Disc herniation at T1–2

1998 ◽  
Vol 88 (1) ◽  
pp. 148-150 ◽  
Author(s):  
Howard Morgan ◽  
Christopher Abood
Keyword(s):  
Disc Herniation ◽  
Clinical Signs ◽  
Cervical Disc ◽  
Motor Deficit ◽  
Thoracic Disc Herniation ◽  
Content Type ◽  
Disc Herniations ◽  
Muscles Of The Hand ◽  
Thoracic Disc ◽  
Intrinsic Muscles

✓ In preparing this paper, the authors reviewed their experiences with four cases of T1–2 disc herniation as well as the medical literature on the subject. Intervertebral thoracic disc herniations are uncommon and high thoracic disc herniations are rare. In the upper third of the thoracic spine, T1–2 is the most common level for disc ruptures. Four cases of disc herniation at T1–2 that caused T-1 radiculopathy are reported in this paper. In reviewing the literature on thoracic disc herniation, the authors found 27 cases at the T1–2 level, 23 of which were lateral disc herniations that produced radiculopathy and four of which were central disc herniations that caused myelopathy. The clinical signs and symptoms of T-1 radiculopathy are similar to those of C-8 radiculopathy; however, distinguishing features can frequently be found on neurological examination. The T-1 radiculopathy usually involves weakness of the intrinsic muscles of the hand. The motor deficit of C-8 radiculopathy involves the intrinsic muscles of the hand and most of the flexors and extensors of the fingers and wrist. The T-1 radiculopathy may produce Horner's syndrome (oculosympathetic paralysis) and diminished sensation in the axilla, which are not found with C-8 radiculopathy. In clinical presentation as well as in treatment, the lateral T1–2 disc herniation resembles a cervical disc herniation, whereas the central T1–2 disc herniation displays the usual appearance of a thoracic disc herniation.

Thoracic microendoscopic discectomy

2004 ◽  
Vol 1 (1) ◽  
pp. 58-63 ◽  
Author(s):  
Mick J. Perez-Cruet ◽  
Bong-Soo Kim ◽  
Faheem Sandhu ◽  
Dino Samartzis ◽  
Richard G. Fessler
Keyword(s):  
Minimally Invasive ◽  
Disc Herniation ◽  
Thoracic Disc Herniation ◽  
Tubular Retractor ◽  
Content Type ◽  
Estimated Blood Loss ◽  
Disc Herniations ◽  
Microendoscopic Discectomy ◽  
Thoracic Disc ◽  
Fine Print

Object. Various approaches exist for the treatment of thoracic disc herniation. Anterior approaches facilitate ventral exposure but place the intrathoracic contents at risk. Posterolateral approaches require extensive muscle dissection that adds to the risk of postoperative morbidity. The authors have developed a novel posterolateral, minimally invasive thoracic microendoscopic discectomy (TMED) technique that provides an approach to the thoracic spine which is associated with less morbidity. Methods. Seven patients 23 to 54 years old with nine disc herniations underwent TMED. All lesions were soft lateral or midline thoracic disc herniations. Under fluoroscopic guidance with the patient positioned prone, the authors used a muscle dilation approach and the procedure was performed with endoscopic visualization through a tubular retractor. Based on a modified Prolo Scale, five patients experienced excellent results, one good, and one fair. No case required conversion to an open procedure. The mean operative time was 1.7 hours per level, and estimated blood loss was 111 ml per level. Hospital stays were short, and no complications occurred. Conclusions. The TMED is safe, effective, and provides a minimally invasive posterolateral alternative for treatment of thoracic disc herniation without the morbidity associated with traditional approaches.

scholarly journals Sleep Apnea and Unilateral Upper and Lower Extremity Allodynia as a Result of a Large Thoracic Disc Herniation: A Case Report

2021 ◽  
Author(s):  
Tyler D. Alexander ◽  
Anthony Stefanelli ◽  
Sara Thalheimer ◽  
Joshua E. Heller
Keyword(s):  
Spinal Cord ◽  
Sleep Apnea ◽  
Sexual Dysfunction ◽  
Lower Extremity ◽  
Disc Herniation ◽  
Cord Compression ◽  
Thoracic Disc Herniation ◽  
Lower Extremity Weakness ◽  
Disc Herniations ◽  
Thoracic Disc

