(b) Axial view shows the posterolaterally located disc is on the left side. Surg Neurol. According to the American Association of Neurological Surgeons, about 75 - 85% of people in the U.S. suffer from back pain at some point in their lifetime. As people age, their thoracic intervertebral discs may lose their cushioning ability and become more likely to rupture. Int J Spine Surg. J Athl Train. (d) Axial T2-weighted axial view also confirms disappearance of the disc. AJR Am J Roentgenol. eCollection 2019. 2019 Apr 24;10:56. doi: 10.25259/SNI-34-2019. 2002. Both of these signs were absent in our patients. your express consent. [ 3 , 6 , 19 , 28 , 30 , 34 ] T1T2 discs account for only approximately 13% of all thoracic discs. T2 sagittal and axial MR images with T1-T2 disk herniation (arrows). Due to high occurrence of complications from open surgery, minimally invasive approaches are desirable. 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. GUIDE: Physical Therapy Guide to Herniated Disk. Choose PT, August 26, 2021. Would you like email updates of new search results? (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable cord compression. Bethesda, MD 20894, Web Policies 1998. 73: 598-9, 13. They can help rule out other conditions and give you a referral to a specialist. The spurs may cause narrowing of the spinal canal and impinge on the spinal cord. It is causing burning/tingling up my neck to my ear and jaw area. 16. If the lower thoracic region is involved, a patient may encounter pain radiating to one or both lower extremities. Posterior approach surgery has most commonly been used for laminectomy and/or foraminotomy.1,5,11-13 Adequate disk access of more central disk herniations may not be accomplished without excessive facet resection leading to hypermobility. 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. For the former patient, cervicothoracic MRI showed a left centro-laterally disc at the T1T2 level. Kumar R, Buckley TF. 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. 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. 2. Apply an ice pack or cold compress to the affected area for 15- to 20-minute intervals every two hours. 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. 1971. 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. Rossitti S, Stephensen H, Ekholm S, von Essen C: The anterior approach to high thoracic (T1-T2) disc herniation. Horwitz NH, Whitcomb BB, Reilly FG. Accessibility (e) Intraoperative clearance of the disc space from both hard disc and osteophytes. Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. Neurology. Although posterior approach surgery is most commonly used for laminectomy and/or foraminotomy, successful anterior approaches to upper thoracic lesions are valid as well. Experience with ruptured T1-T2 discs. 2021 Mar 17;12:108. doi: 10.25259/SNI_941_2020. Symptoms such as these are primarily determined by the location of the cervical herniated disc. A, Right parasagittal T1-, T2-, and STIR-weighted images that demonstrate a discrete fracture line through the pedicles of L4 bilaterally without pedicle marrow signal intensity changes (long arrow) and a less obvious fracture line on T1 images through the L5 pedicle with concomitant type 1 pedicle marrow changes (short arrows). Lucas, Jacqueline W, Eric M Connor, and Jonaki Bose. A disc herniation is a significant cause or contributor of neck pain. Mulpuri K, LeBlanc JG, Reilly CW, Poskitt KJ, Choit RL, Sahajpal V. Sternal split approach to the cervicothoracic junction in children. 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. government site. Yale J Biol Med. Proc Staff Meet Mayo Clin 1954;29:375-378. 1993. Global Spine J. Micheli LJ, Hood RW: Anterior exposure of the cervicothoracic spine using a combined cervical and thoracic approach. 1998 Jan;88(1):148-50. doi: 10.3171/jns.1998.88.1.0148. 33. Br J Neurosurg. Vaidya Ji is well known for his specialisation in Ayurvedic treatment of different ailments. Osteoarthritis appeared to be the predominant cause of the disc herniation in both patients. 24-Apr-2019;10:56. If the disc herniates into the spinal cord area, the thoracic herniated disk may also present with myelopathy . [ 3 , 6 , 19 , 28 , 30 , 34 ] Most thoracic disc herniations occur below the T8 level, and the majority are found at T11T12. (b) The disc space is a little bit above the manubrium line and cervicothoracic (CT) angle is 27. 42: 193-5, 26. Bulge is a term for an image and can be a normal variant . Most T1T2 discs were posterolateral in location (25 cases); only 11 were purely central or centrolateral. Biousse V, Touboul PJ, D'Anglejan-Chatillon J, Levy C, Schaison M, Bousser MG: Ophthalmologic manifestations of internal carotid artery dissection. Love JG, Kiefer EJ: Root pain and paraplegia due to protrusions of thoracic intervertebral disks. t1-2 disc herniation. Spine (Phila Pa 1976). 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. 