(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. This was excised utilizing a transfacet pedicle-sparing left-sided approach with left-sided T1T3 pedicle screw fixation to avoid instability [ Figure 3 ]. (e) Showing removal of the sequestrated disc fragment. Thoracic spinal cord injuries are typically less severe than injuries to the cervical spinal cord. T1T2 disc herniation: Report of four cases and review of the literature. Protrusions of thoracic intervertebral disks. A pinched nerve may cause pain in the back or chest at the first rib, or pain in the ring and/or pinky fingers. Hoffman's sign was negative. 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. Nakahara S, Sato T. First thoracic disc herniation with myelopathy. 12. -, Bransford R, Zhang F, Bellabarba C, Konodi M, Chapman JR. The .gov means its official. (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable cord compression. T1T2 thoracic disc herniations are an extremely rare, and optimal results depend on the central and centrolateral location of the discs and the operative/nonoperative choices were made based on the clinical presentation. Available from: http://surgicalneurologyint.com/surgicalint-articles/9301/. Although anhydrosis was not explicitly tested, Horner syndrome was strongly suspected. Tests such as Tinel sign at carpal/cubital tunnel, elbow flexion test, ulnar nerve compression test, Phalen test, and/or Durkan test are helpful. (e) Intraoperative clearance of the disc space from both hard disc and osteophytes. (f) After placement of peek cage, note brachiocephalic vein at lower border of the scene. 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. The T1-T2 interspace is not fully visualized on a cervical MRI; therefore, a thoracic MRI scan can be helpful. Spine (Phila Pa 1976) 1991;16(10 suppl):S542-S547. Gille O, Razafimahandry HJ, Sderlund C, Gangnet N, Vital JM. This is the reason in few reports it is mentioned as D1-D2 region also. See All About Neck Pain Radicular pain. Both were approached anteriorly with low cervical-suprasternal approaches and accompanied by cage application. It can result from advanced disc degeneration or from vertebral body remodeling . one or two days) and activity modification (eliminating the activities and positions that worsen or cause the thoracic back pain). 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. 2010 Feb;12(2):221-31. doi: 10.3171/2009.9.SPINE09476. Due to high occurrence of complications from open surgery, minimally invasive approaches are desirable. Lloyd TV, Johnson JC, Paul DJ, Hunt W. Horner's syndrome secondary to herniated disc at T1--T2. Had a cervical epidural injection last Thursday and so far no relief. (a) T2-weighted sagittal magnetic resonance imaging (MRI) shows T1T2 disc herniation. and transmitted securely. 2009. (e) Showing removal of the sequestrated disc fragment. Watch: Thoracic Herniated Disc Video 1971. Please enable it to take advantage of the complete set of features! If the lower thoracic region is involved, a patient may encounter pain radiating to one or both lower extremities. Accessibility Vaidya Dr. Pardeep does it according to the scientific principles of Ayurveda. After confirming the diagnosis with MRI, the patient was treated with standard posterior approach with laminoforaminotomy and diskectomy. 2022 Jan;212:107062. doi: 10.1016/j.clineuro.2021.107062. 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. 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). Horner's syndrome secondary to T1-T2 intervertebral disc prolapse Cases 3 and 4, respectively exhibited, a Brown-Sequard syndrome and radiculopathy alone. When we discuss about D1-D2 disc problem or T1-T2 disc problem, symptoms are more like- cervical disc herniation. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. Cervical Radiculopathy: Nonoperative Management of Neck Pain and - AAFP J Neurosurg Spine. your express consent. Abbott KH, Retter RH. Gelch MM: Herniated thoracic disc at T1-2 level associated with Horner's syndrome: Case report. Introduction Surgical intervention is the treatment of choice in patients with thoracic disc herniation with refractory symptoms and progressive myelopathy. T1-2 disk herniation diagnosis is often delayed because of its prevalence and misdiagnosis. 