This document discusses a case of a T1-T2 thoracic disc extrusion in a 50-year-old male presenting with severe radicular pain in the right arm. Conservative treatment was initially attempted with steroids, analgesics, and physical therapy providing some relief. Follow-up MRI two years later showed reduction in the size of the disc fragment without need for surgery. The document then reviews the literature on epidemiology, clinical presentation, diagnostic imaging, and surgical and non-surgical management of upper thoracic disc herniations.
Cervical spine clearance lecture given to 1st-year emergency medicine residents at Duke University. Covers indications for applying cervical collar, types of collars, types of imaging of the spine, and when to remove the collar.
It is an oncologic emergency. This slides contains a brief discussion on mechanism of spinal cord compression , common malignancies presenting with spinal cord compression , approach to a patient with cord compression like features and management this catastrophic situation.
A comprehensive presentation on the epidemiology, pathophysiology, clinical presentation, decision making and treatment options of spinal metastases. Supported with the best available evidence as of October 6, 2008
In thoracolumbar spine trauma, the biomechanical goals in minimally invasive fracture treatment include decompression of the spinal canal, reduction of spinal deformities, and maintenance of stable fixation of the spine to permit early mobilization.
This was a teaching lecture given by Prof. Mohamed Mohi Eldin, professor of neurosurgery, in the Multi- Institutional Neurosurgical Meeting, Kasr El Aini Hospital, Cairo University, April 2nd, 2009.
Newer advances in the field has made surgeons once again looking at Core decompression as an important procedure for treating avascular necrosis of the femoral head. The talk is about the newer development in the field of the Core decompression and how the newer techniques are transforming the way the surgeons take care of this important problem.
An Extremely Rare Case of the Traumatic Spinal Epidural Hematoma in a Child: ...CrimsonPublishersTNN
An Extremely Rare Case of the Traumatic Spinal Epidural Hematoma in a Child: Case Report and Review of the Literature by Ivan Domazet in Techniques in Neurosurgery & Neurology
Cervical spine clearance lecture given to 1st-year emergency medicine residents at Duke University. Covers indications for applying cervical collar, types of collars, types of imaging of the spine, and when to remove the collar.
It is an oncologic emergency. This slides contains a brief discussion on mechanism of spinal cord compression , common malignancies presenting with spinal cord compression , approach to a patient with cord compression like features and management this catastrophic situation.
A comprehensive presentation on the epidemiology, pathophysiology, clinical presentation, decision making and treatment options of spinal metastases. Supported with the best available evidence as of October 6, 2008
In thoracolumbar spine trauma, the biomechanical goals in minimally invasive fracture treatment include decompression of the spinal canal, reduction of spinal deformities, and maintenance of stable fixation of the spine to permit early mobilization.
This was a teaching lecture given by Prof. Mohamed Mohi Eldin, professor of neurosurgery, in the Multi- Institutional Neurosurgical Meeting, Kasr El Aini Hospital, Cairo University, April 2nd, 2009.
Newer advances in the field has made surgeons once again looking at Core decompression as an important procedure for treating avascular necrosis of the femoral head. The talk is about the newer development in the field of the Core decompression and how the newer techniques are transforming the way the surgeons take care of this important problem.
An Extremely Rare Case of the Traumatic Spinal Epidural Hematoma in a Child: ...CrimsonPublishersTNN
An Extremely Rare Case of the Traumatic Spinal Epidural Hematoma in a Child: Case Report and Review of the Literature by Ivan Domazet in Techniques in Neurosurgery & Neurology
With increased longevity, number of patients with spinal stenosis is increasing. It commonly affects the most mobile segments, i.e., cervical and lumbar. Studies have shown that radiographic stenosis is common in the asymptomatic aging population. The clinical presentation varies according to central canal, neural foramina and/or the lateral recess stenosis. Symptomatic degenerative cervical or lumbar spinal stenosis often needs surgical management. Isolated single symptomatic cervical or lumbar stenosis has been frequently reported in the literature, but very few reports of co-existing cervical and lumbar stenosis are available. The severity of stenosis in one region may mask the symptoms of the other.