15. With this technique, there is no retraction of the neural elements, no sacrifice of the nerve roots, and the pedicles are spared.15 When considering anterior surgery, identify the level of the clavicles, sternum, and breast tissue in relation to the upper thoracic levels for adequate preoperative planning. Extruded upper thoracic disc causing horner's syndrome:Report of a case. Case description: The most common symptom of a thoracic herniated disc is pain. Vertebral compression fractures are the most common injury to the thoracic spine. This site needs JavaScript to work properly. This is the least common location for radiculopathy. PMC 6: 1-10, 2. Federal government websites often end in .gov or .mil. C8 and T1 nerve roots compromise both the ulnar and median nerve root; therefore, precise examination of these roots is necessary. The rest of the postganglionic fibers travel along the internal carotid artery and enter the cavernous sinus. Specially in case of T1-T2 disc problem, age plays an important role. (d) Three-dimensional cervical computed tomography (CT) scan shows T1T2 and T3 screw rod fixation on the left side. 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. Withawin Kesornsak, Kanthika Wasinpongwanich & Verapan Kuansongtham, Teresa Plancha da Silva, Marta Amaral Silva, Ftima Carvalho, Guillermo Alejandro Ricciardi, Ignacio Gabriel Garfinkel, Daniel Oscar Ricciardi, Kalyan Kumar Varma Kalidindi, Mayank Gupta & Harvinder Singh Chhabra, Lance L. Goetz, Sean McAvoy & Kate Zakrzewski, Kevin Hines, Karim Hafazalla, Jack Jallo. Bookshelf 35: 329-31, 11. Unauthorized use of these marks is strictly prohibited. High thoracic disc herniation. According to Christopher Good, MD, FACS President of Virginia Spine Institute, often the most optimal treatment is to allow the body to heal naturally with time. (a) T2-weighted sagittal image demonstrating, (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable, (a) T2-weighted sagittal magnetic resonance, (a) T2-weighted sagittal magnetic resonance imaging (MRI) of the second case showing a, (a) T2-weighted sagittal magnetic resonance imaging (MRI) shows T1T2 disc herniation. Diagnosis and treatment of thoracic intervertebral disc protrusions. 2017. Available from: http://surgicalneurologyint.com/surgicalint-articles/9301/. Disc Herniation - Statpearls - NCBI Bookshelf. National Library of Medicine, January 18, 2022. (f) After placement of peek cage, note brachiocephalic vein at lower border of the scene. Your doctor may use the following to diagnose a thoracic herniated disc: Sometimes other tests may be ordered because herniated thoracic disc pain and symptoms can mimic heart, lung, and stomach conditions. 1980. 7: 189-92, 30. Negoveti L, Cerina V, Sajko T, Glavi Z. Intradural disc herniation at the T1-T2 level. Local MD says he is not fimilar with T1-2. Fortschr Neurol Psychiatr 2001;69:236-241. Therefore, once muscles and ligaments are relaxed around the T1-T2, we start working on the kyphotic curve of the spine. Conclusions:We reviewed 4 cervical T1T2 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. Horner syndrome or oculosympathetic paresis is caused by interruption of the sympathetic nerve supply to the face and eye that manifests as facial anhidrosis, blepharoptosis, and miosis. Neurosurgery. High thoracic disc herniation. Because in this case, a patient might get back all those symptoms of T1-T2 slip disc come back again. We report two cases of exceptional first thoracic disc herniation in a 60-year-old man and a 55-year-old woman. [ 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 ]. With cervical disc herniations, the nerve affected by the condition is the one that exits at that specific level of the spine. The T-1 radiculopathy usually involves weakness of the intrinsic muscles of the hand. 1986. 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). Can J Neurol Sci. 18: 782-4, Your email address will not be published. Herniated thoracic discs can cause paralysis. 1. 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. Therefore, if the C6-C7 level has a herniation, then it is the C7 nerve that will be affected. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The patient underwent successful T2-3 anterior discectomy with T2-3 rib autograft fusion. This is the T1 nerve root which originates from the T1-T2 region. Stillerman CB, Chen TC, Couldwell WT, Zhang W, Weiss MH. Movement the blood supply to the disc is interrupted it causes the desiccation of the disc. (g) Plain CT radiograph showing that the cage is located at bicalvicular line. Tokuhashi Y, Matsuzaki H, Uematsu Y, Oda H. Spine (Phila Pa 1976). Arseni C, Nash F. Thoracic intervertebral disc protrusion:A clinical study. However, it is most common in men between the ages of 40 and 60. According to Dr. Good, here are some healthy habits you can build that will help keep your discs healthy. official website and that any information you provide is encrypted BMJ Case Rep. 2014. This clinical condition can commonly be a consequence of cervical sympathetic chain injury, which runs along the lateral aspect of the vertebral body. Although anhydrosis was not explicitly tested, Horner syndrome was strongly suspected. This is the reason in few reports it is mentioned as D1-D2 region also. The main concept ofAyurvedic treatment of T1-T2 slip disc problem is based on the cause of the problem. 