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. Well tell you how, why, and what you can do to treat a thoracic herniated disc if you have one and prevent them in the future. The symptoms of T1-T2 slip disc depends on the severity of the problem. Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. Epub 2014 Jul 18. The tough outer layer (annulus fibrosus) loses elasticity with age, increasing the risk of tears that can result in herniation. 1983. Methods: The visual analogue scale (VAS), Oswestry disability index (ODI), and MacNab scale were used to analyze the results collected during the . Symptoms depend on where and how big the disc herniation is, where it is pressing, and whether the spinal cord has been damaged. When there is a compression on the disc, it starts decaying. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. routine T1 and T2 sequences were used to study the status of the endplate (1.5-T Optima GEM MRI, GE Healthcare, Buck- . Correlating history, examination, and imaging will guide toward a successful diagnosis. Differentiating motor function from the C8-T1 nerve roots and ulnar nerve pathology can be assessed with motor testing. The preganglionic fibers then exit the spinal cord and enter the cervical sympathetic chain. Massage and acupuncture can be useful in managing pain. Evid Based Spine Care J 2010;1:21-28. In this article, we reviewed these 32 prior cases of T1T2 disc herniations and added our four cases. Dont Miss: Group B Strep Pregnancy Symptoms. J Neurosurg Spine. All the discs in the spine, have an inner soft part with harder shell outside. Please enable scripts and reload this page. by the American Academy of Orthopaedic Surgeons. There are several treatment options for thoracic herniated discs. BecauseAyurvedic treatment of T1-T2 slip disc problem is not about suppression of signs and symptoms alone. 17. (b) Axial view shows the posterolaterally located disc is on the left side. Kuzma SA, Doberstein ST, Rushlow DR. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler:A case report. Ayurvedic treatment of T1-T2 slip disc problem also requires the same approach based Panchakarma therapies what we do in other disc problems. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler: a case report. Carousel with three slides shown at a time. Watch: Thoracic Herniated Disc Video Protrusions of thoracic intervertebral disks. Five percent are found in the thoracic, 3% in the cervical, and 92% in the lumbar region. Therefore, once muscles and ligaments are relaxed around the T1-T2, we start working on the kyphotic curve of the spine. 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. Spacey K, Zaidan A, Khazim R, Dannawi Z. Horner's syndrome secondary to intervertebral disc herniation at the level of T1-2. 11: 499-501, 17. So there is no difference in T1-T2 and D1-D2 discs. 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. J Indiana State Med Assoc. 30: E305-10, 24. An accurate diagnosis and timely surgical intervention may provide the patient the best chance for regression of symptoms and a satisfactory outcome. Proc Staff Meet Mayo Clin 1954;29:375-378. 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. Hamlyn PJ, Zeital T, King TT. Case report. Specifically, T1 nerve root compression presents with specific signs and symptoms. This is a rarest condition in case of all thoracic discs, but can appear in this reason due to trauma. Gelch MM. Over-the-counter or prescription meds such as acetaminophen and NSAIDs like ibuprofen are common medicinal treatments. 2000. 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. 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. Intervertebral thoracic disk herniation is rare. 1. J Orthop Sci. Herniated thoracic discs can cause paralysis. If the herniation occurs in the neck, for example, it can cause pain that radiates into the shoulder and arm; if it occurs in the lower back, the pain produced can radiate down into the hip and leg. Nishimura Y, Thani NB, Tochigi S, Ahn H, Ginsberg HJ. 1993. 1986. 2010. J Neurol Neurosurg Psychiatry. Approximately 90% of herniated discs occur at L4-L5 and L5-S1, causing pain in the L5 or S1 nerve that radiates down the sciatic nerve. Micheli LJ, Hood RW: Anterior exposure of the cervicothoracic spine using a combined cervical and thoracic approach. Kurz LT, Pursel SE, Herkowitz HN. T1-2 disk herniation diagnosis is often delayed because of its prevalence and misdiagnosis. T1 and T2 - These lead into nerves that go into the top of your chest and into the arms and hands. Asian Spine Journal, 2012 (evidence level 3A) T2 radiculopathy: A differential screen for upper extremity radicular pain. 