Introduction: Partial or complete aplasia of the posterior arches of the atlas is a well-documented anomaly but a relatively rare condition caused by a defect in their closure. This condition is usually asymptomatic so most are diagnosed incidentally.
Case report: We report the case of a patient who presents a defect of the posterior arch of atlas.
Conclusion: There is a variety of the congenital defects of the arch of the atlas. Further studies are required on these lesions in order to take possible protection measures against trauma, and the selection between conservative or surgical treatment.
Sternal Fractures & Dislocations - EMGuidewire Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Sternal Fractures and Dislocations and is brought to you by Carrie Bissell, MD, Aaron Fox, MD, Kendrick Lim, MD, Stephanie Jensen, MD, and Olivia Rice, MD. It is has special guest editor: Sean Dieffenbaugher, MD and Laurence Kempton, MD
Anatomical Descriptive Study of 337 Thoracic Disc Herniationsasclepiuspdfs
Introduction: Conventionally, thoracic disc herniation has been viewed as a very rare pathology, and the few cases considered were considered to have a very low frequency of symptoms. However, new imaging methods show that the frequency of this pathology is quite high and also that its symptoms are encountered much more frequently than expected (since previously only neurological symptoms were taken into account). In view of these considerations, we conducted an anatomical descriptive study of this circumstance.
Vertebral osteomyelitis( spondylodiskitis )
usually seen in adults (median age is 50 to 60 years)
Location
50-60% of cases occur in lumbar spine
30-40% in thoracic spine
~10% in cervical spine
Study of current pattern of Cervical Spondylotic Myelopathy and to evaluate t...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Chronic Recurrent Multifocal Osteomyelitis - a care report.pptxvinod naneria
Autoimmune chronic multifocal recurrent osteomyelitis , case report, Auto-inflammatory osteomyelitis in children, non-pyogenic osteomyelitis in both Tibia,
Conservative management of Lumbar disc prolapse.pptxvinod naneria
conservative management, non-surgical treatment of lumbar PID,
current concepts on Lumbar disc management, MRI correlation with neurological deficit in PID
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. T1 – T2 Thoracic Disc Extrusion
Vinod Naneria
Girish Yeotikar
Arjun Wadhwani
Choithram Hospital & Research centre,
Indore, India
2. Case History
• A 50 years Male,
• Acute onset of severe radicular pain right arm.
• The right arm is kept in 90 abduction.
• Unable to bring arm close to chest due to pain.
• Clinically there was no detectable neurological
deficit in any dermatome on right side. Planter
were down going.
• MRI was showing lateral extruded disc at T1 – T2
with proximal migration.
13. Review Literature – Incidence & Site
• Thoracic disc herniation accounts for 0.15-4.4% of all disc
herniations.
• 75 % of all thoracic disc problems occur below T8, with a
peak of 26% at T11-12.
• The upper thoracic spine (T1-5) is the region least often
affected, with only 6% of all thoracic disc herniations
occurring here.
• To date, a total of 31 cases of T1-2 disc herniation have
been reported in the literature and all but one of these was
diagnosed by myelography, computed tomography (CT), or
CT myelography. Posterior surgical approaches were
performed in all except one case, in which an anterior
approach was used.
Magnetic Resonance Image Findings and Surgical Considerations in T1-2 Disc
Herniation
H. Caner, B.F. Kilinçoglu, S. Benli, N. Altinörs, M. Bavbek; Can. J. Neurol. Sci. 2003; 30:
152-154
14. Clinical presentation
• Upper thoracic disc herniation is rare. Patients
can easily be misdiagnosed with cervical disc
herniation or thoracic outlet syndrome.
• The common complaints in cases of this type are
pain in the arm, shoulder, and neck (60%), as well
as sensory (23%) and motor changes (18%).
• Radiculopathy is the most frequent finding (87%)
in published cases, and Horner.s syndrome is
seen in 21% of patients.
• Cervical MRI extended to include the upper
thoracic region is diagnostic.
