Unusual Cases of Disc Herniation at T1-2
Brief Alert
Unusual Cases of Disc Herniation at T1-2
Source: Morgan H, Abood C. Disc herniation at T1-2. Report of four cases and literature review. J Neurosurg 1998;88: 148-150.
Morgan and abood describe in four patients the clinical picture of disc herniation and radiculopathy at spinal level T1-2. The condition is uncommon, apparently, with only 27 other cases reported in the medical-surgical literature. By gross reckoning, incidence must be considerably less than most cervical radiculopathy.
Clinically, signs and symptoms overlap those of C8 radiculopathy. Most victims are male, and most complain of relatively recent pain involving the scapula as well as the medial arm and forearm. Weakness usually affects the medial arm and forearm as well as the medial or entire hand, involving the last mentioned part with diminished sensation and paresthesias. An associated Horner's syndrome appears in perhaps one-third of cases. Hypalgesia may involve the axilla itself.
Diagnosis depends on a syndrome resembling that resulting from C8 compression, but imaging studies may often find no defect at that level. Given such circumstances, evidence for upper thoracic disc or radicular disease should be sought out by appropriate MRI or post-myelogram CT. Treatment usually requires surgical removal, especially if associated signs of myelopathy exist. (This Brief Alert is by Fred Plum, MD, Professor and Chairman, Department of Neurology and Neuroscience, New York Hospital, Cornell Medical Center.)
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