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. Herniated discs in the thoracic region account for less than 1% overall. 6. The symptoms began as dull back pain, which the patient initially attributed to a muscle strain, but progressively worsened throughout a 24-hour period. (f) Postoperative T1-weighted MRI, at 3-year follow-up, note clearance of the cord. 11. [ 3 , 6 , 19 , 28 , 30 , 34 ] Most thoracic disc herniations occur below the T8 level, and the majority are found at T11T12. Anterior approaches are useful, but more involved. This site needs JavaScript to work properly. J Neurosurg. Symptoms Thoracic disc degeneration can be a cause of upper or mid back pain. 2. 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. These disc problems in thoracic region remains silent in most of the case. Cases 3 and 4, respectively exhibited, a Brown-Sequard syndrome and radiculopathy alone. 16. Yale J Biol Med. J Bone Joint Surg Am 1983;65:992-997. 1 Cervical pathologies causing these radiculopathies include herniated nucleus pulposus and cervical spondylosis. Epub 2016 Jan 28. (h) Postoperative T2-weighted MRI: showing appropriate decompression of the spinal cord at T1T2 level. Informed consent to present the data concerning the case for publication was obtained by the patient. to maintaining your privacy and will not share your personal information without Thoracic Disc Herniation: Surgical 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. Glaser J. Neuro-Ophthalmology, ed 1. Intradural disc herniations comprise 0.26-0.30% of all herniated discs. Neurology. Neurosurgery. Because in this case, a patient might get back all those symptoms of T1-T2 slip disc come back again. (c) T2-weighted sagittal image shows complete resolution of the disc at 5-month follow-up. J Neurosurg Spine. 6: s-0036, 29. (h) Postoperative T2-weighted MRI: showing appropriate decompression of the spinal cord at T1T2 level. 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. T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. The fibers ascend and synapse at the superior cervical ganglia at the level of the bifurcation of the common carotid artery (C3-C4). The T1-T2 interspace is not fully visualized on a cervical MRI; therefore, a thoracic MRI scan can be helpful. You may be trying to access this site from a secured browser on the server. These are same. Please try again soon. Contained Discs: The disc has not broken through the outer wall of the intervertebral disc, which means the inner gel-like material remains contained. In a systematic review and meta-analysis by Brooks et al, disk height index, Modic changes, and sagittal range of motion were found to be significantly correlated with an increased rate of recurrent lumbar disk herniation. Maloney WF, Younge BR, Moyer NJ: Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. Recommended Reading: Chronic Bronchitis Signs And Symptoms, A limited description of the specific lumbar spinal nerves includes: L1 innervates the abdominal internal obliques via the ilioinguinal nerve L2-4 innervates iliopsoas, a hip flexor, and other muscles via the femoral nerve L2-4 innervates adductor longus, a hip adductor, and other muscles via the obturator nerve L5. From the Department of Orthopaedic Spine Surgery (Dr. Possley), Department of Orthopaedic Surgery (Dr. Luczak), Department of General Surgery (Dr. Angus), and Department of Orthopaedic Spine Surgery (Dr. Montgomery), Beaumont Health, Royal Oak, MI. 2016. Management of Thoracic Disc Herniations via Posterior Unilateral Modified Transfacet Pedicle-Sparing Decompression With Segmental Instrumentation and Interbody Fusion. Pain is often described as sharp or burning. GUIDE: Physical Therapy Guide to Herniated Disk. Choose PT, August 26, 2021. Vaidya Dr. Pardeep Sharma is Chief Ayurvedic Physician at Sukhayu Ayurved Jaipur. PMC 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. Objective: To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1-T2 disc herniation. 10. Rossitti S, Stephensen H, Ekholm S, von Essen C. The anterior approach to high thoracic (T1-T2) disc herniation. 