This condition can happen to anyone at any age but is more prevalent in older populations or with those who are involved in strenuous physical activity for extended periods of time. 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. Myelopathy is rare. Rossitti S, Stephensen H, Ekholm S, von Essen C: The anterior approach to high thoracic (T1-T2) disc herniation. So there is no difference in T1-T2 and D1-D2 discs. After confirming the diagnosis with MRI, the patient was treated with standard posterior approach with laminoforaminotomy and diskectomy. Vaidya Dr. Pardeep Sharma is Chief Ayurvedic Physician at Sukhayu Ayurved Jaipur. All surgically treated patients recovered fully. A spine surgeon or spinal neurosurgeon can assess your herniated thoracic disc and help you decide if it would be best to have surgery or to try conservative treatment. Rahimizadeh A, Zohrevand AH, Kabir NM, Asgari N. Surg Neurol Int. This fact is most likely explained by the restricted mobility and facet orientation of the thoracic spine. 1998. If youre between the ages of 30 and 50, youre more likely to be affected. 3. C8 and T1 nerve roots compromise both the ulnar and median nerve root; therefore, precise examination of these roots is necessary. 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 degenerative changes are more likely to happen in your neck and lower back than your upper and middle back . Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. This is the T1 nerve root which originates from the T1-T2 region. Background: Symptomatic T1-T2 disc herniations are rare and, in most cases, are located posterolaterally. This the next process of degenerative disc disease is- disc bulge. Conclusions: (e) Axial CT scan shows a pedicle screw in an upper thoracic vertebra. Again, the specific symptoms of a cervical herniated disc will depend on the affected pinched nerves. [ 1 , 2 , 4 , 5 , 7 - 9 , 11 - 15 , 17 , 18 , 21 , 24 - 26 , 29 , 31 - 33 , 35 - 37 ]. Osteoarthritis appeared to be the predominant cause of the disc herniation in both patients. Fortschr Neurol Psychiatr 2001;69:236-241. GUIDE: Physical Therapy Guide to Herniated Disk. Choose PT, August 26, 2021. Arbit E. A surgical approach through the pedicle to protruded thoracic discs. Careful radiographic analysis is needed preoperatively to identify the upper limit of the sternum. [ 3 , 6 , 19 , 28 , 30 , 34 ] T1T2 discs account for only approximately 13% of all thoracic discs. 14. You may have pain in your lower back, numbness or pain in your leg, or loss of bladder control. -, Arseni C, Nash F. Thoracic intervertebral disc protrusion:A clinical study. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. 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. Symptoms can also include numbness, tingling, or muscle weakness in one or both lower extremities. This was excised utilizing a transfacet pedicle-sparing left-sided approach with left-sided T1T3 pedicle screw fixation to avoid instability [ Figure 3 ]. 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 ]. Most T1T2 discs were posterolateral in location (25 cases); only 11 were purely central or centrolateral. 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. Herniated discs happen when the soft, jellylike inner layer of a shock-absorbing intervertebral disc bulges into or breaks through the discs tough outer layer. The main symptoms of lumbar disc herniation would radiate based on the location of the disc herniation . The exception to this is for a giant herniated thoracic disc, which almost always requires surgery. 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). 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. You May Like: Symptoms Of Hpa Axis Dysfunction. 1968. 1971. Surgical options will vary based on the size, type, and location of the injury, but the most common are. There was a decreased sensation noted along the left medial forearm and hypothenar region. 25: 910-6, 32. She also works as an Adult and Pediatric Sexual Assault Nurse Examiner. eCollection 2021. Alberico AM, Sahni KS, Hall JA, Young HF. T1-T2 disc herniation:Two cases. 2010;12:22131. Numbness or tingling in areas of one or both legs. For more information, please refer to our Privacy Policy. 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. 1986. Please enable it to take advantage of the complete set of features! 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. Kuzma SA, Doberstein ST, Rushlow DR. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler:A case report. 