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). The details of 36 cases with T1T2 disc herniation. New left-sided partial ptosis and pupillary miosis were found on facial examination (Figure 1, A). Thoracic disc herniation:Operative approaches and results. Please enable it to take advantage of the complete set of features! (d) Three-dimensional cervical computed tomography (CT) scan shows T1T2 and T3 screw rod fixation on the left side. This is disc herniation. [ 15 ] Patients with thoracic discs typically present with neck pain (i.e. Kanno H, Aizawa T, Tanaka Y, Hoshikawa T, Ozawa H, Itoi E. T1 radiculopathy caused by intervertebral disc herniation:Symptomatic and neurological features. 14. PMC Therefore, if the C6-C7 level has a herniation, then it is the C7 nerve that will be affected. 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. (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. (e) Showing removal of the sequestrated disc fragment. 2010. Anto M, Manuel A, Jayachandran A, Thomas SG, Joseph A, Thankachan A, Bahuleyan B. Surg Neurol Int. 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. Withawin Kesornsak, Kanthika Wasinpongwanich & Verapan Kuansongtham, Teresa Plancha da Silva, Marta Amaral Silva, Ftima Carvalho, Guillermo Alejandro Ricciardi, Ignacio Gabriel Garfinkel, Daniel Oscar Ricciardi, Kalyan Kumar Varma Kalidindi, Mayank Gupta & Harvinder Singh Chhabra, Lance L. Goetz, Sean McAvoy & Kate Zakrzewski, Kevin Hines, Karim Hafazalla, Jack Jallo. Pain is usually the first symptom. J Neurosurg Spine. The most common symptom of a thoracic herniated disc is pain. The https:// ensures that you are connecting to the (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable cord compression. Background: Bethesda, MD 20894, Web Policies (g) Plain CT radiograph showing that the cage is located at bicalvicular line. An accurate diagnosis and timely surgical intervention may provide the patient the best chance for regression of symptoms and a satisfactory outcome. symptoms with longer duration or unrelieved by conservative 1978. Abbott KH, Retter RH. PMC They can help rule out other conditions and give you a referral to a specialist. Careful radiographic analysis is needed preoperatively to identify the upper limit of the sternum. The four cases of T1T2 discs included two females and two males who ranged in the age group from 36 to 67 years (average: 47 years). When there is a compression on the disc, it starts decaying. MeSH Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. Weakness. MRI provides the diagnosis. 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. Unlike the usual calcification in the medioposterior position for middle or lower thoracic spine herniations, a soft posterolateral herniation was observed here. (Ayurveda) doctor. 10. Preganglionic sympathetic neurons exit the spinal cord and ascend up the carotid sheath to the superior cervical ganglion at the level of the bifurcation of the common carotid artery. Symptoms depend on where and how big the disc herniation is, where it is pressing, and whether the spinal cord has been damaged. J Bone Joint Surg Am 1983;65:992-997. It can also occur with ligamentous laxity in response to loading. The .gov means its official. Symptoms can also include numbness, tingling, or muscle weakness in one or both lower extremities. T1T2 disc herniation: Report of four cases and review of the literature. Conclusion: Adjacent-segment degeneration after cervical spine fusion may rarely occur even at T1-T2, and the unusual symptoms of a T1 . 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. Sekhar LN, Jannetta PJ. 2016 May;25 Suppl 1:204-8. doi: 10.1007/s00586-016-4402-y. 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. Introduction. Excruciating pain from cervical (C7/T1) radiculopathy. A large herniated disc can compress the spinal cord within the spinal canala condition called myelopathyresulting in numbness, tingling, and or weakness in one or both lower extremities, and sometimes bowel and bladder dysfunction, and in extreme cases, paralysis. 6: 199-202. Pain just below the spine of the scapula. Although . If the disc herniates into the spinal cord area, the thoracic herniated disk may also present with myelopathy . Data is temporarily unavailable. Symptomatic disc herniation in the upper thoracic spine from T1 to T4 is rare, with most occurring at T1T2 levels[ 3 , 6 , 19 , 28 , 30 , 34 ] [ Table 1 ]. (b) Axial view showing the central location of the disc. The fibers ascend and synapse at the superior cervical ganglia at the level of the bifurcation of the common carotid artery (C3-C4). T1-T2 Pinched Nerve: The T1 spinal nerve is responsible for the ring and pinky fingers and the area at the first rib. Herniated discs affect 5 to 20 per 1000 adults annually. 