We present a patient with thoracic disk herniation and Horner syndrome who was treated surgically. Rahimizadeh A, Sami SH, Rahimizadeh S, Williamson WL, Amirzadeh M. Surg Neurol Int. Hammon WM. Treating thoracic-disc herniations: Do we always have to go anteriorly? Management of Thoracic Disc Herniations via Posterior Unilateral Modified Transfacet Pedicle-Sparing Decompression With Segmental Instrumentation and Interbody Fusion. Croat Med J. Trauma, such as a motor vehicle crash or fall can also cause a thoracic herniated disc. 33. Bransford RJ, Zhang F, Bellabarba C, Lee MJ. 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. 1991. (g) Plain CT radiograph showing that the cage is located at bicalvicular line. 1956;6:110. To report a rare thoracic intervertebral disc herniation followed by acutely progressing paraplegia. 2). New left-sided partial ptosis and pupillary miosis were found on facial examination (Figure 1, A). Your email address will not be published. Background: T1-T2 intervertebral disc prolapse (IVDP) is a rare clinical condition.Horner's syndrome is an extremely rare clinical finding in these patients. 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. Carson J, Gumpert J, Jefferson A. 49: 599-606, 23. Oral steroids can also decrease inflammation, which will help alleviate pain. A working differential diagnosis can guide management. 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. 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. There is no medicine or procedure to reverse the process of ageing. Rahimizadeh A, Saghri M. Spontaneous resolution of sequestrated lumbar disc herniation:A prospective cohort study. Kuzma SA, Doberstein ST, Rushlow DR. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler:A case report. Data is temporarily unavailable. Please enable it to take advantage of the complete set of features! 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. Pain is often described as sharp or burning. Disc Herniation - Statpearls - NCBI Bookshelf. National Library of Medicine, January 18, 2022. If there is some deformity behind T1-T2 slip disc than we aim to restore the kyphotic changes. The same decay can be age related too. and transmitted securely. Thoracic discectomy by posterior pedicle-sparing, transfacet approach with real-time intraoperative ultrasonography: Clinical article. 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. The thoracic region, which has more vertebrae than any other part of the spine, is the least-mobile region of the spine and therefore the least susceptible to disc herniation. According to Christopher Good, MD, FACS President of Virginia Spine Institute, often the most optimal treatment is to allow the body to heal naturally with time. 7: 495-7, 37. Horner syndrome or oculosympathetic paresis is caused by interruption of the sympathetic nerve supply to the face and eye that manifests as facial anhidrosis, blepharoptosis, and miosis. 1971. (e) Showing removal of the sequestrated disc fragment. Overall outcomes for T1 disk herniations treated surgically are favorable. 7: 189-92, 30. This the next process of degenerative disc disease is- disc bulge. 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. 12. Report of four cases and literature review. She also works as an Adult and Pediatric Sexual Assault Nurse Examiner. Symptoms Thoracic disc degeneration can be a cause of upper or mid back pain. Horner's syndrome secondary to intervertebral disc herniation at the level of T1-2. Herniated Thoracic Disc. Barrow Neurological Institute, August 3, 2022. Surg Neurol. 2010. Your back has many interconnected bones, nerves, muscles, ligaments and tendons that protect your spinal cord. An official website of the United States government. These all symptoms always confuse before the proper diagnosis of slip disc in D1-D2. A spine specialist determines if surgery is the best option. Natalie Evenson MSN, BSN, RN is a health content writer. (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. A very subtle ptosis and miosis remained. (b) Sagittal, (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up., MeSH 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). Radiation of pain in the upper arm on the front side. Correlating history, examination, and imaging will guide toward a successful diagnosis. Thanks to the rigidity of the thoracic spine and the size of thoracic vertebrae, a thoracic herniated disc is a lot less likely to happen than a lumbar (lower back) or cervical (neck) herniated disc. Disc herniation at T1-2. HHS Vulnerability Disclosure, Help The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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). Hoffman's sign was negative. However, the onset of paralysis in this condition is gradual. Disc herniation; T1T2 disc space; spontaneous resolution; sternal splitting approach; thoracic disc; upper thoracic disc herniation. This displacement can cause inflammation and compression to the spinal nerves or spinal cord, resulting in pain and possible neurological deficits like tingling, numbness, or weakness somewhere down the nerve. On which side the compression is more symptoms will be according to that. 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. 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. 1968. 