The first reported case was in 1945; since then, only 31 additional cases have been published. Drawing showing the anatomy of the oculosympathetic pathway. Keachie K, Shahlaie K, Muizelaar JP. (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. Read Also: Attention Deficit Hyperactivity Disorder Symptoms, Neck Pain, Cervical Disc Herniation & Radiculopathy-Everything You Need To Know Dr. Nabil Ebraheim, Herniated Disc Symptoms, (All You Need To Know To Cure), L3 Herniated Disc/Nerve Root Compression Evaluation, Attention Deficit Hyperactivity Disorder Symptoms, Symptoms Of Ovarian Cysts After Hysterectomy, Magnetic resonance imaging is the best tool for observing and diagnosing problems with intervertebral discs, Other Imaging tests, such as X-ray or computed tomography may be used, but are not as accurate as MRI in diagnosing a herniated thoracic disc, Myelography, which involves injecting dye into the space around your spinal cord and taking X-ray or CT images to identify any narrowing in the spinal canal, Medical history to identify any accidents, pre-existing conditions, or trauma that may have caused an injury to your spine, Physical examination to record the type, severity, and location of your pain or other symptoms and draw conclusions about their cause, Sacrum, where the spine connects to the hips. J Neurosurg. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. This pain is typically felt toward the back or side of the neck. (b) Sagittal cervical fat saturated MRI shows the same. Thoracic herniated discs are less common than herniated discs in the neck or low back, but they do happen. 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 the disc is severely degenerated, bone spurs can form and limit the mobility of the thoracic spine. 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. On examination, she had lower extremity hyperreflexia, an abnormal gait, and lower lumbar pain but lacked any radicular findings. Herniated discs in the thoracic spine have a tendency to become calcified, also known as hard disc herniation. Most people respond well to non-operative or conservative treatment. Surgery for T1T2 posterolateral herniated discs may require transfacet pedicle-sparing decompression with pedicle screw fixation. Six weeks after surgery, the patient had complete resolution of his left-hand weakness and paresthesias, zero back pain, and some significant improvement in the ptosis and miosis (Figure 1, B). Regular exercise and strengthening the core abdominal muscles will help stabilize the spine. Proc Staff Meet Mayo Clin. CT can be used to complement MRI in cases of thoracic disk herniations. The symptoms of T1-T2 slip disc are- Pain just below the spine of the scapula. Patients with cervical radiculopathy symptoms and physical examination findings consistent with Horner syndrome should be evaluated with a MRI that includes the upper thoracic spine. Because your thoracic spine is much more rigid and stable, your thoracic spinal area is much less frequently injured than your lumbar and cervical spine. There will be pain in the front side of Arm Pit. Thoracic disc herniations make up 0.25%0.75% of all disc ruptures. An official website of the United States government. 2003. 1993. Background: T1-T2 intervertebral disc prolapse (IVDP) is a rare clinical condition.Horner's syndrome is an extremely rare clinical finding in these patients. The one interesting aspect about a bulge is that it is an MRI finding that can correlate with an annular tear that causes deep midline low back pain. When the pressure is increasing with the time and jelly starts moving towards the periphery of the disc, it causes several symptoms according the compression on the nerve roots. Thoracic disc herniations are rare conditions compared with other disc herniations seen at cervical and lumbar spine levels. Spine J 2014;14:1654-1662. Save my name, email, and website in this browser for the next time I comment. 8600 Rockville Pike Abbott KH, Retter RH. Thus if there are some brachial plexus injuries on lower side there will be impact on the same nerve root and its supply too. Hoffman's sign was negative. (f) Postoperative T1-weighted MRI, at 3-year follow-up, note clearance of the cord. The tough outer layer (annulus fibrosus) loses elasticity with age, increasing the risk of tears that can result in herniation. Preganglionic sympathetic neurons exit the spinal cord and ascend up the carotid sheath to the superior cervical ganglion at the level of the bifurcation of the common carotid artery. In one case, a central disc fragment extended through the dura. Dont Miss: Group B Strep Pregnancy Symptoms. Follow-up magnetic resonance studies documented full resolution for the patient with radiculopathy and a posterolateral disc. 2002. Overall outcomes for T1 disk herniations treated surgically are favorable. This is disc herniation. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. 2010;12:22131. The most common areas to have a herniated disc are the cervical and lumbar areas of the spine. New left-sided partial ptosis and pupillary miosis were found on facial examination (Figure 1, A). Gelch MM: Herniated thoracic disc at T1-2 level associated with Horner's syndrome: Case report. Symptomatic T1-T2 disc herniations are rare and, in most cases, are located posterolaterally. Arseni C, Nash F. Thoracic intervertebral disc protrusion:A clinical study. 