Abstract BackgroundClinically significant disc herniations in the thoracic spine are rare accounting for approximately 1% of all disc herniations. In patients with significant spinal cord compression, presenting symptoms typically include ambulatory dysfunction, lower extremity weakness, lower extremity sensory changes, as well as bowl, bladder, or sexual dysfunction. Thoracic disc herniations can also present with thoracic radiculopathy including midback pain and radiating pain wrapping around the chest or abdomen. The association between thoracic disc herniation with cord compression and sleep apnea is not well described.Case PresentationThe following is a case of a young male patient with high grade spinal cord compression at T7-8, as a result of a large thoracic disc herniation. The patient presented with complaints of upper and lower extremity unilateral allodynia and sleep apnea. Diagnosis was only made once the patient manifested more common symptoms of thoracic stenosis including left lower extremity weakness and sexual dysfunction. Following decompression and fusion the patient’s allodynia and sleep apnea quickly resolved.ConclusionsThoracic disc herniations can present atypically with sleep apnea – a symptom which may resolve with surgical treatment.

scholarly journals Revision surgery in thoracic disc herniation

2019 ◽  
Vol 29 (S1) ◽  
pp. 39-46
Author(s):  
Stephan Dützmann ◽  
Roli Rose ◽  
Daniel Rosenthal
Keyword(s):  
Disc Herniation ◽  
Revision Surgery ◽  
Cord Compression ◽  
Thoracic Disc Herniation ◽  
Disc Disease ◽  
Neurological Improvement ◽  
Initial Symptoms ◽  
Disc Herniations ◽  
Clinical Records ◽  
Thoracic Disc

Abstract Purpose Surgical treatment failures or strategies for the reoperation of residual thoracic disc herniations are sparsely discussed. We investigated factors that led to incomplete disc removal and recommend reoperation strategies. Methods As a referral centre for thoracic disc disease, we reviewed retrospectively the clinical records and imaging studies before and after the treatment of patients who were sent to us for revision surgery for thoracic disc herniation from 2013 to 2018. Results A total of 456 patients were treated from 2013 to 2018 at our institution. Twenty-one patients had undergone previously thoracic discectomy at an outside facility and harboured residual, incompletely excised and symptomatic herniated thoracic discs. In 12 patients (57%), the initial symptoms that led to their primary operation were improved after the first surgery, but recurred after a mean of 2.8 years. In seven patients (33%) they remained stable, and in two cases they were worse. All patients were treated via all dorsal approaches. In all 21 cases, the initial excision was incomplete regarding medullar decompression. All of the discs were removed completely in a single revision procedure. After mean follow-up of 24 months (range 12–57 months), clinical neurological improvement was demonstrated in seven patients, while three patients suffered a worsening and 11 patients remained stable. Conclusion Our data suggest that pure dorsal decompression provides a short relief of the symptoms caused by spinal cord compression. Progressive myelopathy (probably due to mechanical and vascular deficits) and scar formation may cause worsening of symptoms. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

Spontaneous intracranial hypotension due to thoracic disc herniation

2002 ◽  
Vol 96 (3) ◽  
pp. 343-345 ◽  
Author(s):  
Stuart C. A. Winter ◽  
Nicholas F. Maartens ◽  
Philip Anslow ◽  
Peter J. Teddy
Keyword(s):  
Disc Herniation ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Herniated Disc ◽  
Subdural Effusion ◽  
Thoracic Disc Herniation ◽  
Content Type ◽  
Blood Patch ◽  
Thoracic Disc ◽  
Fine Print

✓ Spontaneous intracranial hypotension is frequently idiopathic. The authors report on a patient presenting with symptomatic intracranial hypotension caused by a transdural calcified thoracic disc herniation. Cranial magnetic resonance (MR) imaging revealed classic signs of intracranial hypotension, and a combination of spinal MR and computerized tomography myelography confirmed a mid-thoracic transdural calcified herniated disc as the cause. The patient was treated with an epidural blood patch and burr hole drainage of the subdural effusion on two occasions. Postoperatively the headache resolved and there was no neurological deficit. Thoracic disc herniation may be a cause of spontaneous intracranial hypotension.

scholarly journals Sleep apnea and unilateral upper and lower extremity allodynia as a result of a large thoracic disc herniation: a case report

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Tyler D. Alexander ◽  
Anthony Stefanelli ◽  
Sara Thalheimer ◽  
Joshua E. Heller
Keyword(s):  
Spinal Cord ◽  
Sleep Apnea ◽  
Sexual Dysfunction ◽  
Lower Extremity ◽  
Disc Herniation ◽  
Cord Compression ◽  
Thoracic Disc Herniation ◽  
Lower Extremity Weakness ◽  
Disc Herniations ◽  
Thoracic Disc

