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Herniated Thoracic Disc

Thoracic Disc Prolapse


Presentation

  • Such acute presentations occur infrequently. 14, 17 Cornips et al. 17 identified an acute presentation with myelopathy in approximately 4% of their HTD series: 5 of the 8 patients with acute presentation had multiple-level HTDs, all HTDs were located[thejns.org]
  • Babinski's sign was present on the left side and equivocal on the right side.[jamanetwork.com]
  • Galtier et al 17 presented a 6-case series where the time to diagnosis varied between 3 days and 2 years.[ncbi.nlm.nih.gov]
  • Far lateral thoracic disc herniation presenting with flank pain. The Spine Journal. 2006; 6 :201–203. [ PubMed ] [ Google Scholar ] 11. Freccero D., Donovan D.J. Adjacent Segment Degeneration at T1-T2 Presenting as Chest PaIn: Case Report.[ncbi.nlm.nih.gov]
  • This is a general catch-all for spinal conditions that could present at any part of your spine.[spinalsurgeonsydney.com.au]
Pain
  • Besides dull pain, many patients experience, burning sensations, shooting pain, tingling, prickling or even a feeling like electric shock.[info.illinoisbackpain.com]
  • Twenty-seven patients (48%) complained of local thoracic back pain in combination with myelopathy and/or radiculopathy, but no patient who underwent surgery presented exclusively with back pain.[thejns.org]
  • Pain in other locations was also reported as follows ( Table 2 ): 88.88% of patients reported back pain, 72.22% reported inguinal pain, 44.44% reported pain in a lower limb, and 44.44% reported pain in the genital area.[ncbi.nlm.nih.gov]
  • Damage to the spine by rheumatoid arthritis leads to neck or back pain and sometimes to nerve or spinal cord compression. The symptoms of nerve compression are shooting pains with numbness, tingling and weakness your arms or legs.[spinalsurgeonsydney.com.au]
  • In the literature opioids may be effective in the treatment of neuropathic pain. 20 ' 21 Physical therapy may improve life quality, and selective nerve blocks target nerve root pain. Steroid injections may be the treatment option of radicular pain.[ncbi.nlm.nih.gov]
Weakness
  • Sensory disturbances like overactive reflexes, numbness, balance problems, difficulty walking, lower extremity weakness or bladder/bowel dysfunction may indicate a more serious problem Instead of or in addition to a thoracic herniated disc, there may[info.illinoisbackpain.com]
  • Physical examination showed mild left leg weakness and a wide-based, unsteady gait. Deep-tendon reflexes in the lower extremities were brisk and symmetric. Babinski's sign was present on the left side and equivocal on the right side.[jamanetwork.com]
  • Numbness of the fourth and fifth fingers or weakness of intrinsic muscles in the hand are accompanying symptoms with C8 and T1 radiculopathy. Cubital tunnel syndrome and Guyon's tunnel syndrome may mimic the symptoms of T1 radiculopathy.[ncbi.nlm.nih.gov]
  • The symptoms of nerve compression are shooting pains with numbness, tingling and weakness your arms or legs.[spinalsurgeonsydney.com.au]
  • The patient (case 4) was a 67-year-old woman, who had low-back pain, numbness, and weakness in her trunk and lower limbs for eight years.[online.boneandjoint.org.uk]
Asymptomatic
  • Thirteen patients harbored 19 additional discs, which were deemed asymptomatic/nonoperative. The mean hospital stay was 6.5 days. Complete disc resection was verified with postoperative imaging in every patient.[thejns.org]
  • Discussion Most thoracic disc herniations are asymptomatic. 7 The clinical presentation of patients varies related to the level of disc herniation.[ncbi.nlm.nih.gov]
  • Some patients are asymptomatic, while others have midline thoracic pain, girdle pain or myelopathy.[online.boneandjoint.org.uk]
  • "Frequency of asymptomatic cervical disc protrusions". Cervical Disc Injuries. eMedicine. Retrieved 2008-02-27. Ernst CW, Stadnik TW, Peeters E, Breucq C, Osteaux MJ (Sep 2005).[en.wikipedia.org]
Disability
  • In order to focus on disabilities in these patients, a widely-accepted measure for these disabilities, such as the Oswestry score, 40 could have been used. Spinal cord monitoring was not performed in all our patients.[online.boneandjoint.org.uk]