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. Numbness or tingling in areas of one or both legs. The symptoms of T1-T2 slip disc depends on the severity of the problem. (f) After placement of a large cage. Herniated Discs: When Is Surgery Necessary?. Disk herniation at T1/T2 can compress the preganglionic fibers of the oculosympathetic pathway causing the classic Horner syndrome presentation of enopthalmos, miosis, blepharoptosis, and facial anhidrosis5,8,9 (Figure 3). Specifically, T1 nerve root compression presents with specific signs and symptoms. 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. government site. (e) Axial CT scan shows a pedicle screw in an upper thoracic vertebra. 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. He completed that match and 1 additional match that day with mild symptoms. The symptoms of T1-T2 slip disc are-. This is possible through panchakarma procedures and Rasyana therapies later on. Movement the blood supply to the disc is interrupted it causes the desiccation of the disc. Outcomes were based on the modified JOA scores for the three patients with thoracic myelopathy and their scores were 10, 11, and 11, respectively, while the visual analog scale for the fourth patient was 0. Before There will be pain in the front side of Arm Pit. The further down the spine the injury occurs, the greater chance for at least partial recovery. Dydyk, Alexander M, Ruben Ngnitewe Massa, and Fassil B Mesfin. Thoracic back pain may be exacerbated when coughing or sneezing. But not in case of T1-T2 slip disc. Would you like email updates of new search results? 12. Surg Neurol. 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. (e) Showing removal of the sequestrated disc fragment. Gokcen HB, Erdogan S, Gumussuyu G, Ozturk S, Ozturk C. A rare case of T1-2 thoracic disc herniation mimicking cervical radiculopathy. Please try again soon. 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. Please enable it to take advantage of the complete set of features! 12: 303-5, 31. Available from: http://surgicalneurologyint.com/surgicalint-articles/9301/. Protrusion of the first thoracic disk. 1980. Hagerstown, MD, Harper & Row, 1978. Massage and acupuncture can be useful in managing pain.
Postfixed brachial plexus radiculopathy due to thoracic disc herniation If any of the thoracic nerves become inflamed, such as from a thoracic herniated disc or a narrowing of the foramen, thoracic radiculopathy can develop with symptoms of pain, tingling, numbness, and/or weakness radiating along the nerve root. Sitting in chairs with a firm back to support the spine will help alleviate back pain. Left upper extremity motor was 5/5 in all myotomes except 4/5 finger abduction. Rahimizadeh A, Saghri M. Spontaneous resolution of sequestrated lumbar disc herniation:A prospective cohort study. A spine surgeon or spinal neurosurgeon can assess your herniated thoracic disc and help you decide if it would be best to have surgery or to try conservative treatment. Dont Miss: Hsv-2 Low Positive No Symptoms, A 65-year-old female patient underwent a transthoracicendoscopic approach to remove a calcified thoracic disc herniation that caused spinal cord compression. 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. It can also occur with ligamentous laxity in response to loading. Successful Smith-Robinson approaches to T1-T2 have been achieved, whereas partial sternotomy has been used in others.9,14 Thoracic disk herniations can be approached posteriorly when little to no retraction of the spinal cord is necessary for disk access. Introduction. Abbott KH, Retter RH. The 2023 edition of ICD-10-CM M51.24 became effective on October 1, 2022. In this condition we work on the posture of the shoulders and neck all together. We reviewed 4 cervical T1-T2 disc herniations; two central/anterolateral lesions warranting anterior surgical approaches/cages, and 2 lateral discs treated with a posterolateral transfacet, pedicle-sparing procedure and no surgery respectively. 1960;17:41830. If the disc herniates into the spinal cord area, the thoracic herniated disk may also present with myelopathy . See this image and copyright information in PMC. J Neurosurg Spine. 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. Symptomatic thoracic disc herniation is uncommon and has been estimated to less than 0.75% of all symptomatic spinal disc herniations. Conclusions: We reviewed 4 cervical T1-T2 disc herniations; two central/anterolateral lesions warranting anterior surgical approaches/cages, and 2 lateral discs treated with a posterolateral transfacet, pedicle-sparing procedure and no surgery respectively. (a) T2-weighted sagittal magnetic resonance imaging (MRI) shows T1T2 disc herniation. A report of five cases. 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). All but five intrinsic hand muscles are innervated by the ulnar nerve; abductor pollicus brevis, flexor pollicis brevis, opponens pollicis, and lateral lumbricals. 1952. Patterson RH. Negoveti L, Cerina V, Sajko T, Glavi Z. Intradural disc herniation at the T1-T2 level. Your message has been successfully sent to your colleague. 