15. Brown CW, Deffer PA Jr, Akmakjian J, et al:
The natural history of thoracic disc herniation.
Spine 17(Suppl):S97–S102, 1992
• Brown, et al.,6 retrospectively reviewed data obtained
in 55 patients with 72 thoracic disc herniations.
• They found that 15 (27%) of these patients eventually
required surgery, especially if they presented with signs
of myelopathy.
• The vast majority of patients, however, did not require
surgery and have continued to perform activities of
daily living, including vigorous sports activities.
• There was no correlation between radiographic
depiction and the patient’s symptoms.
16. operative treatment of thoracic discs
• Posterior approach - transpedicular,
transfacet;
• Posterolateral approach modified
costotransversectomy, lateral extracavitary;
• Anterolateral approach - transthoracic;
• Thoracoscopic approach
Thoracic herniated disc surgery is reserved for cases of
myelopathy, progressive lower extremity weakness, and
intolerable radicular pain that does not get better with
non-surgical treatments.
17. operative treatment of thoracic discs
• Sharan et al reported that anterior discectomy
without sternotomy.
• Rossitti et al reported an approach - anterior
discectomy with sternotomy.
• Total disc excision is not possible when posterior
or posterolateral approaches are used.
• posterior approaches, including laminectomy
with foraminotomies, laminectomy with
transdural disc excision, and thoracotomy with
lateral extracavitary exposure.
18. Disc herniation at T1–2
Report of four cases and literature review
Howard Morgan, M.D., M.A., and Christopher Abood, M.D.
Journal of Neurosurgery; January 1998 / Vol. 88 / No. 1 / Pages 148-150
• 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.
• 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.
19. The anterior approach to high thoracic (T1-T2) disc
herniation; 1993, Vol. 7, No. 2 , Pages 189-192. By - Sandro Rossitti,
Hannes Stephensen, Sven Ekholm and Claes Von Essen
• A patient with a T1-T2 disc herniation, operated on via
the anterior approach, is presented. In a search of the
literature we found 18 reported cases, all operated on by
posterior or posterolateral approaches. The feasibility of
the anterior discectomy in our case was established by
preoperative magnetic resonance imaging of the upper
thorax. We think that an anterior discectomy at the level
of the upper thoracic spine can be easily performed in
selected cases. The clinical picture of T1 root
compression is described.
20. Neurologic manifestations of compressive radiculopathy of the first thoracic root
Kerry H. Levin, MD
From the Department of NeurologyCleveland Clinic Foundation, Cleveland, OH.
• Neurologic deficits in the first thoracic (T1) root
distribution are uncommon and not easily defined.
Myotomal charts indicate that distal arm and hand
muscles receive significant contributions from both the
C8 and T1 roots.
• A patient with focal T1 radiculopathy is presented who
demonstrated motor axon loss isolated to the abductor
pollicis brevis muscle. This finding provides another
source of evidence that the abductor pollicis brevis is
the primary T1 motor structure in the upper extremity,
improving precision in clinical and electromyographic
diagnosis.
21. Disc herniation at T1–2
Report of four cases and literature review
Howard Morgan, M.D., M.A., and Christopher Abood, M.D.
Journal of Neurosurgery; January 1998 / Vol. 88 / No. 1 / Pages 148-150
• 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.
22. High thoracic disc herniation. (PMID:3762895)
Alberico AM, Sahni KS, Hall JA Jr, Young HF
Neurosurgery [1986, 19(3):449-451]
• A case of T-1, T-2 disc herniation is reported. The
patient presented with diminished hand strength,
medial arm and shoulder pain, and medial arm,
forearm, and hand paresthesias.
• After surgical decompression and removal of a disc
fragment, the patient made a complete recovery.
• Routine cervical myelography was considered
inadequate in view of this patient's symptoms.
High thoracic myelography followed by computed
tomographic scanning should be considered for
patients with this presentation.
