The 2023 edition of ICD-10-CM M51.24 became effective on October 1, 2022. 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. (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. Protrusion of the first thoracic disk. There are several treatment options for thoracic herniated discs. For the fourth patient, the sequestrated disc disappeared 5 months later [Figures 4c and d ]. Neurosurgery. Also, patients commonly feel a band of pain that goes around the front of the chest. 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. While the anterior approach tends to be a more familiar approach to most spine surgeons, certain anatomic restrictions may limit its use for T1-T2. Accessibility Apply an ice pack or cold compress to the affected area for 15- to 20-minute intervals every two hours. Before Among these diseases To set the slipped disc to normal is one. 17. (f) After placement of peek cage, note brachiocephalic vein at lower border of the scene. Spine (Phila Pa 1976). T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. J Neurosurg Spine. government site. This is the least common location for radiculopathy. There might be some other reasons like- some addiction or something like this, that causes the desiccation of the T1-T2 disc. There will be pain in the front side of Arm Pit. (h) Postoperative T2-weighted MRI: showing appropriate decompression of the spinal cord at T1T2 level. Learn more by subscribing now. 48: 710-5, 18. 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 further down the spine the injury occurs, the greater chance for at least partial recovery. In one case, a central disc fragment extended through the dura. An accurate diagnosis and timely surgical intervention may provide the patient the best chance for regression of symptoms and a satisfactory outcome. The most common areas to have a herniated disc are the cervical and lumbar areas of the spine. J Orthop Sci. 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. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Possley, Dr. Luczak, Dr. Angus, and Dr. Montgomery. A working differential diagnosis can guide management. 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. 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 annular tear can be confirmed with a discogram followed with a CT scan. Signs and Symptoms of a T1-T2 Herniated Nucleus Pulposis in the Literature (n = 21) Case 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. The one interesting aspect about a bulge is that it is an MRI finding that can correlate with an annular tear that causes deep midline low back pain. may email you for journal alerts and information, but is committed Gelch MM: Herniated thoracic disc at T1-2 level associated with Horner's syndrome: Case report. 1960. Diagnostic testing for herniated disk includes MRI, CT, myelography, and plain radiography, either alone or in different combinations, as the occasion demands. 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). Dydyk, Alexander M, Ruben Ngnitewe Massa, and Fassil B Mesfin. With cervical disc herniations, the nerve affected by the condition is the one that exits at that specific level of the spine. Degenerative disease and trauma are the most common causes of herniated discs in the thoracic spine. At 1-week postoperatively, he had near complete improvement in his left-hand strength with mild forearm paresthesias and persistent ptosis and miosis of the left eye. These symptoms typically follow a pattern as noted above, based on the affected nerve roots location and functions. At 9 months postoperatively, the patient continued to be pain free with full strength and intact sensation. 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. The number one prevention is not smoking. [ 3 , 6 , 19 , 28 , 30 , 34 ] Most thoracic disc herniations occur below the T8 level, and the majority are found at T11T12. 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. 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. We present a rare case of a patient with T1-T2 intervertebral disk herniation and Horner syndrome who was treated surgically. The https:// ensures that you are connecting to the (e) Axial CT scan shows a pedicle screw in an upper thoracic vertebra. This typically breaks down as such: Herniated discs are very common, but they usually occur in the lumbar spine as opposed to the thoracic region. Mulpuri K, LeBlanc JG, Reilly CW, Poskitt KJ, Choit RL, Sahajpal V. Sternal split approach to the cervicothoracic junction in children. Carson J, Gumpert J, Jefferson A. The man was treated surgically and the woman medically. T1T2 disc herniation: Report of four cases and review of the literature. 2021 Mar 17;12:108. doi: 10.25259/SNI_941_2020. Both of these signs were absent in our patients. 12: 221-31, 5. PMC It can range from a mild pain that feels tender when touched to a sharp or burning pain. 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. He is the founder of the Sukhayu Ayurved and working with patients clinically since last 15 years. The https:// ensures that you are connecting to the Symptoms characteristic of T1 disk herniation can often overlap with other maladies. 1991. Surgical approaches to thoracic disk herniations correlate with patient anatomy, location of nerve root compression, and surgeon familiarity. 