Is this all myelopathy ?

Tagged: Myelopathy Nightmare

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Jazzman
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February 12, 2018 at 10:22 pm

Post count: 11

#27539

Hello Dr Corenman
I am a 58 y/o woman with a history of 4 cervical surgeries, 3 anterior and the last posterior. I have had multiple fusions as well as a 2 level corpectomy with all the necessary hardware, titanium cage, plate, rods and screws. My first surgery was close to 30 yrs ago and the last three all within the last 7 yrs with the last 2 , 2 yrs apart( last one 3 yrs ago).

I have noticed leg weakness for at least the last year and a half which I just ignored, but it was causing me to slowly refrain from most activities( I have been totally disabled for the last 8 yrs due to the permanent damage that past cord compression has left me with) because of the severely limited time I could stand at any given time. I have lived with a certain aspect of this for all of the last 8 years but it definitely was intensifying over the course of this last year at least. In hindsight I now know that my hands were affected as well. I have had a significant essential tremor in both hands with the right far worse, for some years.

I noticed back in October that things were getting much worse. I have been having that familiar “ buzzing” and burning feeling in my feet and lower legs( mainly just the “vibrating”/ “buzzing” in the lower legs). Things were progressing all this time until about the end of the first week of January when everything changed overnight. I found that suddenly my neck had an intense feeling of pressure and stiffness like I’ve never known, when I would stand and walk. My walking has become very unstable with that heavy weak feeling in my legs. My legs became so weak suddenly that they were trembling when I would stand. My arms and hands are very weak. When it first changed overnight I had “ hot spots” here and there on my feet and legs as well as the outside of both upper arms ( it felt like my skin had been scalded and was very sensitive). If I stay down I’m not so bad but being on my feet seems to cause everything to worsen. I’m convinced that certan neck positions are aggravating this but don’t know what they are. I had some slight paresthesia in my upper lip area as well as out to my cheeks on both sides when it worsened suddenly but not noticing it now. Seems like it’s affecting my ears some, a little pressure and an intensity of sounds that is irritating.

I saw my neurosurgeon 2 weeks ago for the fastest appointment I’ve ever had with him. I wasn’t in good shape that day at all. He saw me “ walk” into the exam room and came in with a very concerned look on his face. All he did then was ask me what was going on ( he hadn’t seen me in over 2 yrs since my last post op appt). He then barely checked my leg strength and my arm strength ( which was shockingly weak) and stood up and announced that he needs an MRI of the head and neck and a Kyle gram due to my history. I’m still waiting for the tests. Could this all be just myelopathy ? And should I be concerned about my doctors very unusual serious demeanor and the very brief exam ? I am worried this time because of the length of time the symptoms have been present. I have developed edema around my cord before one surgery and was in tough shape but this is worse. I’m barely able to function now, have so much trouble being on my feet and extremely weak clumsy hands. I’m staying off my feet for the most part because that seems to make everything worse. Am I right to be very concerned this time ? Really trying to avoid a fall for sure.

Jazzman
Participant

February 12, 2018 at 10:28 pm

Post count: 11

#27540

In the last paragraph that should say myelogram and not “ Kyle gram” as it does, auto speller I guess. I didn’t notice it until after I submitted it.

Jazzman
Participant

February 17, 2018 at 10:11 pm

Post count: 11

#27595

Need to clarify/update my post from the other day. I did not mean to imply that my essential tremors were caused from my cervical problems because I know they are not. I meant to imply that they get significantly worse during times of cord compression, sometimes have trouble signing my name. The weakness in my hands and arms together with the now worse tremors make ordinary activities challenging at best.

When I referenced ear issues I should have clarified that I have no ear pain or reduced hearing. The intensity of sounds that I find irritating are not sounds outside of myself but rather my own voice( I’ll avoid the possible husband jokes here). I do have pressure and what I would call a constant not ringing but a very slightly perceptive “ noise” and when I talk it is amplified in my own head. I did not tell my NS about this because I thought I told him enough. I saw my primary care dr a few days ago for an already scheduled appointment and mentioned it to her so that she could check my ears. She found nothing out of the ordinary.