  • It may result in back pain, pain or sensation in different parts of the body, and physical disability. The most conclusive diagnostic tool for disc herniation is MRI, and treatment may range from painkillers to surgery.[en.wikipedia.org]
  • If no concurrent myelopathy was present, surgery was recommended only if the symptoms were disabling and after failure of extensive nonoperative measures.[thejns.org]
Surgical Procedure
  • Surgical Procedures Twenty-three thoracotomy, 26 thoracoscopy, and 13 posterolateral procedures were performed ( Table 1 ). In general, a thoracotomy was used for more extensive pathology.[thejns.org]
  • The open surgical procedure, known as a thoracotomy, sounds like something out of a medieval torture chamber or the Mel Gibson movie "Braveheart."[espn.com]
  • This does not mean that the surgical procedure was ineffective. Using the JOA score, sensory function was the most resistant to improvement.[online.boneandjoint.org.uk]
Pleural Effusion
  • As such, 5 of the 9 complications in the thoracotomy group were directly related to operating through the pleural space (3 pleural effusions, 2 chyle leaks).[thejns.org]
  • When the pleural effusion had reduced to less than 100 ml per day, the drain was removed and the patients allowed to walk while wearing a rigid corset. Assessment of clinical outcome.[online.boneandjoint.org.uk]
Sneezing
  • Pain may become sharper when coughing or sneezing. Pain may potentially also occur in the stomach area, in the sternum (behind the breast bone) or the groin. Pain may occur in a band-like manner within the chest wall.[info.illinoisbackpain.com]
Cough
  • Pain may become sharper when coughing or sneezing. Pain may potentially also occur in the stomach area, in the sternum (behind the breast bone) or the groin. Pain may occur in a band-like manner within the chest wall.[info.illinoisbackpain.com]
Abdominal Pain
  • Discussion An abdominal wall source can be found in 30% of cases of chronic abdominal pain. 7 Cyriax was the first one to describe abdominal pain of nonvisceral origin and to postulate that nonvisceral abdominal pain could affect many patients. 8 However[ncbi.nlm.nih.gov]
Chest Pain
  • Adjacent Segment Degeneration at T1-T2 Presenting as Chest PaIn: Case Report. Spine (Phila Pa 1976) 2005; 30 :655–657. [ PubMed ] [ Google Scholar ] 12. Takagi H1, Kawaguchi Y, Kanamori M, Abe Y, Kimura T.[ncbi.nlm.nih.gov]
  • Role of stationary esophageal manometry in clinical practice: manometric results in patients with gastroesophageal reflux, dysphagia or non-cardiac chest pain. Rev Esp Enferm Dig. 2004; 96 (9):606–611. [ PubMed ] [ Google Scholar ][ncbi.nlm.nih.gov]
Back Pain
  • At some point you may develop dull upper back pain, which can extend into the neck or the lower back, which may be either constant or intermittent. Pain may become sharper when coughing or sneezing.[info.illinoisbackpain.com]
  • —This previously healthy 55-year-old man visited a chiropractor with a complaint of low back pain.[jamanetwork.com]
  • "Surgical treatment of low back pain". Primary Care. 39 (3): 525–31. doi : 10.1016/j.pop.2012.06.010. PMID 22958562.[en.wikipedia.org]
  • Twenty-seven patients (48%) complained of local thoracic back pain in combination with myelopathy and/or radiculopathy, but no patient who underwent surgery presented exclusively with back pain.[thejns.org]
  • Damage to the spine by rheumatoid arthritis leads to neck or back pain and sometimes to nerve or spinal cord compression. The symptoms of nerve compression are shooting pains with numbness, tingling and weakness your arms or legs.[spinalsurgeonsydney.com.au]
Fracture
  • Pain could come from a spinal fracture due to osteoporosis, an infection, tumor or metabolic disorder.[info.illinoisbackpain.com]
  • Crush fractures Symptoms Older people with osteoporosis can experience so called ‘crush fractures which often occur from minimal injury, Spinal crush fractures in older people are often very painful, but do not cause paralysis.[spinalsurgeonsydney.com.au]
  • One patient developed a compression fracture at the index level after thoracoscopy and underwent thoracotomy 4 months later for corpectomy and instrumented fusion.[thejns.org]
