Available from: http://surgicalneurologyint.com/surgicalint-articles/9301/. (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. Upper thoracic spine arthroplasty via the anterior approach. Non-Contained Discs: The inner gel-like material has broken through the outer wall of the intervertebral disc. (f) Postoperative T1-weighted MRI, at 3-year follow-up, note clearance of the cord. (e) Intraoperative clearance of the disc space from both hard disc and osteophytes. 16. Yale J Biol Med. Would you like email updates of new search results? With cervical disc herniations, the nerve affected by the condition is the one that exits at that specific level of the spine. J Indiana State Med Assoc. This is possible through panchakarma procedures and Rasyana therapies later on. (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. Carousel with three slides shown at a time. Asian Spine Journal, 2012 (evidence level 3A) T2 radiculopathy: A differential screen for upper extremity radicular pain. 1954. 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. Tests such as Tinel sign at carpal/cubital tunnel, elbow flexion test, ulnar nerve compression test, Phalen test, and/or Durkan test are helpful. Neurology. C8 root pathology will result in weakness in all three of these muscles with manual muscle testing. Intervertebral thoracic disk herniation is rare. (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up. Unable to load your collection due to an error, Unable to load your delegates due to an error. This impingement typically produces neck and radiating arm pain or. J Neurosurg. 8600 Rockville Pike Please enable scripts and reload this page. National Library of Medicine CT can be used to complement MRI in cases of thoracic disk herniations. J Neurosurg 1978;48:128-130. BMJ Case Rep. 2014 Jun 5;2014:bcr2014204820. (a) T2-weighted sagittal magnetic resonance imaging (MRI) of the second case showing a hard disc at T1T2 level. This clinical condition can commonly be a consequence of cervical sympathetic chain injury, which runs along the lateral aspect of the vertebral body. Thoracic region is the first segment of the thoracic or dorsal spine. Had a cervical epidural injection last Thursday and so far no relief. Dydyk, Alexander M, Ruben Ngnitewe Massa, and Fassil B Mesfin. J Athl Train. 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. This is the reason in few reports it is mentioned as D1-D2 region also. Informed consent to present the data concerning the case for publication was obtained by the patient. Federal government websites often end in .gov or .mil. 6: 199-202. Wolters Kluwer Health For example, you may feel pain in your neck, arms, hands, fingers, or parts of the shoulder. 2010. The majority of herniated thoracic discs are diagnosed and treated before they progress to even partial paralysis. J Orthop Sci 2009;14:103-106. Most people dont need surgery for a thoracic herniated disc. Symptoms depend on where and how big the disc herniation is, where it is pressing, and whether the spinal cord has been damaged. 29: 375-8, 36. 12. Horner syndrome with associated T1 weakness and paresthesias is representative of many etiologies (Table 2). First thoracic disc protrusion. (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable cord compression. 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. The most commonly affected levels are C5-C6, C6-C7, and C4-C5. This is the condition, which is more common than other conditions in the T1-T2 disc. 6 Approximately more than 70 . T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. However, the onset of paralysis in this condition is gradual. MRI diagnosis is C7/T1 and C6-C7 severe foraminal narrowing and stenosis. (c) T2-weighted sagittal image shows complete resolution of the disc at 5-month follow-up. -. Remember, the cervical spine is composed of 7 bones stacked one on top of each other. The https:// ensures that you are connecting to the 2000. Publication types Case Reports Thus if there are some brachial plexus injuries on lower side there will be impact on the same nerve root and its supply too. and transmitted securely. There are some simple things that you can do at home to help alleviate the pain. Drawing showing the anatomy of the oculosympathetic pathway. J Neurol Neurosurg Psychiatry. 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. Signs and Symptoms of a T1-T2 Herniated Nucleus Pulposis in the Literature (n = 21). J Bone Joint Surg Am. 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. J Neurosurg Spine. 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. 