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. Acute traumatic sequestrated thoracic disc herniation: A case report and review. [ 6 , 20 , 22 , 23 , 27 , 34 ]. (d) Three-dimensional cervical computed tomography (CT) scan shows T1T2 and T3 screw rod fixation on the left side. The physician explained that you have a Bulging Disc, but you may still have questions that have been unanswered. Two females aged 67 and 48 years presented with acute cord infarction and paraparesis, respectively; the modified Japanese Orthopaedic Association (JOA) score for thoracic myelopathy (maximum 11) was 6 and the second patient was 7 [ Table 1 ]. FOIA This is disc herniation. The latter two cases had posterolateral discs contributing to a Brown-Sequard syndrome and radiculopathy, respectively; one patient required a transfacet pedicle-sparing procedure, while the second case was managed conservatively. M51.24 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Report of four cases and literature review. Rahimizadeh A. Thoracic disc herniation:20 years experience in 82 cases. I've been in excruciating pain in the right shoulder and throughout the arm and hand for months. Non-Contained Discs: The inner gel-like material has broken through the outer wall of the intervertebral disc. Posted by mlerin @mlerin, Nov 4, 2019. It is important to understand the symptoms, causes, and treatments for a bulging disc to prevent the condition from worsening. Nonsurgical treatments are usually tried first to treat CTJ injuries. 1980. (e) Showing removal of the sequestrated disc fragment. Excruciating pain from cervical (C7/T1) radiculopathy. 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. -, Alberico AM, Sahni KS, Hall JA, Jr, Young HF. 2014 Oct;21(4):568-76. doi: 10.3171/2014.6.SPINE13682. Unable to load your collection due to an error, Unable to load your delegates due to an error. Ayurvedic treatment of T1-T2 slip disc problem due to process of ageing is all about slowing down the process of ageing and in deletion of the marks of age. 15: 227-41, 20. Careful radiographic analysis is needed preoperatively to identify the upper limit of the sternum. On examination, she had lower extremity hyperreflexia, an abnormal gait, and lower lumbar pain but lacked any radicular findings. Stillerman CB, Chen TC, Couldwell WT, Zhang W, Weiss MH. 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 iris dilator muscle and Mueller's muscle; a small smooth muscle in the eyelid responsible for a minor portion of upper lid elevation and lower lid retraction. The 12 thoracic vertebrae (T1 just below the neck down to T12 just above the lumbar spine) make up the largest and least flexible area of the spine. The most commonly affected levels are C5-C6, C6-C7, and C4-C5. Therefore an MRI scan is important to find our the proper cause behind the problem. MRI best documents soft T1T2 thoracic discs, while computed tomography is typically optimal for calcified herniations. (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. (a) T2-weighted sagittal magnetic resonance imaging (MRI) of the second case showing a hard disc at T1T2 level. . Neurosurgery. Claude-Bernard-Horner syndrome is not constant but highly suggestive. Herniated Discs: When Is Surgery Necessary?. Sympathetic fibers in the posterolateral hypothalamus pass through the lateral brain stem and synapse at the ciliospinal Center of Budge in the intermediolateral gray substance of the spinal cord at C8 to T2. MRI provides the diagnosis. When there is a change in the consistency of the jelly of disc, this falls under condition of slip disc or disc protrusion. The thickening and buckle of the vertebrae in the lower back are referred to as Ligamentum flavum hypertrophy or infolding. 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 Spine. Both of these signs were absent in our patients. (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. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. 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. (d) Axial T2-weighted axial view also confirms disappearance of the disc. Careers. Symptomatic thoracic disc herniation is uncommon and has been estimated to less than 0.75% of all symptomatic spinal disc herniations. A herniation here may cause pain at the back or chest around the first rib, or pain in the ring and/or pinky fingers. J Athl Train. The arc begins in the hypothalamus and synapses in the intermediolateral gray substance at C8-T2 levels (ciliospinal center of budge). A standard posterior approach with laminoforaminotomy and diskectomy was done. your express consent. The discussion about a disc herniation is much more comprehensive and complicated since there are so many ways and places that a disc can herniate. Dydyk, Alexander M, Ruben Ngnitewe Massa, and Fassil B Mesfin. Some research has shown that herniated discs run in families, suggesting that your genes can make it more likely that you will develop a herniated thoracic disc. Six weeks after surgery, the patient had complete resolution of his left-hand weakness and paresthesias, zero back pain, and some significant improvement in the ptosis and miosis (Figure 1, B).