13. These all symptoms always confuse before the proper diagnosis of slip disc in D1-D2. Case Description: A 56-year-old man presented with the left C8 T1 radiculopathy, left hand grip weakness, and ipsilateral Horner's syndrome.Magnetic resonance imaging of the spine showed a contrast-enhancing lesion in the left T1 . The symptoms began as dull back pain, which the patient initially attributed to a muscle strain, but progressively worsened throughout a 24-hour period. Osteoarthritis appeared to be the predominant cause of the disc herniation in both patients. They occur when a vertebra in your spine collapses, which can lead to severe pain, deformity and loss of height. When Natalie is not working, you can find her gardening and taking care of her animals on her mini farm. When there is a change in the consistency of the jelly of disc, this falls under condition of slip disc or disc protrusion. MRI diagnosis is C7/T1 and C6-C7 severe foraminal narrowing and stenosis. 1983. J Neurosurg 1998;88:148-150. 7. 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. Thoracic Disc Herniation Symptoms Watch: Thoracic Herniated Disc Video 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. Central disk herniations or those that compromise up to 50% across the disk space are often approached through an anterior approach as effective decompression cannot be completed from a posterior only approach. This narrows the space between your vertebrae, causing certain issues. Publication types Case Reports A large herniated disc can compress the spinal cord within the spinal canala condition called myelopathyresulting in numbness, tingling, and or weakness in one or both lower extremities, and sometimes bowel and bladder dysfunction, and in extreme cases, paralysis. There is no medicine or procedure to reverse the process of ageing. This is the least common location for radiculopathy. He is an M.D. Herniated thoracic disc at T1-2 level associated with horner's syndrome. Because in this case, a patient might get back all those symptoms of T1-T2 slip disc come back again. However, it is most common in men between the ages of 40 and 60. MRI best documents soft T1T2 thoracic discs, while computed tomography is typically optimal for calcified herniations. 2021 Mar 17;12:108. doi: 10.25259/SNI_941_2020. If the herniation occurs in the neck, for example, it can cause pain that radiates into the shoulder and arm; if it occurs in the lower back, the pain produced can radiate down into the hip and leg. When we discuss about D1-D2 disc problem or T1-T2 disc problem, symptoms are more like- cervical disc herniation. (g) Post-operative CT AP X-ray: shows the cage in T1T2 disc space. 1. J Neurosurg 1978;48:128-130.
Thoracic Disc Herniation - What You Need to Know - Drugs.com Son ES, Lee SH, Park SY, Kim KT, Kang CH, Cho SW: Surgical treatment of t1-2 disc herniation with t1 radiculopathy: A case report with review of the literature. Son ES, Lee SH, Park SY, Kim KT, Kang CH, Cho SW. Surgical treatment of t1-2 disc herniation with t1 radiculopathy:A case report with review of the literature. The site is secure. Learn more by subscribing now. Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. Glaser J. Neuro-Ophthalmology, ed 1. The patient was then discharged from the emergency center with oral methylprednisolone and follow-up with an orthopaedic spine surgeon. The most common symptom of a thoracic herniated disc is pain. T1-T2 disc herniation:Two cases. You will not be suddenly and completely paralyzed by a herniated thoracic disc. (d) Three-dimensional cervical computed tomography (CT) scan shows T1T2 and T3 screw rod fixation on the left side. Caner H, Kilinoglu BF, Benli S, Altinrs N, Bavbek M. Magnetic resonance image findings and surgical considerations in T1-2 disc herniation. This fact is most likely explained by the restricted mobility and facet orientation of the thoracic spine. Careful radiographic analysis is needed preoperatively to identify the upper limit of the sternum. The preganglionic fibers then exit the spinal cord and enter the cervical sympathetic chain. 14: 103-6, 15. Background: Symptomatic T1-T2 disc herniations are rare and, in most cases, are located posterolaterally. This pain might shoot into your arm or leg when you cough, sneeze or move into certain positions. 2001. 2005. HHS Vulnerability Disclosure, Help While the anterior approach tends to be a more familiar approach to most spine surgeons, certain anatomic restrictions may limit its use for T1-T2. [ 1 , 2 , 4 , 5 , 7 - 9 , 11 - 15 , 17 , 18 , 21 , 24 - 26 , 29 , 31 - 33 , 35 - 37 ]. may email you for journal alerts and information, but is committed
So that we can give the proper space to the disc and it can breathe normally and can remain its space. J Neurosurg. There might be some other reasons like- some addiction or something like this, that causes the desiccation of the T1-T2 disc. We present a rare case of a patient with T1-T2 intervertebral disk herniation and Horner syndrome who was treated surgically. All surgically treated patients recovered fully. Vaidya Dr. Pardeep does it according to the scientific principles of Ayurveda. Svien HJ, Karavitis AL. (g) Post-operative CT AP X-ray: shows the cage in T1T2 disc space. After literature review, 39 cases of T1-2 disk herniation were discovered.1 Only seven of these cases presented with an associated Horner syndrome (Table 1). 15: 227-41, 20. Objective: To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1-T2 disc herniation.