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. The main symptoms of lumbar disc herniation would radiate based on the location of the disc herniation . Turbo spin-echo T1 and T2-weighted sagittal and turbo spin-echo T2 axial 4 mm sections parallel to the disc spaces were taken. In this article, we reviewed these 32 prior cases of T1T2 disc herniations and added our four cases. Background: HHS Vulnerability Disclosure, Help 2002. Non-Contained Discs: The inner gel-like material has broken through the outer wall of the intervertebral disc. Rahimizadeh A, Sami SH, Rahimizadeh S, Williamson WL, Amirzadeh M. Surg Neurol Int. Arseni C, Nash F. Thoracic intervertebral disc protrusion:A clinical study. Winter RB, Siebert R. Herniated thoracic disc at T1-T2 with paraparesis. J Neurosurg Spine. Morgan H, Abood C: Disc herniation at T1-2: Report of four cases and literature review. sharing sensitive information, make sure youre on a federal Although posterior approach surgery is most commonly used for laminectomy and/or foraminotomy, successful anterior approaches to upper thoracic lesions are valid as well. Barrow Neurological Institute. (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. Osteoarthritis appeared to be the predominant cause of the disc herniation in both patients. This pain might shoot into your arm or leg when you cough, sneeze or move into certain positions. A pinched nerve may cause pain in the back or chest at the first rib, or pain in the ring and/or pinky fingers. There is no medicine or procedure to reverse the process of ageing. We report two cases of exceptional first thoracic disc herniation in a 60-year-old man and a 55-year-old woman. It can result from advanced disc degeneration or from vertebral body remodeling . 2010. (i) Postoperative T2-weighted MRI demonstrates the cage in T1T2 interspace. 2014 Oct;21(4):568-76. doi: 10.3171/2014.6.SPINE13682. A comparative cohort of mini-transthoracic versus transpedicular discectomies. by the American Academy of Orthopaedic Surgeons. Clipboard, Search History, and several other advanced features are temporarily unavailable. Rahimizadeh A, Zohrevand AH, Kabir NM, Asgari N. Surg Neurol Int. HHS Vulnerability Disclosure, Help The arc begins in the hypothalamus and synapses in the intermediolateral gray substance at C8-T2 levels (ciliospinal center of budge). Maloney WF, Younge BR, Moyer NJ: Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. (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. (b) Axial view showing the central location of the disc. 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. Please enable it to take advantage of the complete set of features! Increased reflexes in one or both legs that can cause spasticity in the legs. Spacey K, Zaidan A, Khazim R, Dannawi Z. Horner's syndrome secondary to intervertebral disc herniation at the level of T1-2. The location of the pain depends on the location of the herniated disc. But they can happen. Management of Thoracic Disc Herniations via Posterior Unilateral Modified Transfacet Pedicle-Sparing Decompression With Segmental Instrumentation and Interbody Fusion. PMC 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. M51.24 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. To report a rare thoracic intervertebral disc herniation followed by acutely progressing paraplegia. A herniation here may cause pain at the back or chest around the first rib, or pain in the ring and/or pinky fingers. Asian Spine Journal, 2012 (evidence level 3A) T2 radiculopathy: A differential screen for upper extremity radicular pain. (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. Because in this case, a patient might get back all those symptoms of T1-T2 slip disc come back again. Left upper extremity motor was 5/5 in all myotomes except 4/5 finger abduction. Herniated discs in the thoracic region account for less than 1 percent of all herniated discs. 33. (a) T2-weighted sagittal magnetic resonance imaging (MRI) shows T1T2 disc herniation. Nishimura Y, Thani NB, Tochigi S, Ahn H, Ginsberg HJ. This impingement typically produces neck and radiating arm pain or. Herniated thoracic disc at T1-2 level associated with horner's syndrome. 2002. 35: 329-31, 11. 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. Careful radiographic analysis is needed preoperatively to identify the upper limit of the sternum. These all symptoms always confuse before the proper diagnosis of slip disc in D1-D2. 1998 Jan;88(1):148-50. doi: 10.3171/jns.1998.88.1.0148. Find out how, and what you can do to treat them. Oral steroids can also decrease inflammation, which will help alleviate pain. She underwent T1-T2 anterior discectomy and fusion. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. A disc bulge is not a disc herniation. Glaser J. Neuro-Ophthalmology, ed 1. Carousel with three slides shown at a time. J Orthop Sci 2009;14:103-106. If you are experiencing pain or others symptoms of a herniated thoracic disc, you should make an appointment to see your primary care doctor. Although anhydrosis was not explicitly tested, Horner syndrome was strongly suspected. There was a decreased sensation noted along the left medial forearm and hypothenar region. 92: 715-8, 9. Ruptured thoracic discs. 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. He is an M.D. Background: Symptomatic T1-T2 disc herniations are rare and, in most cases, are located posterolaterally. 6: 199-202. Surgery should occur only when objective findings of structural defects are correlated with the patients symptoms and signs. a = artery, n = nerve. one or two days) and activity modification (eliminating the activities and positions that worsen or cause the thoracic back pain). Local MD says he is not fimilar with T1-2. Along with this when we work with pronated shoulders and fixed neck- chances of problem with D1-D2 disc increases in same frequency. [ 1 , 2 , 4 , 5 , 7 - 9 , 11 - 15 , 17 , 18 , 21 , 24 - 26 , 29 , 31 - 33 , 35 - 37 ]. Background: The authors conducted a 2-year retrospective follow-up to investigate the efficiency of an extraforaminal full-endoscopic approach with foraminoplasty used to treat lateral compressive diseases of the lumbar spine in 247 patients. 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. This clinical condition can commonly be a consequence of cervical sympathetic chain injury, which runs along the lateral aspect of the vertebral body.