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 ]. To report a rare thoracic intervertebral disc herniation followed by acutely progressing paraplegia. 1-3 The most affected area in the thoracic region is the T11-12 level. J Neurosurg. This site needs JavaScript to work properly. 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. Pain just below the spine of the scapula. An accurate diagnosis and timely surgical intervention may provide the patient the best chance for regression of symptoms and a satisfactory outcome. 1955. Thoracic spinal cord injuries are rare and only account for 10 15 percent of all spinal cord injuries. Shortly after the postganglionic fibers leave the superior cervical ganglion, vasomotor and sudomotor fibers branch off to travel along the external carotid artery to innervate the blood vessels and sweat glands of the face. An accurate diagnosis and timely surgical intervention may provide the patient the best chance for regression of symptoms and a satisfactory outcome. government site. Before Multiple protrusions of intervertebral disks in the upper thoracic region:Report of case. Surg Neurol. Barrow Neurological Institute. 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. You may have pain in your lower back, numbness or pain in your leg, or loss of bladder control. Here, we reviewed four cases of symptomatic T1-T2 disc herniations; two patients were paraparetic due to central discs and underwent anterior surgery utilizing a cage construct. This clinical condition can commonly be a consequence of cervical sympathetic chain injury, which runs along the lateral aspect of the vertebral body. 2010 Feb;12(2):221-31. doi: 10.3171/2009.9.SPINE09476. Am J Ophthalmol 1980;90:394-402. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. Treating thoracic-disc herniations: Do we always have to go anteriorly? Rev Chir Orthop Reparatrice Appar Mot. 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. (f) After placement of a large cage. This is the reason in few reports it is mentioned as D1-D2 region also. i have a t1-2 herniated disc pinching a nerve, possible thoracic outlet. Patients with cervical radiculopathy symptoms and physical examination findings consistent with Horner syndrome should be evaluated with a MRI that includes the upper thoracic spine. Study design: A retrospective clinical review of patients with thoracolumbar junction disc herniation. Overall outcomes for T1 disk herniations treated surgically are favorable. (e) Axial CT scan shows a pedicle screw in an upper thoracic vertebra. Bookshelf They can help rule out other conditions and give you a referral to a specialist. In this article, we reviewed these 32 prior cases of T1T2 disc herniations and added our four cases. 9. Please enable it to take advantage of the complete set of features! (i) Postoperative T2-weighted MRI demonstrates the cage in T1T2 interspace. J Neurosurg. For the fourth patient, the sequestrated disc disappeared 5 months later [Figures 4c and d ]. Although . But they can happen. Hann EC. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler: a case report. Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. If any of the thoracic nerves become inflamed, such as from a thoracic herniated disc or a narrowing of the foramen, thoracic radiculopathy can develop with symptoms of pain, tingling, numbness, and/or weakness radiating along the nerve root. Anto M, Manuel A, Jayachandran A, Thomas SG, Joseph A, Thankachan A, Bahuleyan B. Surg Neurol Int. 1986;19:44951. Rossitti S, Stephensen H, Ekholm S, von Essen C: The anterior approach to high thoracic (T1-T2) disc herniation. He is the founder of the Sukhayu Ayurved and working with patients clinically since last 15 years. Compression fractures are especially common in the lower thoracic area, and they often result from osteoporosis and mild trauma. Anterior surgery can be achieved without sternotomy. Postoperative MR imaging (MRI) studies in the first two patients showed adequate cord decompression following placement of T1T2 anterior interbody cages [Figures 1 and 2 ]. 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 ]. 1. Thoracic herniated discs are less common than herniated discs in the neck or low back, but they do happen. We present a rare case of a patient with T1-T2 intervertebral disk herniation and Horner syndrome who was treated surgically. Spine (Phila Pa 1976). These degenerative changes are more likely to happen in your neck and lower back than your upper and middle back . Caner H, Kilinoglu BF, Benli S, Altinrs N, Bavbek M. Magnetic resonance image findings and surgical considerations in T1-2 disc herniation. Learn more by subscribing now. The exception to this is for a giant herniated thoracic disc, which almost always requires surgery. See All About Neck Pain Radicular pain. 