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. 2021 Mar 17;12:108. doi: 10.25259/SNI_941_2020. Rarely, C8 nerve injury may cause Horners syndrome characterized by drooping eyelids, small pupils, and sunken eyeballs usually affecting one side of the face.7. If the lower thoracic region is involved, a patient may encounter pain . J Neurosurg. Thoracic region is the first segment of the thoracic or dorsal spine. Herniated discs in the thoracic region account for less than 1% overall. Morgan H, Abood C. Disc herniation at T1-2. In one case, a central disc fragment extended through the dura. We added our cases (four cases) of T1T2 disc herniations to those 32 cases found in the literature. 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. Local MD says he is not fimilar with T1-2. (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. 2001 Nov 15;26(22):E512-8. An orthopedic or neurologic physical therapist can customize a treatment plan of safe herniated disc exercises to help decrease pain, improve strength and posture, and increase mobility. 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 . This fact is most likely explained by the restricted mobility and facet orientation of the thoracic spine. This process of desiccation starts due to the pressure on the spinal arteries. Proc Staff Meet Mayo Clin 1954;29:375-378. These all symptoms always confuse before the proper diagnosis of slip disc in D1-D2. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. So when we provideAyurvedic treatment of T1-T2 slip disc we are careful about providing a proper solution. Keachie K, Shahlaie K, Muizelaar JP. Patients demographic data and common clinical features of the corresponding location at which they generate. At his follow-up appointment, there was no improvement of his symptoms; therefore, the decision was made to intervene surgically given his persistent pain, weakness, and Horner syndrome. Conclusions: J Neurosurg Spine. Causes of T1 nerve root compression has been summarized in the literature (Table 2). Clin Neurol Neurosurg. J Neurosurg. 1983. [ 3 , 6 , 19 , 28 , 30 , 34 ] Most thoracic disc herniations occur below the T8 level, and the majority are found at T11T12. Overall outcomes for T1 disk herniations treated surgically are favorable. Spine J 2014;14:1654-1662. Radiation of pain in the upper arm on the front side. eCollection 2021. (g) Post-operative CT AP X-ray: shows the cage in T1T2 disc space. (f) After placement of peek cage, note brachiocephalic vein at lower border of the scene. Horner's syndrome secondary to T1-T2 intervertebral disc prolapse. Cases 3 and 4, respectively exhibited, a Brown-Sequard syndrome and radiculopathy alone. Morgan H, Abood C: Disc herniation at T1-2: Report of four cases and literature review. An official website of the United States government. 1 Cervical pathologies causing these radiculopathies include herniated nucleus pulposus and cervical spondylosis. When the inner core of the disc when stops getting proper nutrition, than it starts decaying further. Informed consent to present the data concerning the case for publication was obtained by the patient. (i) Postoperative T2-weighted MRI demonstrates the cage in T1T2 interspace. 6: 1-10, 2. Cervical radiculopathy is a disease process marked by nerve compression from herniated disk material or arthritic bone spurs. Diagnostic testing for herniated disk includes MRI, CT, myelography, and plain radiography, either alone or in different combinations, as the occasion demands. Acute traumatic sequestrated thoracic disc herniation: A case report and review. Surgical options will vary based on the size, type, and location of the injury, but the most common are. After confirming the diagnosis with MRI, the patient was treated with standard posterior approach with laminoforaminotomy and diskectomy. 2006. by the American Academy of Orthopaedic Surgeons. Can J Neurol Sci. 1986. 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. and transmitted securely. Vertebral compression fractures are the most common injury to the thoracic spine. 2014: 34. (c) T2-weighted sagittal image shows complete resolution of the disc at 5-month follow-up. 