1, 3, 4, 5 Although uncommon, T1-T2 disk herniation should be suspected if a patient presents with Horner syndrome and upper extremity pain. Differentiating motor function from the C8-T1 nerve roots and ulnar nerve pathology can be assessed with motor testing. Abbott KH, Retter RH. 2016 May;25 Suppl 1:204-8. doi: 10.1007/s00586-016-4402-y. The thoracic spine is surrounded by the rib cage and it is much harder to damage the spinal cord in this area. You May Like: Parvo Symptoms In Older Dogs. 19: 449-51, 3. Extruded upper thoracic disc causing horner's syndrome:Report of a case. Winter RB, Siebert R. Herniated thoracic disc at T1-T2 with paraparesis. 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. Spine (Phila Pa 1976). This is the least common location for radiculopathy. Thus if there are some brachial plexus injuries on lower side there will be impact on the same nerve root and its supply too. Takagi H, Kawaguchi Y, Kanamori M, Abe Y, Kimura T. T1-2 disc herniation following an en bloc cervical laminoplasty. 2003. 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. Horwitz NH, Whitcomb BB, Reilly FG. 12: 221-31, 5. (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. 24-Apr-2019;10:56, How to cite this URL: Abolfazl Rahimizadeh, Amir Hossein Zohrevand, Nima Mohseni Kabir, Naser Asgari. Watch: Thoracic Herniated Disc Video Because this nerve root is the part of the brachial plexus. symptoms with longer duration or unrelieved by conservative Nonsurgical treatments are usually tried first to treat CTJ injuries. A comparative cohort of mini-transthoracic versus transpedicular discectomies. When the inner core of the disc when stops getting proper nutrition, than it starts decaying further. 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. Radiation of pain in the upper arm on the front side. 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. Dont Miss: Group B Strep Pregnancy Symptoms. Correspondence to Dr. Luczak: [emailprotected]. Left upper extremity motor was 5/5 in all myotomes except 4/5 finger abduction. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. Gokcen HB, Erdogan S, Gumussuyu G, Ozturk S, Ozturk C. A rare case of T1-2 thoracic disc herniation mimicking cervical radiculopathy. T1T2 disc herniation: Report of four cases and review of the literature. But not in case of T1-T2 slip disc. Croat Med J. A very subtle ptosis and miosis remained. Symptoms characteristic of T1 disk herniation can often overlap with other maladies. We report two cases of exceptional first thoracic disc herniation in a 60-year-old man and a 55-year-old woman. Ruptured thoracic discs. Radiation of pain in the upper arm on the front side. Disc herniation at T1-2. (a) T2-weighted sagittal magnetic resonance imaging (MRI) shows T1T2 disc herniation. [ 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. Apply an ice pack or cold compress to the affected area for 15- to 20-minute intervals every two hours. 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). Vaidya Dr. Pardeep does it according to the scientific principles of Ayurveda. Asian Spine J 2012;6:199-202. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. 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. High thoracic disc herniation. (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. Background:Symptomatic T1T2 disc herniations are rare and, in most cases, are located posterolaterally. All rights reserved. J Neurol Neurosurg Psychiatry. All but five intrinsic hand muscles are innervated by the ulnar nerve; abductor pollicus brevis, flexor pollicis brevis, opponens pollicis, and lateral lumbricals. This is the condition, which is more common than other conditions in the T1-T2 disc. J Glob Spine J. The location of the pain depends on the location of the herniated disc. When there is a compression on the disc, it starts decaying. They can help rule out other conditions and give you a referral to a specialist. Horner's syndrome secondary to T1-T2 intervertebral disc prolapse. After talking about your symptoms and . Gelch MM: Herniated thoracic disc at T1-2 level associated with Horner's syndrome: Case report. This is a rarest condition in case of all thoracic discs, but can appear in this reason due to trauma. Bethesda, MD 20894, Web Policies and transmitted securely. The spurs may cause narrowing of the spinal canal and impinge on the spinal cord. A cervical herniated disc may cause a number of symptoms in different parts of the body. T2 sagittal and axial MR images with T1-T2 disk herniation (arrows). 