Thoracic radiculopathy. MRI 사진을 동반한 진단과 이슈

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드물지만 한번만 이해하면 짱

흉추디스크는 드물기 때문에 흔히 간과. 

흉추디스크와 당뇨는 흔한 thoracic radiculopathy의 원인

Specific regions display a higher frequency of certain pathological conditions (personal correspondence from the IAOM study group):

• T1-T4: costovertebral joints> acute problem with the intervertebral disk> pathological ZAj.

• T5-T8: acute problem with the intervertebral disk> pathological ZAj > costovertebral joints.

• T9-T12: acute problem with the intervertebral disk> costovertebral joints > pathological ZAj.

- T1-T4 늑척추관절 > 급성흉추간판 문제 > 병리적 후관절

- T5-T8 급성흉추간판 문제 > 병리적 후관절 > 늑척추관절

- T9-T12 급성흉추간판 문제 > 늑척추관절 > 병리적 후관절

panic bird....

Thoracic radiculopathy 2002.pdf

Thoracic radiculopathy represents an uncommon spinal disorder that is frequently overlooked in the eval‎uation of spinal pain syndromes. Thoracic disc disease and diabetes mellitus represent two ofthe most frequent etiologies

for the development of thoracic radiculopathy. Advances in spinal imaging techniques as well as electrodiagnostic medicine have led to increased awareness ofthis disorder. 

Myelopathy often accompanies radiculopathy in the thoracic spine and is associated with increased morbidity,

necessitating prompt diagnosis and treatment. Percutaneous procedures appear to have an increasing role in managing thoracic spinal pain syndromes as well as radiculopathy. Despite recent advances in techniques, thoracic disc surgery remains a complicated procedure reserved for patients with unremitting symptoms or progressive neurologic compromise. 

This article will discuss some of the causes and morbidities associated with thoracic radicular syndromes, as well as the anatomical properties of the thoracic spine, which can make diagnosis and treatment ofthis disorder challenging.

정리) 

The spinal cord/canal ratio is approximately 40% in the thoracic spine compared with 25% in the cervical spine [4]. This theoretically places the spinal cord and neural segments of the thoracic spine at increased risk of injury from a space-occupying lesion (eg, herniated nucleus pulposus), vertebral fracture, or trauma in this region.

The primary movements ofthe thoracic spine are rotation and lateral bending [5]. There are approximately 6 of lateral bending and 8–9 of rotation present at each segment. The motions of flexion and extension (F/E) increase in degrees descending in the thoracic spine, with approximately 6 of F/E present in the middle thoracic spine and 12 of F/E present in the lower, transitional levels of the thoracic spine (T10–T12) [4].

The lower thoracic spine (T8–T12 levels) is the most frequent site of occurrence, with the T11–T12 interspace accounting for 26–50% of all thoracic herniations [10–12].

증상

The symptoms associated with thoracic disc herniation are variable and usually include radicular symptoms such as variable pain, parasthesias, dysesthesias, allodynia, and loss of sensation in a segmental distribution

across the anterior chest, thorax, and abdomen, depending on which nerve root(s) are affected.

For example, T4 radiculopathies usually radiate to the nipple level; T6, the xiphoid; and T10, the umbilicus. First thoracic radiculopathy (T1) radiates into the median arm or ulnar aspect of the hand [9,16, 45], and for our purposes will be covered in the cervical radiculopathy articles.

Physical examination is not a reliable way to diagnose thoracic radiculopathy. There may be localized spine and paraspinal tenderness, and sensory changes in a dermatomal pattern, but this is not universal. Unlike cervical

or lumbosacral radiculopathies, there is no reliable way to test for muscle weakness in a myotomal pattern.

The most serious of symptoms related to thoracic disc herniation and radiculopathy is the development of myelopathy. As in the cervical spine, thoracic myelopathy can result in irreversible neurologic dysfunction and threaten spinal cord tracts. It is often the result of spinal cord compression of a large central thoracic disc, a calcified thoracic HNP, or an intradural herniation [13,21]. Bladder dysfunction, a wide-based ataxic pattern of gait, and upper motor neuron signs such as positive Babinski sign, ankle clonus, and hyperreflexia should be sought for in a patient with suspected myelopathy.

Mild lower extremity paraparesis is the most common symptom associated with thoracic disc herniation with myelopathy [22].