Tests such as Tinel sign at carpal/cubital tunnel, elbow flexion test, ulnar nerve compression test, Phalen test, and/or Durkan test are helpful. It can range from a mild pain that feels tender when touched to a sharp or burning pain. A report of five cases. The support that the rib cage provides to the thoracic spine means it experiences less wear and tear than the other segments of the spine, making it less likely for the thoracic segment to develop thoracic herniated discs and other conditions. Federal government websites often end in .gov or .mil. T1-T2 disc herniation: Report of four cases and review of the Watch: Thoracic Herniated Disc Video An accurate diagnosis and timely surgical intervention may provide the patient the best chance for regression of symptoms and a satisfactory outcome. Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. 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. AJR Am J Roentgenol. A magnetic resonance imaging scan revealed a large focal paracentral herniated disc at the T2-3 level. (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. To keep your spine neutral and avoid putting pressure on any herniated discs, place a small pillow under your head and knees. Spine (Phila Pa 1976). Disc herniation can occur in the cervical, thoracic, or lumbar spine. For the fourth patient, the sequestrated disc disappeared 5 months later [Figures 4c and d ]. Adults, 2019. NCHS Data Brief, Number 415,July 2021, July 2021. An official website of the United States government. If the disc is severely degenerated, bone spurs can form and limit the mobility of the thoracic spine. Med Ann Dist Columbia. We added our cases (four cases) of T1T2 disc herniations to those 32 cases found in the literature. 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. Protrusion of the first thoracic disk. one or two days) and activity modification (eliminating the activities and positions that worsen or cause the thoracic back pain). Symptoms of thoracolumbar junction disc herniation. (e) Axial CT scan shows a pedicle screw in an upper thoracic vertebra. These disc problems in thoracic region remains silent in most of the case. 6: s-0036, 29. t1-2 disc herniation. 30: E305-10, 24. government site. J Neurosurg Spine. Gokcen HB, Erdogan S, Gumussuyu G, Ozturk S, Ozturk C. A rare case of T1-2 thoracic disc herniation mimicking cervical radiculopathy. The authors certify that they have obtained all appropriate patient consent forms. (f) Postoperative T1-weighted MRI, at 3-year follow-up, note clearance of the cord. 2022 Jan;212:107062. doi: 10.1016/j.clineuro.2021.107062. Despite having a long learning curve, the surgical technique described herein can be even used in patients with complex and calcified thoracic disc herniations. J Neurosurg. [ 3 , 6 , 19 , 28 , 30 , 34 ] Most thoracic disc herniations occur below the T8 level, and the majority are found at T11T12. A herniated thoracic disc is considered giant if it obstructs more than 50% of the central canal of the spine . by the American Academy of Orthopaedic Surgeons. Medications, traction, dry needling, and epidural spinal injections can be used with physical therapy to help manage pain and allow the body to heal on its own, says Dr. Good. 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. Abbott KH, Retter RH. Physical examination revealed pain in the left upper paraspinal and scapular region radiating to the left shoulder with mild improvement of the pain with abduction of the left shoulder above the head. Natalie Evenson MSN, BSN, RN is a health content writer. 1983. J Neurosurg 1998;88:623-633. A case of the patient with severe neurological deficits, caused by intradural thoracic disc herniation at T1-T2 interspace, which required surgical treatment and the symptoms were relieved immediately after surgery. Surg Neurol. Degenerative changes of the spine is the same condition as spinal osteoarthritis, spondylosis and degenerative disk disease. 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. Most studies report improvement in pain and neurologic dysfunction, but Horner syndrome can be refractory to surgical decompression.12,18 Similarly, our patient at 6 weeks postoperative had resolution of his pain, motor, and sensory deficits but persistent Horner syndrome at nine months postoperatively. 