Abstract Background Clinically significant disc herniations in the thoracic spine are rare accounting for approximately 1% of all disc herniations. In patients with significant spinal cord compression, presenting symptoms typically include ambulatory dysfunction, lower extremity weakness, lower extremity sensory changes, as well as bowl, bladder, or sexual dysfunction. Thoracic disc herniations can also present with thoracic radiculopathy including midback pain and radiating pain wrapping around the chest or abdomen. The association between thoracic disc herniation with cord compression and sleep apnea is not well described. Case presentation The following is a case of a young male patient with high grade spinal cord compression at T7-8, as a result of a large thoracic disc herniation. The patient presented with complaints of upper and lower extremity unilateral allodynia and sleep apnea. Diagnosis was only made once the patient manifested more common symptoms of thoracic stenosis including left lower extremity weakness and sexual dysfunction. Following decompression and fusion the patient’s allodynia and sleep apnea quickly resolved. Conclusions Thoracic disc herniations can present atypically with sleep apnea. We recommend taking into consideration that sleep symptoms may resolve when planning treatment for thoracic disc herniation.

scholarly journals Full-endoscopic uniportal decompression in disc herniations and stenosis of the thoracic spine using the interlaminar, extraforaminal, or transthoracic retropleural approach

2018 ◽  
Vol 29 (2) ◽  
pp. 157-168 ◽  
Author(s):  
Sebastian Ruetten ◽  
Patrick Hahn ◽  
Semih Oezdemir ◽  
Xenophon Baraliakos ◽  
Harry Merk ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Thoracic Spine ◽  
Surgical Techniques ◽  
Anatomical Location ◽  
Thoracic Disc Herniation ◽  
Advantages And Disadvantages ◽  
Canal Stenosis ◽  
Secondary Bleeding ◽  
Disc Herniations ◽  
Thoracic Disc

OBJECTIVESurgery for thoracic disc herniation and spinal canal stenosis is comparatively rare and often challenging. Individual planning and various surgical techniques and approaches are required. The key factors for selecting the technique and approach are anatomical location, consistency of the pathology, general condition of the patient, and the surgeon’s experience. The objective of the study was to evaluate the technical implementation and outcomes of a full-endoscopic uniportal technique via the interlaminar, extraforaminal, or transthoracic retropleural approach in patients with symptomatic disc herniation and stenosis of the thoracic spine, taking specific advantages and disadvantages and literature into consideration.METHODSBetween 2009 and 2015, decompression was performed in 55 patients with thoracic disc herniation or stenosis using a full-endoscopic uniportal technique via an interlaminar, extraforaminal, or transthoracic retropleural approach. Imaging and clinical data were collected during follow-up examinations for 18 months.RESULTSSufficient decompression was achieved in the full-endoscopic uniportal technique. One patient required revision due to secondary bleeding, and another exhibited persistent deterioration on myelopathy. No other serious complications were observed. All but one patient experienced regression or improvement of their symptoms.CONCLUSIONSThe full-endoscopic uniportal technique with an interlaminar, extraforaminal, or transthoracic retropleural approach was found to be a sufficient and minimally invasive method. To cover the entire range of thoracic disc herniations and stenosis within the criteria named, all full-endoscopic approaches are required.

Spontaneous intracranial hypotension from intradural thoracic disc herniation

2003 ◽  
Vol 98 (3) ◽  
pp. 282-284 ◽  
Author(s):  
Richard L. Rapport ◽  
David Hillier ◽  
Tim Scearce ◽  
Camari Ferguson
Keyword(s):  
Mr Imaging ◽  
Disc Herniation ◽  
Intracranial Hypotension ◽  
Clinical Course ◽  
Spontaneous Intracranial Hypotension ◽  
Thoracic Disc Herniation ◽  
Content Type ◽  
The Past ◽  
Intradural Disc Herniation ◽  
Thoracic Disc

✓ Spontaneous intracranial hypotension (SIH) may result from occult leaks anywhere along the neuraxis. Although this syndrome has been recognized over the past 10 years in the neurology and radiology literature, the typical magnetic resonance (MR) imaging picture and clinical course are less well known to neurosurgeons. The authors describe the case of a patient with positional headache and MR imaging findings typical of SIH that resulted from an intradural disc herniation.

scholarly journals Herniated discs: when is surgery necessary?

2021 ◽  
Vol 6 (6) ◽  
pp. 526-530
Author(s):  
Wai Weng Yoon ◽  
Jonathan Koch
Keyword(s):  
Disc Herniation ◽  
Controlled Trial ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Neurological Symptoms ◽  
Neurological Deficits ◽  
Cervical Disc ◽  
Indications For Surgery ◽  
Disc Herniations ◽  
Thoracic Disc