2003;30:1524. A pinched nerve may cause pain in the back or chest at the first rib, or pain in the ring and/or pinky fingers. Ayurvedic treatment of T1-T2 slip disc problem also requires the same approach based Panchakarma therapies what we do in other disc problems. Required fields are marked *. For example, you may feel pain in your neck, arms, hands, fingers, or parts of the shoulder. The exception to this is for a giant herniated thoracic disc, which almost always requires surgery. (f) After placement of a large cage. Abbott KH, Retter RH. Although . T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. posterolateral discs) and, in some cases, spontaneously resolved (2 of 36 cases). Horwitz NH, Whitcomb BB, Reilly FG. In one case, a central disc fragment extended through the dura. When there is some problem in the T1-T2 diss, it gives similar symptoms to cervical problem. Among these diseases To set the slipped disc to normal is one. Before An accurate diagnosis and timely surgical intervention may provide the patient the best chance for regression of symptoms and a satisfactory outcome. 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. Evid Based Spine Care J 2010;1:21-28. Case report. Due to the location of the thoracic spine, a herniated disc can cause pain to the mid-back, unilateral or bilateral chest wall, or abdominal areas around the affected vertebrae. Find out how, and what you can do to treat them. Delineating the location of nerve compression begins with assessing sites of peripheral compression with physical examination. Remember, the cervical spine is composed of 7 bones stacked one on top of each other. After confirming the diagnosis with MRI, the patient was treated with standard posterior approach with laminoforaminotomy and diskectomy. (b) Axial view shows the posterolaterally located disc is on the left side. 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 video can be found here1). The symptoms of a herniated disc depends on either the size and position of the disc. Symptoms such as these are primarily determined by the location of the cervical herniated disc. MeSH Horner syndrome or oculosympathetic paresis is evident because of interruption of sympathetic nerve supply to the eye, which consists of a 3-neuron pathway. Conservative treatments are appropriate for T1T2 discs resulting in just mild radiculopathy (e.g. [ 3 , 6 , 19 , 28 , 30 , 34 ] Most thoracic disc herniations occur below the T8 level, and the majority are found at T11T12. Kanno H, Aizawa T, Tanaka Y, et al. 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. Also Check: Symptoms Of Heartworm In Dogs. 1993. -, Caner H, Kilinoglu BF, Benli S, Altinrs N, Bavbek M. Magnetic resonance image findings and surgical considerations in T1-2 disc herniation. Kanno H, Aizawa T, Tanaka Y, Hoshikawa T, Ozawa H, Itoi E. T1 radiculopathy caused by intervertebral disc herniation:Symptomatic and neurological features. J Neurosurg 1950;7:62-69. 6 Approximately more than 70 . Hagerstown, MD, Harper & Row, 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. Maloney WF, Younge BR, Moyer NJ: Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. government site. Horner syndrome with associated T1 weakness and paresthesias is representative of many etiologies (Table 2). Can J Neurol Sci. 2017 Sep;7(6):506-513. doi: 10.1177/2192568217694140. Watch: Thoracic Herniated Disc Video Approximately 75% of all thoracic disc herniations are seen below T8. When there is a compression on the disc, it starts decaying. Luk KD, Cheung KM, Leong JC. Radiation of pain in the upper arm on the front side. eCollection 2019. Proc Staff Meet Mayo Clin. If youve been having intolerable pain that fails to respond to conservative treatments and or causes neurological deficits. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. Patterson RH. Informed consent to present the data concerning the case for publication was obtained by the patient. (c) T2-weighted sagittal image shows complete resolution of the disc at 5-month follow-up. Disc herniation can occur in the cervical, thoracic, or lumbar spine. eCollection 2021. Cervical radiculopathy is a disease process marked by nerve compression from herniated disk material or arthritic bone spurs. Glaser J. Neuro-Ophthalmology, ed 1. When there is a change in the consistency of the jelly of disc, this falls under condition of slip disc or disc protrusion. Even if it is not causing pain or symptoms, a giant disc herniation will usually require surgical treatment. [ 1 , 2 , 4 , 5 , 7 - 9 , 11 - 15 , 17 , 18 , 21 , 24 - 26 , 29 , 31 - 33 , 35 - 37 ]. Thoracic Disc Herniation Symptoms Watch: Thoracic Herniated Disc Video 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. The symptoms often follow a dermatomal distribution, . The C8 nerve root innervates the extensor indicus and abductor pollicis brevis from the radial and median nerves, respectively, in addition to finger flexion (ulnar nerve). They occur when a vertebra in your spine collapses, which can lead to severe pain, deformity and loss of height. Furthermore, more than 75% of thoracic protrusions are located below T8, and only approximately 3% occur at the T1-T2 level, as in our patient. So when we provideAyurvedic treatment of T1-T2 slip disc we are careful about providing a proper solution. A cervical herniated disc may cause a number of symptoms in different parts of the body. Surg Neurol. MRI diagnosis is C7/T1 and C6-C7 severe foraminal narrowing and stenosis. 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. J Bone Joint Surg Am. Thus if there are some brachial plexus injuries on lower side there will be impact on the same nerve root and its supply too. Stillerman CB, Chen TC, Couldwell WT, Zhang W, Weiss MH. Unauthorized use of these marks is strictly prohibited. The number one prevention is not smoking. 