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. It is causing burning/tingling up my neck to my ear and jaw area. 134: 184-5, 19. 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. These all symptoms always confuse before the proper diagnosis of slip disc in D1-D2. 24-Apr-2019;10:56. Both of these signs were absent in our patients. Rossitti S, Stephensen H, Ekholm S, von Essen C: The anterior approach to high thoracic (T1-T2) disc herniation. Thoracic disc herniation:Operative approaches and results. As people age, their thoracic intervertebral discs may lose their cushioning ability and become more likely to rupture. Also Check: Symptoms Of Heartworm In Dogs. Federal government websites often end in .gov or .mil. Surg Neurol. Also, patients commonly feel a band of pain that goes around the front of the chest. 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. Spine (Phila Pa 1976). Your doctor may use the following to diagnose a thoracic herniated disc: Sometimes other tests may be ordered because herniated thoracic disc pain and symptoms can mimic heart, lung, and stomach conditions. Weakness with finger abduction results from C8 radiculopathy and/or peripheral ulnar nerve entrapment. However, it is most common in men between the ages of 40 and 60. M51.24 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Biousse V, Touboul PJ, D'Anglejan-Chatillon J, Levy C, Schaison M, Bousser MG: Ophthalmologic manifestations of internal carotid artery dissection. J Neurosurg. All surgically treated patients recovered fully. 13. Patients with upper extremity radicular pain/paresthesias are often sent for radiographs and MRI. When the pressure is increasing with the time and jelly starts moving towards the periphery of the disc, it causes several symptoms according the compression on the nerve roots. 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 ]. 1978. The T1-T2 interspace is not fully visualized on a cervical MRI; therefore, a thoracic MRI scan can be helpful. This was excised utilizing a transfacet pedicle-sparing left-sided approach with left-sided T1T3 pedicle screw fixation to avoid instability [ Figure 3 ]. Conservative treatments are appropriate for T1T2 discs resulting in just mild radiculopathy (e.g. Abbott KH, Retter RH. (d) Axial T2-weighted axial view also confirms disappearance of the disc. (c) T2-weighted sagittal image shows complete resolution of the disc at 5-month follow-up. 8. The .gov means its official. Unauthorized use of these marks is strictly prohibited. If the C8 nerve is compressed or irritated, additional symptoms may occur, such as: If the spinal cord is injured, the upper and/or lower limbs and the torso may be completely or partially paralyzed.2 There may also be changes in bowel and/or bladder functions. New left-sided partial ptosis and pupillary miosis were found on facial examination (Figure 1, A). Good office ergonomics, such as a supportive chair, can reduce the risk of thoracic herniated discs, which are already rare. National Library of Medicine 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). C8 and T1 nerve roots compound both ulnar and median nerves.3 Therefore C8 and T1 radiculopathies . For example, T3 radiculopathy could radiate pain and other symptoms into the chest via the branch of the nerve root that becomes an intercostal nerve traveling along the route between the third and fourth ribs. There was a decreased sensation noted along the left medial forearm and hypothenar region. Possley, Daniel DO; Luczak, S. Brandon MD; Angus, Andrew MD; Montgomery, David MD. (f) After placement of peek cage, note brachiocephalic vein at lower border of the scene. The number one prevention is not smoking. 11. Svien HJ, Karavitis AL. A disc herniation is a significant cause or contributor of neck pain. Muscle weakness in certain muscles of one or both legs. See All About Neck Pain Radicular pain. Trauma, such as a motor vehicle crash or fall can also cause a thoracic herniated disc. From the Department of Orthopaedic Spine Surgery (Dr. Possley), Department of Orthopaedic Surgery (Dr. Luczak), Department of General Surgery (Dr. Angus), and Department of Orthopaedic Spine Surgery (Dr. Montgomery), Beaumont Health, Royal Oak, MI. There might be some other reasons like- some addiction or something like this, that causes the desiccation of the T1-T2 disc. T1T2 myelopathy and/or radiculopathy, magnetic resonance (MR) localization (anterior/anterolateral/lateral posterior), and optimal surgical management. The authors certify that they have obtained all appropriate patient consent forms. But they can happen. T1-2 disk herniation diagnosis is often delayed because of its prevalence and misdiagnosis. 