23. Thoracic intervertebral disc herniations: diagnostic value of
magnetic resonance imaging. (PMID:3173662)
Blumenkopf B
Department of Neurological Surgery, Vanderbilt University,
Nashville, Tennessee. Neurosurgery[1988, 23(1):36-40]
Thoracic disc herniation is relatively rare and frequently
poses a challenge in clinical diagnosis. These protrusions
have been categorized into two major anatomical types
and three main clinical syndromes. A number of
characteristic radiographic features have been reported.
Recently, magnetic resonance imaging (MRI) has gained
popularity as a neurodiagnostic imaging tool.
A series of nine cases of thoracic intervertebral disc
herniation is reported. The clinical aspects of the cases
are discussed, and the potential value of spine MRI for
thoracic disc herniation diagnosis is emphasized.
24. Eur Spine J. 1995;4(6):366-7.
First thoracic disc herniation with myelopathy.
Nakahara S, Sato T.
Department of Orthopaedic Surgery, Okayama University
Medical School, Japan.
• The case of a patient with progressive
paraparesis due to first thoracic disc
herniation is reported. He was treated
successfully with anterior interbody fusion by
the Smith-Robinson approach.
• An anterior approach is desirable for surgical
treatment of T1/2 disc herniation, and up to
this level the Smith-Robinson approach,
without thoracotomy, is entirely possible.
25. Awwad EE, Martin DS, Smith KR Jr, et al:
Asymptomatic versus symptomatic herniated thoracic
discs: their frequency and characteristics as detected by
computed tomography after myelography.
Neurosurgery 28:180–186, 1991
• Awwad, et al., in a retrospective review they
compared myelography studies obtained in
68 patients harboring asymptomatic
herniated thoracic discs with those obtained
in five patients harboring symptomatic
thoracic herniated discs.
26. References
• Rossitti S, Stephensen H, Ekholm S, von Essen C. The anterior
approach to high thoracic (T1-T2) disc herniation. Br J Neurosurg
1993; 7:189-192.
• Winter RB, Siebert R. Herniated thoracic disc at T1-T2 with
paraparesis. Transthoracic excision and fusion - case report with 4-
year follow-up. Spine 1993; 18:782-784.
• Hamlyn PJ, Zeital T, King TT. Protrusion of the first thoracic disc.
Surg Neurol 1991; 35:329-331.
• Korovessis PG, Stamatakis M, Michael A, Baikousis A. Three-level
thoracic disc herniation: case report and review of the literature.
Eur Spine J 1997; 6:74-76.
• Kumar R, Buckley TF. First thoracic disc protrusion. Spine 1986;
11:499-501.
• Morgan H. Abood C. Disc herniation at T1-2. J Neurosurg 1998; 88:
148-150.
27. References
• Gelch MM. Herniated thoracic disc at T1-2 level associated with
Horner.s syndrome. Case report. J Neurosurg 1978; 48:128-130.
• Hammon WM. Extruded upper thoracic disc causing Horner.s
syndrome. Report of a case. Med Ann Dist Columbia 1968; 37:541-
542.
• Lloyd TV, Johnson JC, Paul DJ, et al. Horner.s syndome secondary to
herniated disc at T1-T2. AJR Am J Roentgenol 1980;134:184-185.
• Sharan AD, Przybylski GJ, Tartaglino L. Approaching the upper
thoracic vertebrae without sternotomy or thoracotomy: a
radiographic analysis with clinical application. Spine 2000;
• 25:1910-1916,
• Nakahara S, Sato T. First thoracic disc herniation with myelopathy.
Eur Spine J 1995, 4:366-367
28. DISCLAIMER
Information contained and transmitted by this presentation is
based on personal experience and collection of cases at
Choithram Hospital & Research centre, Indore, India, during
last 32 years. It is intended for use only by the students of
orthopaedic surgery. Views and opinion expressed in this
presentation are personal opinion. Depending upon the x-
rays and clinical presentations viewers can make their own
opinion. For any confusion please contact the sole author for
clarification. Every body is allowed to copy or download and
use the material best suited to him. I am not responsible for
any controversies arise out of this presentation. There is no
direct or indirect involvement of finances in preparation of
this presentation. For any correction or suggestion please
contact naneria@yahoo.com