1-3 The most affected area in the thoracic region is the T11-12 level. All but five intrinsic hand muscles are innervated by the ulnar nerve; abductor pollicus brevis, flexor pollicis brevis, opponens pollicis, and lateral lumbricals. Lloyd TV, Johnson JC, Paul DJ, Hunt W: Horner's syndrome secondary to herniated disc at T1-T2. Thoracic spinal cord injuries are rare and only account for 10 15 percent of all spinal cord injuries. 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. All surgically treated patients recovered fully. 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. By specifically examining these five muscles, one can differentiate between cubital tunnel syndrome, which leaves their motor strength intact, and C8-T1 radiculopathy. Pain just below the spine of the scapula. (b) Axial view showing the central location of the disc. Gelch MM: Herniated thoracic disc at T1-2 level associated with Horner's syndrome: Case report. Bransford R, Zhang F, Bellabarba C, Konodi M, Chapman JR. J Neurosurg Spine. Over-the-counter or prescription meds such as acetaminophen and NSAIDs like ibuprofen are common medicinal treatments. Asian Spine J. Caner H, Kilinoglu BF, Benli S, Altinrs N, Bavbek M. Magnetic resonance image findings and surgical considerations in T1-2 disc herniation. Upper back pain is usually attributed to minor injuries, such as muscle strain, sprain, poor posture, improper lifting, or twisting, but not often a herniated disc. 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. A report of five cases. Would you like email updates of new search results? This is the T1 nerve root which originates from the T1-T2 region. 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. Kurz LT, Pursel SE, Herkowitz HN. Herniated thoracic disc at T1-2 level associated with horner's syndrome. Non-surgical treatment options for symptoms of a thoracic herniated disc will typically include one or a combination of the following: A short period of rest (e.g. Disc herniation at T1-2. 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. Muscle weakness in certain muscles of one or both legs. Nishimura Y, Thani NB, Tochigi S, Ahn H, Ginsberg HJ. Symptomatic Lumbar Disc Herniation MadanMohanSahoo,MSOrth1,SudhirKumarMahapatra,DNBOrth1, Sheetal Kaur, MD1, Jitendra Sarangi, . (b) The disc space is a little bit above the manubrium line and cervicothoracic (CT) angle is 27. Love JG, Schorn VG: Thoracic-disk protrusions. The preganglionic fibers then exit the spinal cord and enter the cervical sympathetic chain. BMJ Case Rep. 2014 Jun 5;2014:bcr2014204820. T1T2 disc herniation: Report of four cases and review of the literature. Am J Ophthalmol 1998;126:565-577. Epub 2017 Apr 6. Hamlyn PJ, Zeital T, King TT. Court, C., E. Mansour, and C. Bouthors. (a) T2-weighted sagittal magnetic resonance imaging (MRI) shows T1T2 disc herniation. Acute traumatic sequestrated thoracic disc herniation: A case report and review. Vertebral compression fractures are the most common injury to the thoracic spine. 1954. Sebastian . Its not easy figuring out how to sleep with a herniated disc. A modified anterior approach to the cervicothoracic junction with clavicle resection16 or combined cervicothoracic approach for diskectomy has proven useful as well.14,17. PMC T1-T2 disc herniation:Two cases. Negoveti L, Cerina V, Sajko T, Glavi Z. Intradural disc herniation at the T1-T2 level. C8 and T1 nerve roots compromise both the ulnar and median nerve root; therefore, precise examination of these roots is necessary. For more information, please refer to our Privacy Policy. Thoracic disc herniations make up 0.25%0.75% of all disc ruptures. Degenerative changes of the spine is the same condition as spinal osteoarthritis, spondylosis and degenerative disk disease. This is possible through panchakarma procedures and Rasyana therapies later on. The rib cage adds extra protection, support, and stabilization to the spine, making it less susceptible to damage in general and disc trouble in particular. The site is secure. One of the main differences between thoracic vertebrae and vertebrae in other levels of the spine is that each thoracic vertebra has joints that connect it to the rib bone on each side of the spine. Spacey K, Zaidan A, Khazim R, Dannawi Z. Horner's syndrome secondary to intervertebral disc herniation at the level of T1-2. People who have a herniated disk often have radiating numbness or tingling in the body part served by the affected nerves. Thoracic herniated discs are less common than herniated discs in the neck or low back, but they do happen. T1 motor root innervates the flexor digitorum superficialis, flexor pollicis longus, flexor pollicis longus, flexor digitorum profundus, lumbricals, interossei, and the pectoralis major. 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. 6: s-0036, 28. Experiencing pain in your thoracic region could be due to many conditions that can affect these tissues, including: More common causes of thoracic spine pain that directly involve your spinal column include: Conditions that specifically affect your vertebrae, spinal cord and/or nerve roots in your thoracic spine, include: Other conditions that can affect any region of your spine, including your thoracic region, include: You may have had a medical exam that revealed an underlying health problem. (b) Axial view shows the posterolaterally located disc is on the left side. 1978. The patient understand that her name and initial will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. 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. According to the American Association of Neurological Surgeons, about 75 - 85% of people in the U.S. suffer from back pain at some point in their lifetime.