Excruciating pain from cervical (C7/T1) radiculopathy The symptoms of a herniated disc in the thoracic area usually include: Pain that travels around the body and into one or both legs. For the fourth patient, the sequestrated disc disappeared 5 months later [Figures 4c and d ]. sharing sensitive information, make sure youre on a federal The fibers ascend and synapse at the superior cervical ganglia at the level of the bifurcation of the common carotid artery (C3-C4).
Thoracic Radiculopathy - Physiopedia Summary of background data: Thoracolumbar junction disc herniations show a variety of signs and symptoms because of . 48: 128-30, 8. The fourth patient had an MR left-sided laterally located extruded disc at the T1T2 level managed nonsurgically [ Figure 4a and b ]. To keep your spine neutral and avoid putting pressure on any herniated discs, place a small pillow under your head and knees. Patients demographic data and common clinical features of the corresponding location at which they generate. T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. . This is a rarest condition in case of all thoracic discs, but can appear in this reason due to trauma. She underwent T1-T2 anterior discectomy and fusion. The video can be found here1). 25: 910-6, 32. The pain may be centered over the injured disc but may spread to one or both sides of the mid-back. Herniated Thoracic Disc. Barrow Neurological Institute, August 3, 2022. At 1-week postoperatively, he had near complete improvement in his left-hand strength with mild forearm paresthesias and persistent ptosis and miosis of the left eye. T1 motor root innervates the flexor digitorum superficialis, flexor pollicis longus, flexor pollicis longus, flexor digitorum profundus, lumbricals, interossei, and the pectoralis major. 2014: 34. Spine (Phila Pa 1976). MeSH 34: 68-77, 7. Spine (Phila Pa 1976). Because this nerve root is the part of the brachial plexus. Approximately 90% of herniated discs occur at L4-L5 and L5-S1, causing pain in the L5 or S1 nerve that radiates down the sciatic nerve. Clipboard, Search History, and several other advanced features are temporarily unavailable. Case description: As we all know there are only few chances of the disc problems in dorsal spine, because this area is fixed in comparison to the cervical spine and lumbar spine. 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. J Neurosurg. Spine (Phila Pa 1976). He is the founder of the Sukhayu Ayurved and working with patients clinically since last 15 years. 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. This clinical condition can commonly be a consequence of cervical sympathetic chain injury, which runs along the lateral aspect of the vertebral body. A modified anterior approach to the cervicothoracic junction with clavicle resection16 or combined cervicothoracic approach for diskectomy has proven useful as well.14,17. Management of Thoracic Disc Herniations via Posterior Unilateral Modified Transfacet Pedicle-Sparing Decompression With Segmental Instrumentation and Interbody Fusion. Pain just below the spine of the scapula. Keywords: You May Like: Parvo Symptoms In Older Dogs. Fortschr Neurol Psychiatr 2001;69:236-241. [ 6 , 20 , 22 , 23 , 27 , 34 ]. This site needs JavaScript to work properly. Surgical approaches to thoracic disk herniations correlate with patient anatomy, location of nerve root compression, and surgeon familiarity. It is causing burning/tingling up my neck to my ear and jaw area. Gelch MM. Background: A 23-year-old male collegiate wrestler injured his neck in a wrestling tournament match and experienced pain, weakness, and numbness in his left upper extremity. Pain is often described as sharp or burning. 33. Pain is the most common symptom of a thoracic herniated disc and may be isolated to the upper back or radiate in a dermatomal (single nerve root) pattern. The symptoms often follow a dermatomal distribution, . doi: 10.1136/bcr-2014-204820. Cervical radiographs are not usually clinically useful because of the difficulty in visualizing through the shoulders. Sebastian . 