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). [ 3 , 6 , 19 , 28 , 30 , 34 ] T1T2 discs account for only approximately 13% of all thoracic discs. 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. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. Because this nerve root is the part of the brachial plexus. one or two days) and activity modification (eliminating the activities and positions that worsen or cause the thoracic back pain). High thoracic disc herniation. J Neurosurg Spine. eCollection 2021. Movement the blood supply to the disc is interrupted it causes the desiccation of the disc. HHS Vulnerability Disclosure, Help 1. HHS Vulnerability Disclosure, Help Most people respond well to non-operative or conservative treatment. 49: 599-606, 23. Nishimura Y, Thani NB, Tochigi S, Ahn H, Ginsberg HJ. T1 and T2 - These lead into nerves that go into the top of your chest and into the arms and hands. 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). Maloney WF, Younge BR, Moyer NJ: Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. Background:Symptomatic T1T2 disc herniations are rare and, in most cases, are located posterolaterally. Myelopathy is rare. 17. The fourth patient had an MR left-sided laterally located extruded disc at the T1T2 level managed nonsurgically [ Figure 4a and b ]. 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 pupil dilator muscle and Mueller's muscles; small smooth muscles in the eyelid responsible for a minor portion of upper lid elevation and lower lid retraction. J Neurosurg. Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. (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. Disc herniation at T1-2. Bethesda, MD 20894, Web Policies Background: These all symptoms always confuse before the proper diagnosis of slip disc in D1-D2. Management of Thoracic Disc Herniations via Posterior Unilateral Modified Transfacet Pedicle-Sparing Decompression With Segmental Instrumentation and Interbody Fusion. Background: T1-T2 intervertebral disc prolapse (IVDP) is a rare clinical condition.Horner's syndrome is an extremely rare clinical finding in these patients. 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. 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. When there is a compression on the disc, it starts decaying. On postoperative day 1, the patient reported improvement in his left-sided radiating back pains, partial return of sensation along the left medial forearm, and hand with some mild persistent paresthesias. 1986;19:44951. (b) Sagittal cervical fat saturated MRI shows the same. 17: 418-30, 4. Gelch MM: Herniated thoracic disc at T1-2 level associated with Horner's syndrome: Case report. your express consent. J Neurosurg. 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. The incidence of a herniated disc may disrupt activities of daily living and sleep. Am J Ophthalmol 1980;90:394-402. Symptomatic thoracic disc herniation is uncommon and has been estimated to less than 0.75% of all symptomatic spinal disc herniations. 1968. Thoracic herniated discs are less common than herniated discs in the neck or low back, but they do happen. T2 sagittal and axial MR images with T1-T2 disk herniation (arrows). This is the American ICD-10-CM version of M51.24 - other international versions of ICD-10 M51.24 may differ. (f) After placement of a large cage. You will not be suddenly and completely paralyzed by a herniated thoracic disc. The symptoms of a herniated disc depends on either the size and position of the disc. J Neurosurg Spine. Patients demographic data and common clinical features of the corresponding location at which they generate. If the disc herniates into the spinal cord area, the thoracic herniated disk may also present with myelopathy . Nonsurgical treatments are usually tried first to treat CTJ injuries. Love JG, Kiefer EJ: Root pain and paraplegia due to protrusions of thoracic intervertebral disks. This sympathetic pathway begins in the hypothalamus and synapses in the intermediolateral gray substance of the spinal cord at C8-T2 levels making it susceptible to disruption via a high thoracic intervertebral disk herniation. Alberico AM, Sahni KS, Hall JA, Young HF. Int J Spine Surg. 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. 