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. 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. (b) Sagittal cervical fat saturated MRI shows the same. Reflex examination was 2/4 in C 6, 7, and 8 roots. Because thoracic disc herniation can be caused by an injury, it can affect anyone. 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. Nonsurgical treatments are usually tried first to treat CTJ injuries. 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. 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. This process of desiccation starts due to the pressure on the spinal arteries. 88: 148-50, 22. 6: s-0036, 29. 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. You will not be suddenly and completely paralyzed by a herniated thoracic disc. Clin Neurol Neurosurg. 7: 495-7, 37. (a) T2-weighted sagittal magnetic resonance imaging (MRI) of the second case showing a hard disc at T1T2 level. Protrusions of thoracic intervertebral disks. Rossitti S, Stephensen H, Ekholm S, von Essen C. The anterior approach to high thoracic (T1-T2) disc herniation. 48: 128-30, 8. Your spine is made up of 33 vertebrae divided into five different segments, which are listed below in order from your head to your legs: Thoracic herniated discs occur in the thoracic spine, which is made up of the 12 vertebrae that extend from the base of your neck to the bottom of your rib cage. [ 6 , 20 , 22 , 23 , 27 , 34 ]. 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. The preganglionic fibers then exit the spinal cord and enter the cervical sympathetic chain. Left upper extremity motor was 5/5 in all myotomes except 4/5 finger abduction. Weakness. But they can happen. Dont Miss: Group B Strep Pregnancy Symptoms. Herniated discs affect 5 to 20 per 1000 adults annually. The rib cage adds extra protection, support, and stabilization to the spine, making it less susceptible to damage in general and disc trouble in particular. Historically, symptomatic thoracic disk herniation occurred with a frequency of 2 to 3/1,000 cases of disk herniation.2 This is likely even less frequent with the advent of MRI use in diagnosis. Please try after some time. The details of 36 cases with T1T2 disc herniation. J Neurosurg Spine. Turbo spin-echo T1 and T2-weighted sagittal and turbo spin-echo T2 axial 4 mm sections parallel to the disc spaces were taken. Treating thoracic-disc herniations: Do we always have to go anteriorly? 49: 599-606, 23. If there is some deformity behind T1-T2 slip disc than we aim to restore the kyphotic changes. Herniated thoracic disc at T1-2 level associated with horner's syndrome. (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up. In this condition we work on the posture of the shoulders and neck all together. It is important to understand the symptoms, causes, and treatments for a bulging disc to prevent the condition from worsening. For more information, please refer to our Privacy Policy. For the fourth patient, the sequestrated disc disappeared 5 months later [Figures 4c and d ]. 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. Caner H, Kilinoglu BF, Benli S, Altinrs N, Bavbek M. Magnetic resonance image findings and surgical considerations in T1-2 disc herniation. 30: 152-4, 6. T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. Horner syndrome or oculosympathetic paresis is evident because of interruption of sympathetic nerve supply to the eye, which consists of a 3-neuron pathway. 17. The C8 nerve root innervates the extensor indicus and abductor pollicis brevis from the radial and median nerves, respectively, in addition to finger flexion (ulnar nerve). T1T2 thoracic disc herniations are an extremely rare, and optimal results depend on the central and centrolateral location of the discs and the operative/nonoperative choices were made based on the clinical presentation. J Neurosurg Spine. (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. Evid Based Spine Care J 2010;1:21-28. 2002. Data is temporarily unavailable. The location of the pain depends on the location of the herniated 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. Asian Spine J. Correlating history, examination, and imaging will guide toward a successful diagnosis. Maloney WF, Younge BR, Moyer NJ: Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. [ 1 , 2 , 4 , 5 , 7 - 9 , 11 - 15 , 17 , 18 , 21 , 24 - 26 , 29 , 31 - 33 , 35 - 37 ]. Conservative treatments are appropriate for T1T2 discs resulting in just mild radiculopathy (e.g. (a) T2-weighted sagittal magnetic resonance imaging (MRI) shows T1T2 disc herniation. eCollection 2022. The arc begins in the hypothalamus and synapses in the intermediolateral gray substance at C8-T2 levels (ciliospinal center of budge). 6 Approximately more than 70 . 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. 2014 Oct;21(4):568-76. doi: 10.3171/2014.6.SPINE13682. 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. 