6 Approximately more than 70 . For example, you may feel pain in your neck, arms, hands, fingers, or parts of the shoulder. This is the reason in few reports it is mentioned as D1-D2 region also. The most common symptom of a thoracic herniated disc is pain. 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. Non-Contained Discs: The inner gel-like material has broken through the outer wall of the intervertebral disc. Accessibility (i) Postoperative T2-weighted MRI demonstrates the cage in T1T2 interspace. 6: s-0036, 29. 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. 42: 193-5, 26. Its not easy figuring out how to sleep with a herniated disc. 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). 6. 2022 Sep 9;13:412. doi: 10.25259/SNI_580_2022. J Neurosurg. . (e) Showing removal of the sequestrated disc fragment. (b) Sagittal, (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up., MeSH J Neurosurg. 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. 9. Morgan H, Abood C. Disc herniation at T1-2. Avoid lifting, twisting, or straining the back. 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. The symptoms of T1-T2 slip disc depends on the severity of the problem. The video can be found here1). 10. 18. Correspondence Address:Naser AsgariPars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran, How to cite this article: Abolfazl Rahimizadeh, Amir Hossein Zohrevand, Nima Mohseni Kabir, Naser Asgari. J Neurosurg. However, the onset of paralysis in this condition is gradual. Svien HJ, Karavitis AL: Multiple protrusions of intervertebral disks in the upper thoracic region: Report of case. Surgical Treatment of T1-2 Disc Herniation with T1 Radiculopathy: A Case Report with Review . The T-1 radiculopathy usually involves weakness of the intrinsic muscles of the hand. An official website of the United States government. 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 ]. When there is some problem in the T1-T2 diss, it gives similar symptoms to cervical problem. Trauma, such as a motor vehicle crash or fall can also cause a thoracic herniated disc. The number one prevention is not smoking. So that we can give the proper space to the disc and it can breathe normally and can remain its space. Arseni C, Nash F. Thoracic intervertebral disc protrusion:A clinical study. There is no charge to read or download any SNI content, but registering for a free membership will provide you with additional special features. Thoracic disc herniation:Operative approaches and results. The fourth patient had an MR left-sided laterally located extruded disc at the T1T2 level managed nonsurgically [ Figure 4a and b ]. Tokuhashi Y, Matsuzaki H, Uematsu Y, Oda H. Spine (Phila Pa 1976). Love JG, Schorn VG: Thoracic-disk protrusions. 1986. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. We focused on the clinical presentation, e.g. Lloyd TV, Johnson JC, Paul DJ, Hunt W. Horner's syndrome secondary to herniated disc at T1--T2. For the fourth patient, the sequestrated disc disappeared 5 months later [Figures 4c and d ]. 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. 2009. Learn more by subscribing now. 34: 68-77, 7. The rest of the postganglionic fibers travel along the internal carotid artery and enter the cavernous sinus. one or two days) and activity modification (eliminating the activities and positions that worsen or cause the thoracic back pain). Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. These all symptoms always confuse before the proper diagnosis of slip disc in D1-D2. Cervical radiographs are not usually clinically useful because of the difficulty in visualizing through the shoulders. 13. But they can also happen after more severe trauma in the absence of osteoporosis or as a result of tumors on your spine. When Natalie is not working, you can find her gardening and taking care of her animals on her mini farm. The presence of an accurate and reproducible radiologic description is essential for the success of any interventional therapy, in addition to disc removal. In this article, we reviewed these 32 prior cases of T1T2 disc herniations and added our four cases. Also, patients commonly feel a band of pain that goes around the front of the chest. 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). Unable to load your collection due to an error, Unable to load your delegates due to an error. Among these diseases To set the slipped disc to normal is one. 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.