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 ]. The symptoms of a herniated disc in the thoracic area usually include: Pain that travels around the body and into one or both legs. Conclusions: Historically, symptomatic thoracic disk herniation occurred with a frequency of 2 to 3/1,000 cases of disk herniation.2 This is likely even less frequent with the advent of MRI use in diagnosis. Surgery was done 8 days from the onset of symptoms. Wolters Kluwer Health 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. Lucas, Jacqueline W, Eric M Connor, and Jonaki Bose. A spine specialist determines if surgery is the best option. Pain is often described as sharp or burning. The most commonly affected levels are C5-C6, C6-C7, and C4-C5. Love JG, Kiefer EJ: Root pain and paraplegia due to protrusions of thoracic intervertebral disks. Along with this when we work with pronated shoulders and fixed neck- chances of problem with D1-D2 disc increases in same frequency. 18. 4 ' 5 The first T1-2 disc herniation case was reported in 1954 by Sivien and Karavitis. You May Like: Parvo Symptoms In Older Dogs. The T1-T2 interspace is not fully visualized on a cervical MRI; therefore, a thoracic MRI scan can be helpful. Contained Discs: The disc has not broken through the outer wall of the intervertebral disc, which means the inner gel-like material remains contained. (d) Three-dimensional cervical computed tomography (CT) scan shows T1T2 and T3 screw rod fixation on the left side. If any of the thoracic nerves become inflamed, such as from a thoracic herniated disc or a narrowing of the foramen, thoracic radiculopathy can develop with symptoms of pain, tingling, numbness, and/or weakness radiating along the nerve root. These all symptoms always confuse before the proper diagnosis of slip disc in D1-D2. 2014 Oct;21(4):568-76. doi: 10.3171/2014.6.SPINE13682. 2010. If the disc is severely degenerated, bone spurs can form and limit the mobility of the thoracic spine. 2. AJR Am J Roentgenol. 1986. You May Like: Symptoms Of Hpa Axis Dysfunction. Please enable it to take advantage of the complete set of features! 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. This is possible through panchakarma procedures and Rasyana therapies later on. Neurology. Epub 2021 Nov 26. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. 2016. Find out how, and what you can do to treat them. 2016 May;25 Suppl 1:204-8. doi: 10.1007/s00586-016-4402-y. 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. Myelopathy is rare. J Glob Spine J. Back, Lower Limb, and Upper Limb Pain among U.S. She also works as an Adult and Pediatric Sexual Assault Nurse Examiner. 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. 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. Mulier S, Debois V. Thoracic disc herniations:Transthoracic, lateral, or posterolateral approach?A review. 2014: 34. 4: 366-7, 25. Disc herniation can occur in the cervical, thoracic, or lumbar spine. This is disc herniation. 15. Herniated thoracic disc at T1-2 level associated with horner's syndrome. Avoid lifting, twisting, or straining the back. Br J Neurosurg 1993;7:189-192. 13. [ 1 , 2 , 4 , 5 , 7 , 8 , 11 - 15 , 17 , 18 , 25 , 26 , 29 , 32 , 33 , 35 - 37 ] T1T2 disc herniation can present with either radiculopathy or myelopathy. Clipboard, Search History, and several other advanced features are temporarily unavailable. Proc Staff Meet Mayo Clin. Svien HJ, Karavitis AL: Multiple protrusions of intervertebral disks in the upper thoracic region: Report of case. -, Alberico AM, Sahni KS, Hall JA, Jr, Young HF. Physical examination revealed pain in the left upper paraspinal and scapular region radiating to the left shoulder with mild improvement of the pain with abduction of the left shoulder above the head. Keywords: Disc herniation, spontaneous resolution, sternal splitting approach, T1T2 disc space, thoracic disc, upper thoracic disc herniation. 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. (f) After placement of peek cage, note brachiocephalic vein at lower border of the scene. 1 Cervical pathologies causing these radiculopathies include herniated nucleus pulposus and cervical spondylosis. Drawing showing the anatomy of the oculosympathetic pathway. Delineating the location of nerve compression begins with assessing sites of peripheral compression with physical examination. It can result from advanced disc degeneration or from vertebral body remodeling . The levels affected are often T11 and T12, with 75% occurring below T8comparatively closer to the more flexible lumbar spine. -, Arseni C, Nash F. Thoracic intervertebral disc protrusion:A clinical study. Watch: Thoracic Herniated Disc Video It can also occur with ligamentous laxity in response to loading. official website and that any information you provide is encrypted Herniated discs in the thoracic region account for less than 1% overall. 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). Herniated Discs: When Is Surgery Necessary?. The same decay can be age related too. The symptoms of T1-T2 slip disc depends on the severity of the problem. Acute traumatic sequestrated thoracic disc herniation: A case report and review. may email you for journal alerts and information, but is committed This is a rarest condition in case of all thoracic discs, but can appear in this reason due to trauma. PMC Report of four cases and literature review. 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.