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. Please try again soon. A cervical herniated disc may cause a number of symptoms in different parts of the body. MRI provides the diagnosis. The physician explained that you have a Bulging Disc, but you may still have questions that have been unanswered. Morgan H, Abood C. Disc herniation at T1-2. T1T2 disc herniation: Report of four cases and review of the literature. Five percent are found in the thoracic, 3% in the cervical, and 92% in the lumbar region. I have a severe pressure senstation in the area of the bulge and when I lay down I have the burning in my neck and also in my (L)arm. symptoms with longer duration or unrelieved by conservative Kanno H, Aizawa T, Tanaka Y, Hoshikawa T, Ozawa H, Itoi E. T1 radiculopathy caused by intervertebral disc herniation:Symptomatic and neurological features. T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. Horner syndrome or oculosympathetic paresis is evident because of interruption of sympathetic nerve supply to the eye, which consists of a 3-neuron pathway. Numbness or tingling in areas of one or both legs. Kurz LT, Pursel SE, Herkowitz HN. Results: The patient's symptoms resolved completely. Therefore an MRI scan is important to find our the proper cause behind the problem. Krasnianski M, Georgiadis D, Grehl H, Lindner A: Correlation of clinical and magnetic resonance imaging findings in patients with brainstem infarction. The T-1 radiculopathy usually involves weakness of the intrinsic muscles of the hand. 7: 189-92, 30. Along with this when we work with pronated shoulders and fixed neck- chances of problem with D1-D2 disc increases in same frequency. We present a patient with thoracic disk herniation and Horner syndrome who was treated surgically. 18: 782-4, Your email address will not be published. Keywords: Disc herniation, spontaneous resolution, sternal splitting approach, T1T2 disc space, thoracic disc, upper thoracic disc herniation. So that we can give the proper space to the disc and it can breathe normally and can remain its space. Introduction. Barrow Neurological Institute. Modified anterior approach to the cervicothoracic junction. Causes of T1 nerve root compression has been summarized in the literature (Table 2). 7: 495-7, 37. 1986. Love JG, Schorn VG: Thoracic-disk protrusions. Dont Miss: Group B Strep Pregnancy Symptoms. Case report. Would you like email updates of new search results? 15: 227-41, 20. (b) Sagittal cervical fat saturated MRI shows the same. Sometimes, there may be difficulty in breathing if the first rib or rib muscles are injured. 15. [ 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). An accurate diagnosis and timely surgical intervention may provide the patient the best chance for regression of symptoms and a satisfactory outcome. Horner's syndrome secondary to T1-T2 intervertebral disc prolapse. 6: 1-10, 2. These symptoms typically follow a pattern as noted above, based on the affected nerve roots location and functions. Unlike the usual calcification in the medioposterior position for middle or lower thoracic spine herniations, a soft posterolateral herniation was observed here. eCollection 2022. Surg Neurol. Thoracic disc herniations are rare conditions compared with other disc herniations seen at cervical and lumbar spine levels. 92: 715-8, 9. Its not easy figuring out how to sleep with a herniated disc. 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. 48: 128-30, 8. Cervical radiculopathy is a disease process marked by nerve compression from herniated disk material or arthritic bone spurs. I've been in excruciating pain in the right shoulder and throughout the arm and hand for months. 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. Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. 1956. 2006. The site is secure. This may be evident by sensory disturbances below the level of compression, difficulty with balance and walking, lower extremity weakness, or bowel or bladder dysfunction. 2005. 73: 598-9, 13. You May Like: Symptoms Of Hpa Axis Dysfunction. PMC In this condition we work on the posture of the shoulders and neck all together. Herniated thoracic disc at T1-2 level associated with horner's syndrome. Recommended Reading: Heart Disease Symptoms In Dogs. 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. Morgan H, Abood C: Disc herniation at T1-2: Report of four cases and literature review. Sebastian . (e) Axial CT scan shows a pedicle screw in an upper thoracic vertebra. This is disc herniation. 2010 Feb;12(2):221-31. doi: 10.3171/2009.9.SPINE09476. 2016. 