  • Both developed a kyphotic deformity because of fracture of the rib graft. Consequently, we used spinal instrumentation for all operations after September 1999 (ten patients).[online.boneandjoint.org.uk]
  • Traditional plain X-rays are limited in their ability to image soft tissues such as discs, muscles, and nerves, but they are still used to confirm or exclude other possibilities such as tumors, infections, fractures, etc.[en.wikipedia.org]
Osteoporosis
  • Pain could come from a spinal fracture due to osteoporosis, an infection, tumor or metabolic disorder.[info.illinoisbackpain.com]
  • The most important thing is to treat osteoporosis, which is proven to reduce the chance of another fracture. Spinal Infection Symptoms Post-operative infection is a risk with any spinal procedure.[spinalsurgeonsydney.com.au]
Upper Back Pain
  • At some point you may develop dull upper back pain, which can extend into the neck or the lower back, which may be either constant or intermittent. Pain may become sharper when coughing or sneezing.[info.illinoisbackpain.com]
Incontinence
  • Seventeen patients (30%) presented with bowel/bladder incontinence.[thejns.org]
  • Smaller spine procedures such as endoscopic transforaminal lumbar discectomy can not cause failed back syndrome, because no bone is removed. [50] The presence of cauda equina syndrome (in which there is incontinence, weakness, and genital numbness) is[en.wikipedia.org]
  • […] stairs 2 Capable of fast walking but clumsily 3 Normal 4 Sensory function Lower extremity Apparent sensory loss 0 Minimal sensory loss 1 Normal 2 Trunk Apparent sensory loss 0 Minimal sensory loss 1 Normal 2 Bladder function Urinary retention and/or incontinence[online.boneandjoint.org.uk]
Myelopathy
  • Some patients are asymptomatic, while others have midline thoracic pain, girdle pain or myelopathy.[online.boneandjoint.org.uk]
  • […] spinal manipulation has been associated with numerous neurologic complications, including brain-stem infarction, 1 cervical spinal cord injury, 2 and cauda equina syndrome. 3-5 We describe a case of thoracic intervertebral disk herniation with resultant myelopathy[jamanetwork.com]
  • TMS can aid physicians to: determine if myelopathy exists identify the level of the spinal cord where myelopathy is located.[en.wikipedia.org]
  • First thoracic disc herniation with myelopathy. Eur Spine J. 1995; 4 (6):366–7. [ PubMed ] [ Google Scholar ][ncbi.nlm.nih.gov]
Radiculopathy
  • Results Symptomatology The most common presenting symptom was myelopathy (46 patients [82%]), followed by radiculopathy (36 patients [63%]). Twenty-four (43%) of these patients had varying degrees of both myelopathy and radiculopathy.[thejns.org]
  • T1 radiculopathy may be accompanied by C8 radiculopathy symptoms. Numbness of the fourth and fifth fingers or weakness of intrinsic muscles in the hand are accompanying symptoms with C8 and T1 radiculopathy.[ncbi.nlm.nih.gov]
  • ( e.g., diabetic radiculopathy) are less frequent. 3 Early exclusion of a parietal source could increase diagnostic accuracy when evaluating patients with chronic abdominal pain.[ncbi.nlm.nih.gov]
  • "Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review". Spine. 35 (11): E488–504. doi : 10.1097/BRS.0b013e3181cc3f56. PMID 20421859. Snelling N (2006).[en.wikipedia.org]
Tingling
  • Besides dull pain, many patients experience, burning sensations, shooting pain, tingling, prickling or even a feeling like electric shock.[info.illinoisbackpain.com]
  • The symptoms of nerve compression are shooting pains with numbness, tingling and weakness your arms or legs.[spinalsurgeonsydney.com.au]
  • Symptoms may include sensory changes such as numbness, tingling, paresthesia, and motor changes such as muscular weakness, paralysis, and affection of reflexes.[en.wikipedia.org]
Burning Sensation
  • Besides dull pain, many patients experience, burning sensations, shooting pain, tingling, prickling or even a feeling like electric shock.[info.illinoisbackpain.com]
Radiculitis
  • "Chemical radiculitis". Pain. 127 (1–2): 11–6. doi : 10.1016/j.pain.2006.06.034. PMID 16963186. Marshall LL, Trethewie ER (Aug 1973). "Chemical irritation of nerve-root in disc prolapse". Lancet. 2 (7824): 320. doi : 10.1016/S0140-6736(73)90818-0.[en.wikipedia.org]