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 PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Gille O, Razafimahandry HJ, Sderlund C, Gangnet N, Vital JM. But not in case of T1-T2 slip disc. Vaidya Ji is well known for his specialisation in Ayurvedic treatment of different ailments. Br J Neurosurg. These degenerative changes are more likely to happen in your neck and lower back than your upper and middle back . J Glob Spine J. For more information, please refer to our Privacy Policy. T1-2 disk herniation diagnosis is often delayed because of its prevalence and misdiagnosis. your express consent. (Ayurveda) doctor. Sympathetic fibers in the posterolateral hypothalamus pass through the lateral brain stem and synapse at the ciliospinal Center of Budge in the intermediolateral gray substance of the spinal cord at C8 to T2. This study can distinguish calcified disk herniations, which may lead to modified treatment strategies and surgical approach.3 The T1 nerve root supplies the ulnar nerve with C8 at a root level, the medial pectoral, medial brachial cutaneous, the medial antebrachial cutaneous nerves at a cord level, and the first intercostal nerve. Approximately 75% of all thoracic disc herniations are seen below T8. : T1 radiculopathy caused by intervertebral disc herniation: Symptomatic and neurological features. Background:Symptomatic T1T2 disc herniations are rare and, in most cases, are located posterolaterally. Keywords: Disc herniation, spontaneous resolution, sternal splitting approach, T1T2 disc space, thoracic disc, upper thoracic disc herniation. It can also occur with ligamentous laxity in response to loading. Pinched Nerve Symptoms & More - FREE MRI Review Cases 3 and 4, respectively exhibited, a Brown-Sequard syndrome and radiculopathy alone. In this article, we reviewed these 32 prior cases of T1T2 disc herniations and added our four cases. 6: 1-10, 2. The thoracic spine is surrounded by the rib cage and it is much harder to damage the spinal cord in this area. Hann EC. i have a t1-2 herniated disc pinching a nerve, possible thoracic outlet. J Neurosurg. Hammon WM. Where. J Neurosurg. Kumar R, Buckley TF. J Neurosurg 1998;88:148-150. Thoracic Disc Degeneration - Spine Care | UCLA Health to maintaining your privacy and will not share your personal information without J Orthop Sci 2009;14:103-106. I've been in excruciating pain in the right shoulder and throughout the arm and hand for months. 1954. Therefore an MRI scan is important to find our the proper cause behind the problem. Your message has been successfully sent to your colleague. J Bone Joint Surg Am 1983;65:992-997. 2). T2 sagittal and axial MR images with T1-T2 disk herniation (arrows). But they can happen. This is possible through panchakarma procedures and Rasyana therapies later on. We present a rare case of a patient with T1-T2 intervertebral disk herniation and Horner syndrome who was treated surgically. 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. (d) Axial T2-weighted axial view also confirms disappearance of the disc. -, Bransford R, Zhang F, Bellabarba C, Konodi M, Chapman JR. If youre between the ages of 30 and 50, youre more likely to be affected. Maloney WF, Younge BR, Moyer NJ: Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. Careers. Dydyk, Alexander M, Ruben Ngnitewe Massa, and Fassil B Mesfin. (f) Postoperative T1-weighted MRI, at 3-year follow-up, note clearance of the cord. Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. Thoracic Disc Herniation Treatment | Spine-health J Neurol Neurosurg Psychiatry. It is causing burning/tingling up my neck to my ear and jaw area. Bethesda, MD 20894, Web Policies She has 24 years of experience in various areas, including Trauma, Neuro, Orthopedics, Critical Care, Emergency and Perioperative nursing. 2003. Background: The authors conducted a 2-year retrospective follow-up to investigate the efficiency of an extraforaminal full-endoscopic approach with foraminoplasty used to treat lateral compressive diseases of the lumbar spine in 247 patients. Correlating history, examination, and imaging will guide toward a successful diagnosis. Compression fractures are especially common in the lower thoracic area, and they often result from osteoporosis and mild trauma. 2. The patient was then discharged from the emergency center with oral methylprednisolone and follow-up with an orthopaedic spine surgeon. Vaidya Dr. Pardeep does it according to the scientific principles of Ayurveda. Symptoms Thoracic disc degeneration can be a cause of upper or mid back pain. Patients with upper extremity radicular pain/paresthesias are often sent for radiographs and MRI. Movement the blood supply to the disc is interrupted it causes the desiccation of the disc. Herniated discs in the thoracic region account for less than 1 percent of all herniated discs. While the diagnosed problems at the C7-T1 level are less common,2 research suggests that CTJ injuries may be missed during due to difficulties in visualizing this region on plain X-Ray films.3 A few conditions that may affect the CTJ are: In severe cases, CTJ injuries may affect the spinal cord or the C8 nerve roots. Use the Previous and Next buttons to navigate three slides at a time, or the slide dot buttons at the end to jump three slides at a time. On which side the compression is more symptoms will be according to that. This was excised utilizing a transfacet pedicle-sparing left-sided approach with left-sided T1T3 pedicle screw fixation to avoid instability [ Figure 3 ]. When the inner core of the disc when stops getting proper nutrition, than it starts decaying further. Management of Thoracic Disc Herniations via Posterior Unilateral Modified Transfacet Pedicle-Sparing Decompression With Segmental Instrumentation and Interbody Fusion. 