1998. Cervical radiographs are not usually clinically useful because of the difficulty in visualizing through the shoulders. This site needs JavaScript to work properly. The thoracic spine is surrounded by the rib cage and it is much harder to damage the spinal cord in this area. A 29-year-old surgical resident presented to the emergency department complaining of acute onset left periscapular back pain, along with progressive left medial forearm and fourth and fifth digit numbness with grip weakness of the left hand. Most T1T2 discs were posterolateral in location (25 cases); only 11 were purely central or centrolateral. Anterior approach to the cervicothoracic junction by unilateral or bilateral manubriotomy. A disc bulge is not a disc herniation. Yale J Biol Med. -. Disc herniation at T1-2 in: Journal of Neurosurgery Volume 88 - jns J Neurosurg. Diagnosis and treatment of thoracic intervertebral disc protrusions. Before Remember, the cervical spine is composed of 7 bones stacked one on top of each other. Pain is often described as sharp or burning. Signs and Symptoms of a T1-T2 Herniated Nucleus Pulposis in the Literature (n = 21) Case A 29-year-old surgical resident presented to the emergency department complaining of acute onset left periscapular back pain, along with progressive left medial forearm and fourth and fifth digit numbness with grip weakness of the left hand. Radiation of pain in the upper arm on the front side. Careers. It is causing burning/tingling up my neck to my ear and jaw area. 2003;30:1524. 6: 1-10, 2. A Rare Case of T1-2 Thoracic Disc Herniation Mimicking Cervical Christopher Good, MD, FACS President of Virginia Spine Institute, https://www.barrowneuro.org/condition/thoracic-disc-herniation/, https://doi.org/10.1016/j.otsr.2017.04.022, https://www.ncbi.nlm.nih.gov/books/NBK441822/, https://www.choosept.com/guide/physical-therapy-guide-herniated-disk, https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Low-Back-Pain, https://www.cdc.gov/nchs/data/databriefs/db415-H.pdf, https://doi.org/10.1302/2058-5241.6.210020, Upper Back Pain Causes, Risk Factors, Diagnosis and Treatment, Spondylosis Symptoms, Causes, Diagnosis and Treatment, 7 Lower Back Pain Causes That Affect Women, Muscle Relaxants for Back Pain and Neck Pain, Herniated Disc: Symptoms, Causes, Diagnosis, and Treatment. Doctors order these vertebrae from C1 to C7, starting at the base of the skull and extending downward. 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. 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. Report of four cases and literature review. (e) Axial CT scan shows a pedicle screw in an upper thoracic vertebra. The main reason behind this is the inappropriate process of ageing. 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. 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. JAAOS Global Research & Reviews2(11):e016, November 2018. Symptoms such as these are primarily determined by the location of the cervical herniated disc. Thoracic Herniated Disc: Symptoms and Treatment 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. Nonsurgical treatments are usually tried first to treat CTJ injuries. Turbo spin-echo T1 and T2-weighted sagittal and turbo spin-echo T2 axial 4 mm sections parallel to the disc spaces were taken. While the anterior approach tends to be a more familiar approach to most spine surgeons, certain anatomic restrictions may limit its use for T1-T2. The support that the rib cage provides to the thoracic spine means it experiences less wear and tear than the other segments of the spine, making it less likely for the thoracic segment to develop thoracic herniated discs and other conditions. J Neurosurg. (b) The disc space is a little bit above the manubrium line and cervicothoracic (CT) angle is 27. Full-endoscopic discectomy for thoracic disc herniations: a single-arm T1T2 disc herniation: Report of four cases and review of the literature. A spine specialist determines if surgery is the best option. Case Description: A 56-year-old man presented with the left C8 T1 radiculopathy, left hand grip weakness, and ipsilateral Horner's syndrome.Magnetic resonance imaging of the spine showed a contrast-enhancing lesion in the left T1 . Sekhar LN, Jannetta PJ. Intradural disc herniations comprise 0.26-0.30% of all herniated discs. T2 sagittal and axial MR images with T1-T2 disk herniation (arrows). J Neurosurg. (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. Magnetic resonance imaging revealed a left-sided T1-T2 herniated disc compressing the T1 nerve root. Back, Lower Limb, and Upper Limb Pain among U.S. Recommended Reading: Heart Disease Symptoms In Dogs. Medications, traction, dry needling, and epidural spinal injections can be used with physical therapy to help manage pain and allow the body to heal on its own, says Dr. Good. Required fields are marked *. Both of these signs were absent in our patients. 15: 227-41, 20. J Neurosurg 1978;48:128-130. So there is no difference in T1-T2 and D1-D2 discs. Background: The authors conducted a 2-year retrospective follow-up to investigate the efficiency of an extraforaminal full-endoscopic approach with foraminoplasty used to treat lateral compressive diseases of the lumbar spine in 247 patients. 2. J Athl Train. 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). They can help rule out other conditions and give you a referral to a specialist. This clinical condition can commonly be a consequence of cervical sympathetic chain injury, which runs along the lateral aspect of the vertebral body. This pain might shoot into your arm or leg when you cough, sneeze or move into certain positions.
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