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. Lucas, Jacqueline W, Eric M Connor, and Jonaki Bose. Massage and acupuncture can be useful in managing pain. 92: 715-8, 9. Approximately 75% of all thoracic disc herniations are seen below T8. Required fields are marked *. Hagerstown, MD, Harper & Row, 1978. Transthoracic excision and fusion, case report with 4-year follow-up. Gokcen HB, Erdogan S, Gumussuyu G, Ozturk S, Ozturk C. A rare case of T1-2 thoracic disc herniation mimicking cervical radiculopathy. Yoon, Wai Weng, and Jonathan Koch. Maloney WF, Younge BR, Moyer NJ: Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. 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. If you are experiencing pain or others symptoms of a herniated thoracic disc, you should make an appointment to see your primary care doctor. Stillerman CB, Chen TC, Couldwell WT, Zhang W, Weiss MH. Kuzma SA, Doberstein ST, Rushlow DR. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler:A case report. The authors certify that they have obtained all appropriate patient consent forms. A disc bulge is not a disc herniation. 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. (d) Axial T2-weighted axial view also confirms disappearance of the disc. 28: 322-30, 14. When Natalie is not working, you can find her gardening and taking care of her animals on her mini farm. a = artery, n = nerve. 15. The symptoms of T1-T2 slip disc are- Pain just below the spine of the scapula. T1 motor root innervates the flexor digitorum superficialis, flexor pollicis longus, flexor pollicis longus, flexor digitorum profundus, lumbricals, interossei, and the pectoralis major. Surgery for T1T2 posterolateral herniated discs may require transfacet pedicle-sparing decompression with pedicle screw fixation. Learn more by subscribing now. He is an M.D. 1998. 1954. Kurz LT, Pursel SE, Herkowitz HN. Thoracic discectomy by posterior pedicle-sparing, transfacet approach with real-time intraoperative ultrasonography: Clinical article. We report two cases of exceptional first thoracic disc herniation in a 60-year-old man and a 55-year-old woman. Sometimes, there may be difficulty in breathing if the first rib or rib muscles are injured. . The further down the spine the injury occurs, the greater chance for at least partial recovery. There is no medicine or procedure to reverse the process of ageing. Smoking wrecks your discs along with everything else, weakening and drying them out (in case you needed another reason to quit). 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. Disc herniation; T1T2 disc space; spontaneous resolution; sternal splitting approach; thoracic disc; upper thoracic disc herniation. Avoid lifting, twisting, or straining the back. While the diagnosed problems at the C7-T1 level are less common,2 research suggests that CTJ injuries may be missed during due to difficulties in visualizing this region on plain X-Ray films.3 A few conditions that may affect the CTJ are: In severe cases, CTJ injuries may affect the spinal cord or the C8 nerve roots. 9. T1-T2 disc herniation: Report of four cases and review of the literature. The main symptoms of lumbar disc herniation would radiate based on the location of the disc herniation . Increased reflexes in one or both legs that can cause spasticity in the legs. 1960. (e) Intraoperative clearance of the disc space from both hard disc and osteophytes. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. So the treatment is dependent on the following parameters-. With age, the discs soft inner layer (nucleus pulposus) becomes less hydrated, making it less gelatinous and effective as a shock absorber. 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. (c) T2-weighted sagittal image shows complete resolution of the disc at 5-month follow-up. There are many different condition with T1-T2 disc and these are as follows-. AJR Am J Roentgenol 1980;134:184-185. Neurology. J Athl Train. She also works as an Adult and Pediatric Sexual Assault Nurse Examiner. This pain is typically felt toward the back or side of the neck. 35: 329-31, 11. Symptoms such as these are primarily determined by the location of the cervical herniated disc. Rahimizadeh A. Thoracic disc herniation:20 years experience in 82 cases. 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). All surgically treated patients recovered fully. The presence of an accurate and reproducible radiologic description is essential for the success of any interventional therapy, in addition to disc removal. Therefore an MRI scan is important to find our the proper cause behind the problem. It is causing burning/tingling up my neck to my ear and jaw area. (b) Axial view showing the central location of the disc. 1955. Protrusion of the first thoracic disk. [ 6 , 20 , 22 , 23 , 27 , 34 ].