculopathy is a disease process marked by nerve compression from herniated disk material or arthritic bone spurs. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. BMJ Case Rep. 2014. 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. T1-T2 disc herniation: Report of four cases and review of the literature. 1978. 1 Far less common is C7-T1 or T1-T2 pathology, causing a C8 or T1 radiculopathy, with a prevalence of 6.2% of affected nerve roots in one series. 88: 623-33, 35. Clipboard, Search History, and several other advanced features are temporarily unavailable. Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. Follow-up magnetic resonance studies documented full resolution for the patient with . 2013 Sep-Oct;48(5):710-5. doi: 10.4085/1062-6050-48.5.03. 15: 227-41, 20. By specifically examining these five muscles, one can differentiate between cubital tunnel syndrome, which leaves their motor strength intact, and C8-T1 radiculopathy. For example, you may feel pain in your neck, arms, hands, fingers, or parts of the shoulder. 11. Nonsurgical treatments are usually tried first to treat CTJ injuries. Please enable scripts and reload this page. Thoracic spinal cord injuries are rare and only account for 10 15 percent of all spinal cord injuries. Objectives: To evaluate the clinical features of thoracolumbar junction disc herniation and to prepare a chart for the level diagnosis in the neurologic findings and symptoms. Please enable it to take advantage of the complete set of features! Background: A 23-year-old male collegiate wrestler injured his neck in a wrestling tournament match and experienced pain, weakness, and numbness in his left upper extremity. JAMA 1965;191:627-631. When there is a compression on the disc, it starts decaying. Symptomatic T1-T2 disc herniations are rare and, in most cases, are located posterolaterally. 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. Tests such as Tinel sign at carpal/cubital tunnel, elbow flexion test, ulnar nerve compression test, Phalen test, and/or Durkan test are helpful. Careers. With age, the discs soft inner layer (nucleus pulposus) becomes less hydrated, making it less gelatinous and effective as a shock absorber. PMC Anto M, Manuel A, Jayachandran A, Thomas SG, Joseph A, Thankachan A, Bahuleyan B. Surg Neurol Int. 1995. The same decay can be age related too. There will be pain in the front side of Arm Pit. The https:// ensures that you are connecting to the [ 6 , 20 , 22 , 23 , 27 , 34 ]. [ 1 , 2 , 4 , 5 , 7 - 9 , 11 - 15 , 17 , 18 , 21 , 24 - 26 , 29 , 31 - 33 , 35 - 37 ]. [ 15 ] Patients with thoracic discs typically present with neck pain (i.e. An official website of the United States government. High thoracic disc herniation. Careful radiographic analysis is needed preoperatively to identify the upper limit of the sternum. Therefore an MRI scan is important to find our the proper cause behind the problem. Kumar R, Buckley TF. MRI provides the diagnosis. T1-T2 Herniation: The T1 spinal nerve is responsible for the ring and pinky fingers and the area around the first rib. 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. With cervical disc herniations, the nerve affected by the condition is the one that exits at that specific level of the spine. A disc herniation is a significant cause or contributor of neck pain. When the inner core of the disc when stops getting proper nutrition, than it starts decaying further. 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. Management of Thoracic Disc Herniations via Posterior Unilateral Modified Transfacet Pedicle-Sparing Decompression With Segmental Instrumentation and Interbody Fusion. 6. Despite having a long learning curve, the surgical technique described herein can be even used in patients with complex and calcified thoracic disc herniations. Because in this case, a patient might get back all those symptoms of T1-T2 slip disc come back again. Cervical radiographs are not usually clinically useful because of the difficulty in visualizing through the shoulders. Drawing showing the anatomy of the oculosympathetic pathway. Because your thoracic spine is much more rigid and stable, your thoracic spinal area is much less frequently injured than your lumbar and cervical spine. J Neurosurg. -, Caner H, Kilinoglu BF, Benli S, Altinrs N, Bavbek M. Magnetic resonance image findings and surgical considerations in T1-2 disc herniation. J Orthop Sci. Carr DA, Volkov AA, Rhoiney DL, Setty P, Barrett RJ, Claybrooks R, Bono PL, Tong D, Soo TM. Good office ergonomics, such as a supportive chair, can reduce the risk of thoracic herniated discs, which are already rare. Report of four cases and literature review. 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. 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. (b) Sagittal, (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up., MeSH On examination, she had lower extremity hyperreflexia, an abnormal gait, and lower lumbar pain but lacked any radicular findings. 1 Cervical pathologies causing these radiculopathies include herniated nucleus pulposus and cervical spondylosis. Patterson RH. A pinched nerve may cause pain in the back or chest at the first rib, or pain in the ring and/or pinky fingers. 2022 Sep 9;13:412. doi: 10.25259/SNI_580_2022. 13: 240-5, 16. Apply an ice pack or cold compress to the affected area for 15- to 20-minute intervals every two hours. 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. Within the spine itself there are also many other disorders that can have similar presenting symptoms of upper back pain and/or radiating pain, such as a spine fracture , infection, tumor, and certain metabolic disorders. This is the condition, which is more common than other conditions in the T1-T2 disc. Publication types Case Reports To keep your spine neutral and avoid putting pressure on any herniated discs, place a small pillow under your head and knees. AJR Am J Roentgenol. 1983. There is no medicine or procedure to reverse the process of ageing. 12: 221-31, 5. 18: 782-4, Your email address will not be published. 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. Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. Hammon WM. 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). 2016. Surgical repair carries a risk of complications, including worsening neurological outcomes due to the close proximity to the spinal cord. Herniated discs in the thoracic spine have a tendency to become calcified, also known as hard disc herniation. 1952. 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. This impingement typically produces neck and radiating arm pain or. Symptoms of thoracolumbar junction disc herniation. Causes of T1 nerve root compression has been summarized in the literature (Table 2). 2001 Nov 15;26(22):E512-8. The location of the pain depends on the location of the herniated disc. Morgan H, Abood C: Disc herniation at T1-2: Report of four cases and literature review. 2005. These all symptoms always confuse before the proper diagnosis of slip disc in D1-D2. 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 showing that T1T2 disc space is far enough above biclavicular line. Please enable it to take advantage of the complete set of features! Two of the most common causes of thoracic radiculopathy are from compression caused by a herniated disc or from a narrowing of the spinal foramen, an opening through which these nerves pass. Rossitti S, Stephensen H, Ekholm S, von Essen C. The anterior approach to high thoracic (T1-T2) disc herniation. The patient underwent successful T2-3 anterior discectomy with T2-3 rib autograft fusion. A working differential diagnosis can guide management. Multiple protrusions of intervertebral disks in the upper thoracic region:Report of case. 37: 541-2, 12. The most common areas to have a herniated disc are the cervical and lumbar areas of the spine. Disclaimer. Thoracic Disc Herniation: Surgical Treatment.. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. But not in case of T1-T2 slip disc. (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable cord compression. Turbo spin-echo T1 and T2-weighted sagittal and turbo spin-echo T2 axial 4 mm sections parallel to the disc spaces were taken. An accurate diagnosis and timely surgical intervention may provide the patient the best chance for regression of symptoms and a satisfactory outcome. Spine J 2014;14:1654-1662.