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). 6: s-0036, 29. Thoracic spinal cord injuries are typically less severe than injuries to the cervical spinal cord. 30: 152-4, 6. Lloyd TV, Johnson JC, Paul DJ, Hunt W: Horner's syndrome secondary to herniated disc at T1-T2. J Neurosurg Spine. The rest of the postganglionic fibers travel along the internal carotid artery and enter the cavernous sinus. Posted by mlerin @mlerin, Nov 4, 2019. 4 ' 5 The first T1-2 disc herniation case was reported in 1954 by Sivien and Karavitis. Biousse V, Touboul PJ, D'Anglejan-Chatillon J, Levy C, Schaison M, Bousser MG: Ophthalmologic manifestations of internal carotid artery dissection. 1978. Left upper extremity motor was 5/5 in all myotomes except 4/5 finger abduction. Dont Miss: Group B Strep Pregnancy Symptoms. Surgical options will vary based on the size, type, and location of the injury, but the most common are. (f) After placement of a large cage. Watch: Thoracic Herniated Disc Video For the former patient, cervicothoracic MRI showed a left centro-laterally disc at the T1T2 level. (i) Postoperative T2-weighted MRI demonstrates the cage in T1T2 interspace. (c) T2-weighted sagittal image shows complete resolution of the disc at 5-month follow-up. Two of the most common causes of thoracic radiculopathy are from compression caused by a herniated disc or from a narrowing of the spinal foramen, an opening through which these nerves pass. 2003;30:1524. The spurs may cause narrowing of the spinal canal and impinge on the spinal cord. The presence of an accurate and reproducible radiologic description is essential for the success of any interventional therapy, in addition to disc removal. 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 ]. 12. But not in case of T1-T2 slip disc. 1971. 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. 8600 Rockville Pike Please enable it to take advantage of the complete set of features! Spine (Phila Pa 1976). [ 4 , 6 , 27 , 30 , 34 ] However, for central T1T2 disc herniations, resulting in significant myelopathy, anterior surgery may be warranted (e.g., the low cervical-manubrium method and/or limited sternal splitting procedures). Please enable it to take advantage of the complete set of features! Most people respond well to non-operative or conservative treatment. 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. So the treatment is dependent on the following parameters-. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. Smoking wrecks your discs along with everything else, weakening and drying them out (in case you needed another reason to quit). 48: 768-72, 27. 2010. 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. Bookshelf Herniated Thoracic Disc. Barrow Neurological Institute, August 3, 2022. 17: 418-30, 4. A standard posterior approach with laminoforaminotomy and diskectomy was done. i have a t1-2 herniated disc pinching a nerve, possible thoracic outlet. Study design: A retrospective clinical review of patients with thoracolumbar junction disc herniation. official website and that any information you provide is encrypted 1960. The physician explained that you have a Bulging Disc, but you may still have questions that have been unanswered. Given the neurologic findings on examination, a cervical and thoracic MRI was obtained which revealed T1-T2 left paracentral disk extrusion with mild superior migration and left intraforaminal extension causing moderate left lateral recess stenosis and abutment of the left T1 nerve root (Figure 2). Vaidya Ji is well known for his specialisation in Ayurvedic treatment of different ailments. Increased reflexes in one or both legs that can cause spasticity in the legs. An accurate diagnosis and timely surgical intervention may provide the patient the best chance for regression of symptoms and a satisfactory outcome. 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). Glaser J. Neuro-Ophthalmology, ed 1. When the inner core of the disc when stops getting proper nutrition, than it starts decaying further. Recommended Reading: Heart Disease Symptoms In Dogs. Grade 1 Cervical Spinal Stenosis: Causes Symptoms And Treatment Methods: The visual analogue scale (VAS), Oswestry disability index (ODI), and MacNab scale were used to analyze the results collected during the . MRI best documents soft T1T2 thoracic discs, while computed tomography is typically optimal for calcified herniations. 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. National Library of Medicine posterolateral discs) and, in some cases, spontaneously resolved (2 of 36 cases). T1-T2 Disk Herniation Presenting With Horner Syndrome: A Cas - LWW Required fields are marked *. Eur Spine J. 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. (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable cord compression. Symptoms characteristic of T1 disk herniation can often overlap with other maladies. 6 Approximately more than 70 . Hammon WM. Successful Smith-Robinson approaches to T1-T2 have been achieved, whereas partial sternotomy has been used in others.9,14 Thoracic disk herniations can be approached posteriorly when little to no retraction of the spinal cord is necessary for disk access. Thoracic spinal cord injuries are rare and only account for 10 15 percent of all spinal cord injuries. Weakness. Bookshelf A disc bulge is not a disc herniation. Federal government websites often end in .gov or .mil. J Bone Joint Surg Am 1983;65:992-997. Conservative treatments are appropriate for T1T2 discs resulting in just mild radiculopathy (e.g. (b) The disc space is a little bit above the manubrium line and cervicothoracic (CT) angle is 27. 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. Herniated thoracic discs can cause paralysis. Asian Spine Journal, 2012 (evidence level 3A) T2 radiculopathy: A differential screen for upper extremity radicular pain. (c) T2-weighted sagittal image shows complete resolution of the disc at 5-month follow-up. (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. On examination, she had lower extremity hyperreflexia, an abnormal gait, and lower lumbar pain but lacked any radicular findings. by the American Academy of Orthopaedic Surgeons. A herniated thoracic disc is considered giant if it obstructs more than 50% of the central canal of the spine . 1956;6:110. Evid Based Spine Care J 2010;1:21-28. A magnetic resonance imaging scan revealed a large focal paracentral herniated disc at the T2-3 level. 15. Herniated Thoracic Disc | University of Maryland Medical Center 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. 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. 2014: 34. If the disc is severely degenerated, bone spurs can form and limit the mobility of the thoracic spine. (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. eCollection 2021. Non-Contained Discs: The inner gel-like material has broken through the outer wall of the intervertebral disc. It can also occur with ligamentous laxity in response to loading. Anterior surgery can be achieved without sternotomy. If we just suppress the pain and associated discomfort due to T1-T2 slip disc, that wont be a permanent solution of the problem. 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. Federal government websites often end in .gov or .mil. government site. Asian Spine J 2012;6:199-202. . Gelch MM: Herniated thoracic disc at T1-2 level associated with Horner's syndrome: Case report. Some error has occurred while processing your request. Logue V. Thoracic intervertebral disc prolapse with spinal cord compression. With cervical disc herniations, the nerve affected by the condition is the one that exits at that specific level of the spine. Thoracic disc herniations are rare conditions compared with other disc herniations seen at cervical and lumbar spine levels. 1960;17:41830. A herniation here may cause pain at the back or chest around the first rib, or pain in the ring and/or pinky fingers. (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. This is a rarest condition in case of all thoracic discs, but can appear in this reason due to trauma. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Spine J 2014;14:1654-1662. T1-T2 disc herniation: Report of four cases and review of the Surgical approaches to thoracic disk herniations correlate with patient anatomy, location of nerve root compression, and surgeon familiarity. An accurate diagnosis and timely surgical intervention may provide the patient the best chance for regression of symptoms and a satisfactory outcome.