24-Apr-2019;10:56, How to cite this URL: Abolfazl Rahimizadeh, Amir Hossein Zohrevand, Nima Mohseni Kabir, Naser Asgari. Thoracic spinal cord injuries are typically less severe than injuries to the cervical spinal cord. 24-Apr-2019;10:56. This typically breaks down as such: Herniated discs are very common, but they usually occur in the lumbar spine as opposed to the thoracic region. After confirming the diagnosis with MRI, the patient was treated with standard posterior approach with laminoforaminotomy and diskectomy. The thoracic spine is surrounded by the rib cage and it is much harder to damage the spinal cord in this area. T1-T2 slip disc or disc protrusion is a common word for all these conditions. Neurology. AJR Am J Roentgenol. Under his, Cost effective alternative for spinal surgery. FOIA 2016. We focused on the clinical presentation, e.g. one or two days) and activity modification (eliminating the activities and positions that worsen or cause the thoracic back pain). Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. With cervical disc herniations, the nerve affected by the condition is the one that exits at that specific level of the spine. Accessibility Magnetic resonance imaging revealed a left-sided T1-T2 herniated disc compressing the T1 nerve root. (d) Chest X-ray shows that T1T2 disc is a few mm above the manubrium. Again, the specific symptoms of a cervical herniated disc will depend on the affected pinched nerves. For example, you may feel pain in your neck, arms, hands, fingers, or parts of the shoulder. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. Objectives: To evaluate the clinical features of thoracolumbar junction disc herniation and to prepare a chart for the level diagnosis in the neurologic findings and symptoms. You May Like: Symptoms Of Hpa Axis Dysfunction. 1998. The authors certify that they have obtained all appropriate patient consent forms. Correlating history, examination, and imaging will guide toward a successful diagnosis. (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. The spurs may cause narrowing of the spinal canal and impinge on the spinal cord. BMJ Case Rep. 2014 Jun 5;2014:bcr2014204820. Spine (Phila Pa 1976). The majority of herniated thoracic discs are diagnosed and treated before they progress to even partial paralysis. 1998. 2010 Feb;12(2):221-31. doi: 10.3171/2009.9.SPINE09476. The location of the pain depends on the location of the herniated disc. Int J Spine Surg. (b) Sagittal, (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up., MeSH Case report. Takagi H, Kawaguchi Y, Kanamori M, Abe Y, Kimura T. T1-2 disc herniation following an en bloc cervical laminoplasty.
Clinical Reasoning: Partial Horner syndrome and upper right limb Full-endoscopic discectomy for thoracic disc herniations: a single-arm [ 1 , 2 , 4 , 5 , 7 , 8 , 10 - 17 , 21 , 24 - 26 , 29 , 31 - 33 , 35 - 37 ] There were 24 males and 12 females averaging 49.1 years of age (range 2372 years of age) [ Table 2 ]. For the former patient, cervicothoracic MRI showed a left centro-laterally disc at the T1T2 level.
Grade 1 Cervical Spinal Stenosis: Causes Symptoms And Treatment 28: 322-30, 14. In simple terms, a disc bulge refers to an apparent generalized extension of disc tissues beyond the edges of the edge of vertebrae, usually less than 3mm. Informed consent to present the data concerning the case for publication was obtained by the patient. All rights reserved. Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. -, Arseni C, Nash F. Thoracic intervertebral disc protrusion:A clinical study. Lloyd TV, Johnson JC, Paul DJ, Hunt W. Horner's syndrome secondary to herniated disc at T1--T2. Conclusions: At his follow-up appointment, there was no improvement of his symptoms; therefore, the decision was made to intervene surgically given his persistent pain, weakness, and Horner syndrome. 2012. Non-surgical treatment options for symptoms of a thoracic herniated disc will typically include one or a combination of the following: A short period of rest (e.g. Diagnostic testing for herniated disk includes MRI, CT, myelography, and plain radiography, either alone or in different combinations, as the occasion demands.
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