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. The T1-T2 interspace is not fully visualized on a cervical MRI; therefore, a thoracic MRI scan can be helpful. Under his, Cost effective alternative for spinal surgery. (b) Sagittal, (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up., MeSH (f) After placement of peek cage, note brachiocephalic vein at lower border of the scene. (b) Axial view shows the posterolaterally located disc is on the left side. Please enable it to take advantage of the complete set of features! Publication types Case Reports Signs and Symptoms of a T1-T2 Herniated Nucleus Pulposis in the Literature (n = 21) Case 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. So the treatment is dependent on the following parameters-. The video can be found here1). All surgically treated patients recovered fully. A standard posterior approach with laminoforaminotomy and diskectomy was done. Caner H, Kilinoglu BF, Benli S, Altinrs N, Bavbek M. Magnetic resonance image findings and surgical considerations in T1-2 disc herniation. Croat Med J. Required fields are marked *. National Library of Medicine 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. Global Spine J. High thoracic disc herniation. Arbit E. A surgical approach through the pedicle to protruded thoracic discs. In one case, a central disc fragment extended through the dura. 6: 199-202. With cervical disc herniations, the nerve affected by the condition is the one that exits at that specific level of the spine. Save my name, email, and website in this browser for the next time I comment. Myeloradiculopathy: C8 and T1 radiculopathy - ScienceDirect Hoffman's sign was negative. [ 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). Excruciating pain from cervical (C7/T1) radiculopathy BMJ Case Rep. 2014 Jun 5;2014:bcr2014204820. Disc herniation at T1-2 in: Journal of Neurosurgery Volume 88 - jns 12: 221-31, 5. t1-2 disc herniation - Neurology - MedHelp Case Description:Here, we reviewed four cases of symptomatic T1T2 disc herniations; two patients were paraparetic due to central discs and underwent anterior surgery utilizing a cage construct. HHS Vulnerability Disclosure, Help 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. 37: 541-2, 12. Although . Intradural disc herniation at the T1-T2 level. | Semantic Scholar The symptoms of T1-T2 slip disc are-. Thanks to the rigidity of the thoracic spine and the size of thoracic vertebrae, a thoracic herniated disc is a lot less likely to happen than a lumbar (lower back) or cervical (neck) herniated disc. The incidence of a herniated disc may disrupt activities of daily living and sleep. Evid Based Spine Care J 2010;1:21-28. The majority of herniated thoracic discs are diagnosed and treated before they progress to even partial paralysis. There might be some other reasons like- some addiction or something like this, that causes the desiccation of the T1-T2 disc. Recommended Reading: Heart Disease Symptoms In Dogs. 2002. Spine (Phila Pa 1976). AJR Am J Roentgenol 1980;134:184-185. Krasnianski M, Georgiadis D, Grehl H, Lindner A: Correlation of clinical and magnetic resonance imaging findings in patients with brainstem infarction. 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. Informed consent to present the data concerning the case for publication was obtained by the patient. [ 15 ] Patients with thoracic discs typically present with neck pain (i.e. 1998 Jan;88(1):148-50. doi: 10.3171/jns.1998.88.1.0148. Here, we reviewed four cases of symptomatic T1-T2 disc herniations; two patients were paraparetic due to central discs and underwent anterior surgery utilizing a cage construct. Both were approached anteriorly with low cervical-suprasternal approaches and accompanied by cage application. 2012. Careers. (b) Axial view showing the central location of the disc. Sharan AD, Przybylski GJ, Tartaglino L. Approaching the upper thoracic vertebrae without sternotomy or thoracotomy:A radiographic analysis with clinical application. Osteoarthritis appeared to be the predominant cause of the disc herniation in both patients. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. 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. Disc herniation at T1-2. Posterior-only approach for the treatment of symptomatic central thoracic disc herniation regardless of calcification: A consecutive case series of 30 cases over five years. Thoracic spinal cord injuries are typically less severe than injuries to the cervical spinal cord. 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). . Epub 2013 Aug 16. (e) Intraoperative clearance of the disc space from both hard disc and osteophytes. Follow-up magnetic resonance studies documented full resolution for the patient with radiculopathy and a posterolateral disc. Br J Neurosurg 1993;7:189-192. Disclaimer. There will be pain in the front side of Arm Pit. The annular tear can be confirmed with a discogram followed with a CT scan. 8. It is important to understand the symptoms, causes, and treatments for a bulging disc to prevent the condition from worsening. J Neurosurg Spine. 2002. Numbness or tingling. (e) Showing removal of the sequestrated disc fragment. 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. A working differential diagnosis can guide management. All rights reserved. 2001 Nov 15;26(22):E512-8. Herniated thoracic disc at T1-2 level associated with horner's syndrome. 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. The site is secure. Although posterior approach surgery is most commonly used for laminectomy and/or foraminotomy, successful anterior approaches to upper thoracic lesions are valid as well. Glaser J. Neuro-Ophthalmology, ed 1. The spurs may cause narrowing of the spinal canal and impinge on the spinal cord. The rest of the postganglionic fibers travel along the internal carotid artery and enter the cavernous sinus. Most people respond well to non-operative or conservative treatment. (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. 30: 152-4, 6. (e) Intraoperative clearance of the disc space from both hard disc and osteophytes. 14. Radiating pain may be perceived to be in the chest or belly, and this leads to a quite different diagnosis that will need to include an assessment of heart, lung, kidney and gastrointestinal disorders as well as other non-spine musculoskeletal causes. 84-A: 1013-7, 21. The site is secure. According to Dr. Good, here are some healthy habits you can build that will help keep your discs healthy. She underwent T1-T2 anterior discectomy and fusion. [ 1 , 2 , 4 , 5 , 7 , 8 , 11 - 15 , 17 , 18 , 25 , 26 , 29 , 32 , 33 , 35 - 37 ] T1T2 disc herniation can present with either radiculopathy or myelopathy. Symptoms characteristic of T1 disk herniation can often overlap with other maladies. Follow-up magnetic resonance studies documented full resolution for the patient with radiculopathy and a posterolateral disc. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. Winter RB, Siebert R. Herniated thoracic disc at T1-T2 with paraparesis. 1, 3, 4, 5 Although uncommon, T1-T2 disk herniation should be suspected if a patient presents with Horner syndrome and upper extremity pain. 34: 68-77, 7. Case report. The rest of the postganglionic fibers travel along the internal carotid artery and enter the cavernous sinus. and transmitted securely. However, it is most common in men between the ages of 40 and 60. Along with this when we work with pronated shoulders and fixed neck- chances of problem with D1-D2 disc increases in same frequency. The main concept ofAyurvedic treatment of T1-T2 slip disc problem is based on the cause of the problem. 2017 Sep;7(6):506-513. doi: 10.1177/2192568217694140. The fourth patient had an MR left-sided laterally located extruded disc at the T1T2 level managed nonsurgically [ Figure 4a and b ]. The thoracic region, which has more vertebrae than any other part of the spine, is the least-mobile region of the spine and therefore the least susceptible to disc herniation. Christopher Good, MD, FACS President of Virginia Spine Institute, https://www.barrowneuro.org/condition/thoracic-disc-herniation/, https://doi.org/10.1016/j.otsr.2017.04.022, https://www.ncbi.nlm.nih.gov/books/NBK441822/, https://www.choosept.com/guide/physical-therapy-guide-herniated-disk, https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Low-Back-Pain, https://www.cdc.gov/nchs/data/databriefs/db415-H.pdf, https://doi.org/10.1302/2058-5241.6.210020, Upper Back Pain Causes, Risk Factors, Diagnosis and Treatment, Spondylosis Symptoms, Causes, Diagnosis and Treatment, 7 Lower Back Pain Causes That Affect Women, Muscle Relaxants for Back Pain and Neck Pain, Herniated Disc: Symptoms, Causes, Diagnosis, and Treatment. Horner's syndrome secondary to intervertebral disc herniation at the level of T1-2. 1971. 