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. After talking about your symptoms and . It can range from a mild pain that feels tender when touched to a sharp or burning pain. Report of four cases and literature review. (e) Axial CT scan shows a pedicle screw in an upper thoracic vertebra. 1983. An official website of the United States government. Anto M, Manuel A, Jayachandran A, Thomas SG, Joseph A, Thankachan A, Bahuleyan B. Surg Neurol Int. 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. J Indiana State Med Assoc. official website and that any information you provide is encrypted 24/36 patients). Save my name, email, and website in this browser for the next time I comment. J Neurosurg. Herniated Thoracic Disc. Barrow Neurological Institute, August 3, 2022. If the herniation compresses a thoracic spinal nerve, it can cause radiculopathypain that radiates down the nerve and away from the spinewith pain, numbness, and tingling. Arts MP, Bartels RH: Anterior or posterior approach of thoracic disc herniation? Publication types Case Reports 2001. Due to the location of the thoracic spine, a herniated disc can cause pain to the mid-back, unilateral or bilateral chest wall, or abdominal areas around the affected vertebrae. Sebastian . There was a decreased sensation noted along the left medial forearm and hypothenar region. Lloyd TV, Johnson JC, Paul DJ, Hunt W: Horner's syndrome secondary to herniated disc at T1-T2. Symptoms depend on where and how big the disc herniation is, where it is pressing, and whether the spinal cord has been damaged. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. i have a t1-2 herniated disc pinching a nerve, possible thoracic outlet. Lloyd TV, Johnson JC, Paul DJ, Hunt W. Horner's syndrome secondary to herniated disc at T1--T2. MeSH The most commonly affected levels are C5-C6, C6-C7, and C4-C5. This is the condition, which is more common than other conditions in the T1-T2 disc. If we just suppress the pain and associated discomfort due to T1-T2 slip disc, that wont be a permanent solution of the problem. 2010. Thoracic discectomy by posterior pedicle-sparing, transfacet approach with real-time intraoperative ultrasonography: Clinical article. J Bone Joint Surg Am 1983;65:992-997. Abbott KH, Retter RH. 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). 25: 910-6, 32. The same decay can be age related too. 4: 366-7, 25. We present a rare case of a patient with T1-T2 intervertebral disk herniation and Horner syndrome who was treated surgically. The video can be found here1). Modified anterior approach to the cervicothoracic junction. 2013. 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). Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. Symptoms of a herniated thoracic disc may include: A vertebral, rib, and/or disc injury at the C7-T1 level may cause moderate to severe neck pain and/or upper back pain. Band-like pain travelling from the back to the abdomen/chest on one or both sides of the body Headaches when you sit or lie in certain positions Numbness, tingling, or a burning feeling in your legs Trouble walking or moving your legs Weakness in your arms or legs Trouble urinating or having a bowel movement Trauma, such as a motor vehicle crash or fall can also cause a thoracic herniated disc. These all symptoms always confuse before the proper diagnosis of slip disc in D1-D2. (d) Chest X-ray showing that T1T2 disc space is far enough above biclavicular line. Smoking wrecks your discs along with everything else, weakening and drying them out (in case you needed another reason to quit). [ 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. Neurosurgical Developments on the Horizon, Leksell Gamma Knife Society Meeting Series, Dubai, 2018, Mayo Clinic Neuroscience Neurosurgery Lecture Series, http://surgicalneurologyint.com/surgicalint-articles/9301/, Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran. The symptoms of a herniated disc depends on either the size and position of the disc. J Neurosurg. Postoperative MR imaging (MRI) studies in the first two patients showed adequate cord decompression following placement of T1T2 anterior interbody cages [Figures 1 and 2 ]. 1968. Some error has occurred while processing your request. She also works as an Adult and Pediatric Sexual Assault Nurse Examiner. 6: 199-202. The https:// ensures that you are connecting to the 6. T1-2 disk herniation diagnosis is often delayed because of its prevalence and misdiagnosis. Radiation of pain in the upper arm on the front side. A modified anterior approach to the cervicothoracic junction with clavicle resection16 or combined cervicothoracic approach for diskectomy has proven useful as well.14,17. 9. (f) After placement of a large cage. 28: 322-30, 14. Specifically, T1 nerve root compression presents with specific signs and symptoms. Intervertebral thoracic disk herniation is rare. 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 back pain may be exacerbated when coughing or sneezing. Conclusion: Adjacent-segment degeneration after cervical spine fusion may rarely occur even at T1-T2, and the unusual symptoms of a T1 . 2022 Jan;212:107062. doi: 10.1016/j.clineuro.2021.107062. 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.

Gregory Dickow Biography, Articles T