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. Correspondence to Dr. Luczak: [emailprotected]. Neurosurgery. Disk herniation at T1/T2 can compress the preganglionic fibers of the oculosympathetic pathway causing the classic Horner syndrome presentation of enopthalmos, miosis, blepharoptosis, and facial anhidrosis5,8,9 (Figure 3). Anterior approaches are useful, but more involved. Lloyd TV, Johnson JC, Paul DJ, Hunt W: Horner's syndrome secondary to herniated disc at T1-T2. Left upper extremity motor was 5/5 in all myotomes except 4/5 finger abduction. Pain is often described as sharp or burning. Within the spine itself there are also many other disorders that can have similar presenting symptoms of upper back pain and/or radiating pain, such as a spine fracture , infection, tumor, and certain metabolic disorders. 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). A cervical herniated disc may cause a number of symptoms in different parts of the body. (a) T2-weighted sagittal magnetic resonance imaging (MRI) of the second case showing a hard disc at T1T2 level. Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. Glaser J. Neuro-Ophthalmology, ed 1. 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. 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. 12: 221-31, 5. Disc herniation can occur in the cervical, thoracic, or lumbar spine. The patient was then discharged from the emergency center with oral methylprednisolone and follow-up with an orthopaedic spine surgeon. She has 24 years of experience in various areas, including Trauma, Neuro, Orthopedics, Critical Care, Emergency and Perioperative nursing. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. An MRI showing a herniated thoracic disc compressing the spinal cord.An MRI from the same patient shown above after minimally invasive lateral thoracic discectomy and fusion. Rahimizadeh A, Saghri M. Spontaneous resolution of sequestrated lumbar disc herniation:A prospective cohort study. Disclaimer. Thoracic back pain may be exacerbated when coughing or sneezing. Proc Staff Meet Mayo Clin 1954;29:375-378. In a systematic review and meta-analysis by Brooks et al, disk height index, Modic changes, and sagittal range of motion were found to be significantly correlated with an increased rate of recurrent lumbar disk herniation. C8 and T1 nerve roots compromise both the ulnar and median nerve root; therefore, precise examination of these roots is necessary. (g) Plain CT radiograph showing that the cage is located at bicalvicular line. Massage and acupuncture can be useful in managing pain. 10. The thoracic spine is surrounded by the rib cage and it is much harder to damage the spinal cord in this area. Degenerative changes of the spine is the same condition as spinal osteoarthritis, spondylosis and degenerative disk disease. 1983. There are several treatment options for thoracic herniated discs. Study design: A retrospective clinical review of patients with thoracolumbar junction disc herniation. They can help rule out other conditions and give you a referral to a specialist. Arbit E. A surgical approach through the pedicle to protruded thoracic discs. 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. Lumbar diskectomy is a common procedure for the management of lumbar radiculopathy, but recurrent lumbar disk herniation is one of the most common complications of the procedure, sometimes necessitating repeat surgery. 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 patient underwent successful T2-3 anterior discectomy with T2-3 rib autograft fusion. Stillerman CB, Chen TC, Couldwell WT, Zhang W, Weiss MH: Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. Neurology. 1955. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler: a case report. The .gov means its official. With age, the soft disks that act as cushions between your spines vertebrae wear down, dry out and/or shrink. There will be pain in the front side of Arm Pit. 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. These are same. Accessibility (i) Postoperative T2-weighted MRI demonstrates the cage in T1T2 interspace. 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. All surgically treated patients recovered fully. J Orthop Sci. A standard posterior approach with laminoforaminotomy and diskectomy was done. Preganglionic sympathetic neurons exit the spinal cord and ascend up the carotid sheath to the superior cervical ganglion at the level of the bifurcation of the common carotid artery. Disc herniation; T1T2 disc space; spontaneous resolution; sternal splitting approach; thoracic disc; upper thoracic disc herniation. 12: 303-5, 31. Vaidya Dr. Pardeep Sharma is Chief Ayurvedic Physician at Sukhayu Ayurved Jaipur. 2017 Sep;7(6):506-513. doi: 10.1177/2192568217694140. 1 Cervical pathologies causing these radiculopathies include herniated nucleus pulposus and cervical spondylosis.