Workup

Pleural Effusion
  • As such, 5 of the 9 complications in the thoracotomy group were directly related to operating through the pleural space (3 pleural effusions, 2 chyle leaks).[thejns.org]
  • When the pleural effusion had reduced to less than 100 ml per day, the drain was removed and the patients allowed to walk while wearing a rigid corset. Assessment of clinical outcome.[online.boneandjoint.org.uk]

Treatment

  • The consultation can help determine if you’re a candidate for non-invasive Functional Disc Rehydration TM or other natural treatments. Functional Disc Rehydration TM is an innovative, proven treatment developed by Dr.[info.illinoisbackpain.com]
  • Clinical manifestations and surgical treatment.[thejns.org]
  • Treatment Treatment is based on the severity of symptoms and may include exercises, medication, injection of cortisone and very occasionally surgery.[spinalsurgeonsydney.com.au]
  • The second step for thoracic radiculopathy not responding to conservative treatment modalities is surgical treatment.[ncbi.nlm.nih.gov]
  • None of these patients reported no improvement or worsening of the symptoms after treatment.[ncbi.nlm.nih.gov]

Prognosis

  • The role of surgery in metastatic disease is to control the spinal tumour and prevent paralysis, but surgery cannot improve the overall prognosis. The role of the surgeon is as part of a team that includes radiation and medical cancer specialists.[spinalsurgeonsydney.com.au]
  • […] significant negative correlations between the clinical outcome and the duration of symptoms. 29 They also reported 33 patients with thoracic disc herniation which had been treated by a trans-thoracic approach and concluded that the indicators of a poor prognosis[online.boneandjoint.org.uk]
  • "Natural course and prognosis of intervertebral disc diseases. International Society for the Study of the Lumbar Spine Seattle, Washington, June 1994". Spine. 20 (6): 635–9. doi : 10.1097/00007632-199503150-00001. PMID 7604337. Hsu, Wellington K.[en.wikipedia.org]

Etiology

  • Three of these patients (16.66%) had undergone surgical interventions because of different suspected etiologies (oophorectomy, adrenalectomy, and umbilical hernia repair).[ncbi.nlm.nih.gov]

Epidemiology

  • Epidemiology [ edit ] Disc herniation can occur in any disc in the spine, but the two most common forms are lumbar disc herniation and cervical disc herniation.[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology [ edit ] The majority of spinal disc herniations occur in the lumbar spine (95% at L4–L5 or L5–S1). [12] The second most common site is the cervical region (C5–C6, C6–C7). The thoracic region accounts for only 1–2% of cases.[en.wikipedia.org]

Prevention

  • Prevention [ edit ] Because there are various causes of back injuries, prevention must be comprehensive.[en.wikipedia.org]
  • The role of surgery in metastatic disease is to control the spinal tumour and prevent paralysis, but surgery cannot improve the overall prognosis. The role of the surgeon is as part of a team that includes radiation and medical cancer specialists.[spinalsurgeonsydney.com.au]

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