15: 227-41, 20. Please try again soon. To complicate matters, sometimes fragments from the annulus may break away from the parent disc and drift into the spinal canal. Also, if the branch of the thoracic nerve going toward the back becomes inflamed, pain and other symptoms could be felt in the back at or near the location of the inflammation. Introduction. Among these diseases To set the slipped disc to normal is one. For the former patient, cervicothoracic MRI showed a left centro-laterally disc at the T1T2 level. However, the onset of paralysis in this condition is gradual. Therefore, if the C6-C7 level has a herniation, then it is the C7 nerve that will be affected. 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. Thoracic disc herniations make up 0.25%0.75% of all disc ruptures. 88: 148-50, 22. 1968. 2010. He is the founder of the Sukhayu Ayurved and working with patients clinically since last 15 years. Fortschr Neurol Psychiatr 2001;69:236-241. Apply an ice pack or cold compress to the affected area for 15- to 20-minute intervals every two hours. The main symptoms of lumbar disc herniation would radiate based on the location of the disc herniation . Drawing showing the anatomy of the oculosympathetic pathway. T2-3 Thoracic disc herniation with myelopathy - PubMed Vaidya Dr. Pardeep Sharma is Chief Ayurvedic Physician at Sukhayu Ayurved Jaipur. The .gov means its official. Biousse V, Touboul PJ, D'Anglejan-Chatillon J, Levy C, Schaison M, Bousser MG: Ophthalmologic manifestations of internal carotid artery dissection. Two of the most common causes of thoracic radiculopathy are from compression caused by a herniated disc or from a narrowing of the spinal foramen, an opening through which these nerves pass. (h) Postoperative T2-weighted MRI: showing appropriate decompression of the spinal cord at T1T2 level. 24-Apr-2019;10:56, How to cite this URL: Abolfazl Rahimizadeh, Amir Hossein Zohrevand, Nima Mohseni Kabir, Naser Asgari. 2016 May;25 Suppl 1:204-8. doi: 10.1007/s00586-016-4402-y. Thoracic Disc Herniation: Surgical Treatment.. Epub 2016 Jan 28. Herniated discs happen when the soft, jellylike inner layer of a shock-absorbing intervertebral disc bulges into or breaks through the discs tough outer layer. If there is some deformity behind T1-T2 slip disc than we aim to restore the kyphotic changes. Would you like email updates of new search results? 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. Morgan H, Abood C. Disc herniation at T1-2. 2010 Feb;12(2):221-31. doi: 10.3171/2009.9.SPINE09476. 2014: 34. Delineating the location of nerve compression begins with assessing sites of peripheral compression with physical examination. If the lower thoracic region is involved, a patient may encounter pain radiating to one or both lower extremities. 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. Posted by mlerin @mlerin, Nov 4, 2019. Asian Spine Journal, 2012 (evidence level 3A) T2 radiculopathy: A differential screen for upper extremity radicular pain. The third patient undergoing a transfacet pedicle-sparing left-sided approach had a postoperative three-dimensional computed tomography scans showing adequate root decompression and screw placement screws [Figures 3e and d ]. Horner syndrome with associated T1 weakness and paresthesias is representative of many etiologies (Table 2). Dont Miss: Group B Strep Pregnancy Symptoms. Degenerative disease and trauma are the most common causes of herniated discs in the thoracic spine. (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. BMJ Case Rep. 2014. J Neurosurg Spine. 9. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. Anterior approaches are useful, but more involved. Correspondence Address:Naser AsgariPars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran, How to cite this article: Abolfazl Rahimizadeh, Amir Hossein Zohrevand, Nima Mohseni Kabir, Naser Asgari. (c) Reconstructed sagittal computed tomography (CT) scan of the CT region showing T1T2 hard disc, indicating that the compression, also note that CT angle is 10. Some common signs and symptoms of a cervical herniated disc include: Neck pain. Epub 2017 Apr 6. Svien HJ, Karavitis AL: Multiple protrusions of intervertebral disks in the upper thoracic region: Report of case. There will be pain in the front side of Arm Pit. doi: 10.1097/00007632-200111150-00021. Nonsurgical treatments are usually tried first to treat CTJ injuries. Bulge is a term for an image and can be a normal variant . 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. She also works as an Adult and Pediatric Sexual Assault Nurse Examiner. Data is temporarily unavailable. The fibers ascend and synapse at the superior cervical ganglia at the level of the bifurcation of the common carotid artery (C3-C4).