In all levels of disc herniations the absolute surgical indications include deteriorating neurological deficits with myelopathy or cauda equina syndrome. However, this review summarized the relative indications for surgery in each level. In cervical disc herniation (CDH), the indications for surgery consist of six months of persisting symptoms, not responding to conservative treatment. However, high-quality studies are lacking, and a randomized controlled trial is now underway to clarify the indications. In thoracic disc herniation (TDH), the indications for surgery comprise failure of conservative measures and/or worsening neurological symptoms. Moreover, giant calcified thoracic disc herniations or myelopathy signs on magnetic resonance imaging, even in the absence of neurological symptoms, may benefit from surgical treatment as a preventive measure. In lumbar disc herniation (LDH), the indications for surgery include imaging confirmation of LDH, consistent with clinical findings, and failure to improve after six weeks of conservative care. Cite this article: EFORT Open Rev 2021;6:526-530. DOI: 10.1302/2058-5241.6.210020

scholarly journals Operation of Soft or Calcified Thoracic Disc Herniations in the Full-Endoscopic Uniportal Extraforaminal Technique

2018 ◽  
Vol 1 (21;1) ◽  
pp. E331-E340 ◽  
Author(s):  
Sebastian Ruetten
Keyword(s):  
Spinal Cord ◽  
Retrospective Study ◽  
Minimally Invasive ◽  
Disc Herniation ◽  
Thoracic Spine ◽  
Surgical Trauma ◽  
Thoracic Disc Herniation ◽  
Soft Or ◽  
Disc Herniations ◽  
Thoracic Disc

Background: Surgery for thoracic disc herniation and stenosis is comparatively rare and often demanding. The goal is to achieve sufficient decompression without manipulating the spinal cord and to minimize surgical trauma and its consequences. Individual planning and various surgical techniques and approaches are required. The key factors for selecting the technique are anatomical location, consistency of the pathology, general condition of the patient, and the surgeon’s experience. Objectives: The objective of the study was the evaluation of the technical implementation and outcomes of a full-endoscopic uniportal technique via the extraforaminal approach in patients with symptomatic soft or calcified disc herniation of the thoracic spine, taking specific advantages and disadvantages and literature into consideration. Study Design: Retrospective study Setting: A center for spine surgery and pain medicine. Methods: Between 2009 and 2015, decompression was performed on 26 patients with thoracic disc herniation or stenosis with radicular or myelopathic symptoms in a full-endoscopic uniportal technique with an extraforaminal approach. No patients underwent additional posterior stabilization. Imaging and clinical data were collected in follow-up examinations for 18 months. Results: Sufficient decompression was achieved in the full-endoscopic uniportal technique in all cases. The individual selection of the respective approach made it possible to reach the target area without manipulating the spinal cord. One patient experienced deterioration of a myelopathy. No other serious complications were observed. All patients, except one, experienced regression or improvement of symptoms. No evidence of increasing instability was found in imaging. Limitations: This is a retrospective study. The limited number of cases must be considered. Conclusions: The full-endoscopic uniportal technique with an extraforaminal approach was found to be a sufficient and minimally invasive method with the known advantages of an endoscopic procedure under continuous irrigation for monosegmental disc herniations. The inclusion criteria must be taken into consideration. If they are not met, an alternative full-endoscopic approach (interlaminar, transthoracic retropleural) or decompression in a conventional method must be selected. Additional stabilization does not appear to be necessary due to the low level of trauma. Key Words: Extraforaminal approach, thoracic disc herniation, giant disc herniation, Fullendoscopic, minimally invasive, thoracic spine

scholarly journals Thoracic Disc Herniation Presenting with Transient Anterior Spinal Artery Syndrome

2000 ◽  
Vol 6 (4) ◽  
pp. 327-331 ◽  
Author(s):  
J.D. Guest ◽  
D.E. Griesdale ◽  
T. Marotta
Keyword(s):  
Spinal Cord ◽  
Disc Herniation ◽  
Sudden Onset ◽  
Anterior Spinal Artery ◽  
Thoracic Disc Herniation ◽  
Anterior Spinal Artery Syndrome ◽  
Disc Herniations ◽  
Artery Of Adamkiewicz ◽  
Severe Back Pain ◽  
Thoracic Disc

This report is a clinical and radiologic correlation of anterior spinal arterial distribution ischemia with a thoracic disc herniation affecting the artery of Adamkiewicz. We could only find one other similar reported case. A 38-year-old woman developed sudden onset of severe back pain and radiculopathy, followed by rapidly evolving paraparesis. The neurological examination was consistent with a deficit caused by anterior spinal artery ischemia. MRI revealed T2 signal change in the thoracolumbar spinal cord and a laterally placed, non-calcified disc herniation. Selective spinal angiography performed 30 hours after onset revealed displacement of the left T9 radicular feeding artery by the disc herniation; at this time the artery was patent. The patient experienced some resolution of symptoms within the first 24 hours and was managed conservatively and made a significant recovery within two weeks. Appropriately located thoracic disc herniations can disturb the blood supply to the thoracolumbar spinal cord.

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