Symptoms are all still the same with some days a little better than others. I did experience left arm pain all day yesterday with pins and needles in that hand and some slight numb feeling in the thumb and index finger. No arm pain today at all. My tests aren’t scheduled until week after next. I know myelopathy can be a very “diffuse” problem but some of these on and off symptoms are driving me nuts. I am from a medical background and not one given to worrying about myself, on the contrary, I usually ignore things until I absolutely can’t any longer.

Still want to know if you could attribute all this to cervical myelopathy. I understand why my NS wanted a CT of the head but I’m sure I don’t have a brain tumor. So much of this is all too familiar but with some new twists. I don’t have a good feeling about this time. Oh yes, have had some loss of bowel control this which I’ve had much worse in an episode of cord compression before. Would you think that a CT myelogram would be the best way to diagnose this ? I hope so since this is what I’m having. Thank you in advance for your reply

Donald Corenman, MD, DC
Moderator

February 18, 2018 at 7:14 am

Post count: 8660

#27616

Yes- all your symptoms could be a result of myelopathy. Because of all your prior cord insults, you could also be developing syringomyelia which would be seen on am MRI but is somewhat harder to spot on a CT myelogram. The CT myelogram might be a good test however due to all your implanted hardware which can cause image distortion on an MRI scan. Another problem is that your physical examination will have residuals from all of your prior cord insults and might not be reliable to look for worsening of your disorder. All-in-all, I would agree on a CT myelogram and a new MRI also.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Jazzman
Participant

March 1, 2018 at 8:27 pm

Post count: 11

#27775

Well I’m thouroughly confused now. I had my myelogram 3 days ago and my NS nurse called me today to say that it looked “ok”, don’t know what that means. She said he wanted to get me into a neurologist to evaluate my extremity symptoms. I can’t believe this! I have had myelopathy 4 times before and this sure seems like myelopathy to me. I’m having trouble holding my head up, it’s easier to just drop my head now,holding it up causes severe muscle strain and horrible head tremors. Still can’t stand but a few minutes because my legs are so weak they tremble. Feet are burning, have pins and needles here and there on my arms and hands, not constantly but happens enough. I get relief when I lay down. I know that there is a positional aspect to this. I sit with my head propped against a couple pillows and I think this is aggravating this. When I get up from this position my legs have that heavy feeling and so does the base of my neck and right under it.

Does this ring any bells for you? I am beside myself because I thought I was close to getting some relief. I told you I was concerned about the brief visit from my NS, didn’t do any neuro exam at all. Could these symptoms still be myelopathy from an area other than my neck such as upper thoracic? The corpectomy I had was C7 T1. Is there any guidance you can give me as far as what to discuss with the neurologist? I’m so afraid of being slipped into an “oh well” category. I’m not an expert at anything except my own body and I know there is something messing with my cord somewhere. Could this also be something that is positional and has to be diagnosed in a “ positional” manner. I won’t let my self be pushed off into a medical abyss with patronizing double talk( yes I have trust issues with the medical profession, I came from that field). My first episode of myelopathy lasted 3 months before I could get my GI doctor to listen to me when I was saying they needed to look at my spinal cord( was having horrible loss of bowel issues as well as weak heavy legs). I could go into my horror stories with myelopathy and dr’s not recognizing it but my point is I have never been wrong about this. Anything you could suggest would be greatly appreciated.

Jazzman
Participant

March 2, 2018 at 10:47 am

Post count: 11

#27777

I don’t know if this is relevant but I am a person that forms copious amounts of scar tissue. I have an abdomen full and have had to be hospitalized many times with small bowel blockages due to the scar tissue. And my neurosurgeon had a horrible time when he went in to do my corpectomy. It took 8 1/2 hrs to do a 4 hr surgery. He said “ I’m a neurosurgeon and I nor my colleague ( he had to call him in to assist) have never seen this much scar tissue in the neck, even around the cord”. I also have a history of forming very large bone spurs. During that same surgery the spur was very large and growing into my cord, and had set up a rich blood supply so that each time they tried to chip away at it I bled profusely so I had to receive a transfusion. Don’t know if this helps or further confuses a complicated picture but thought I would share this info. Thanks
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Donald Corenman, MD, DC

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Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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