[Jellyhall]

#10636

Dr Corenman,
I congratulate you on your excellent website and thank you for the answers and help that you give.

When an ACDF is done to relieve cord compression when hyperreflexia is evident, will it resolve after surgery?

What about spasticity, should that resolve once the cord is decompressed? If it remains, is it likely that there is cord damage or compression somewhere else?

[Donald Corenman, MD, DC]

#10642

The textbook answer is that decompressive surgery of the spinal cord is designed to prevent further progression of cord injury (myelopathy) and that the cord injury will not heal.

That has not been my experience. In many (but not all) cases, symptoms and physical examination findings improve after surgery. There are many cases where hyperreflexia and clonus (some of the signs of myelopathy) disappear after surgery.

If there is no further compression noted after surgery and symptoms remain, this is most likely permanent cord injury and needs to be managed.

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.

[Jellyhall]

#10643

Thank you Dr Corenman.
Some more questions;

Is it possible to have cord injury without high signal on the MRI scan?

The first neurosurgeon that I saw left me for over two years with cord compression while he ‘waited and watched’. (I am in the UK!) I was seen at 6 monthly intervals, and each time by his registrars and they felt that the symptoms I had indicated that I had myelopathy and should get on with an ACDF, but when they went to talk to him, they would come back and say that he said we should continue to wait and watch. This was without him coming into the room and examining me himself or explaining why he felt that we should continue to wait. I got another opinion and that neurosurgeon said that we should get on and do the surgery because ‘things were very tight on my cord’ which was being pushed back and indented. (You were kind enough to also view my MRI scans and you felt that my neck needed attention.)

How is a permanent cord injury managed?

I still have most of my pre-surgery symptoms and get stiffening spasms several times every day when both legs either go stiffly straight or bend upwards with tight muscles. When this happens my feet, but especially my right foot, turn inwards with my big toe pulling tightly upwards. Also I get tight muscles around my abdomen which causes my back to arch up off the bed. I also get a mobile phone type buzzing in my legs (mostly right leg) and the feeling of cold water being splashed on me. I also have pain and symptoms in both hands and arms (mostly on the right). I think that this is coming from the levels below the fused levels, which were C3/4 and C4/5. I also have tingling and nerve pain in my feet, legs and buttocks.

I am seeing a neurologist soon to discuss my symptoms with him. I have not had a nerve tesst done since the surgery, but I assume that he will do one to check my reflexes etc.

[Donald Corenman, MD, DC]

#10657

It is possible to have myelopathy without cord signal change on the MRI.

You are finding out that there are incentives and disincentives depending on the social health program you are in to perform surgery and occasionally incentives not to do surgery. The disincentive in a national health care program for surgery is that the surgeon does not financially benefit from greater numbers of surgery. Surgery can look like a burden and the indications for surgery can be “watered down”.

The opposite side of the coin is that in a fee for service model (the USA), there are incentives for surgery and some physicians can possibly be influenced by that financial benefit. Occasionally, someone will argue that there is too much surgery here due to the financial incentives but I have only rarely see that side of this problem.

Your symptoms do fit with myelopathy but there are other disorders that can cause these symptoms. The neurologist you are going to see should be able to ferret out what the causes of these symptoms are. If he or she is convinced that this is myelopathy generated, you should have an advocate for surgery in your corner.

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.

[Jellyhall]

#10661

Thank you Dr Corenman.

I had an ACDF of C3/4 and C4/5 done nearly 18 months ago. I still have most of my pre-surgery symptoms including spasticity causing both legs to stiffen and my back to arch up off the bed several times every morning as I start to move on waking. I also get this if I stand up after sitting for a long time such as the cinema or a meal out. I also have some loss of sensation (not complete loss)and temperature sensation in both feet and legs up to the knee and in both hands and wrists.

An MRI done about 6 months after this surgery shows fluid around the cord again, although there is some nerve root compression, particularly at C5/6.

The neurologist yesterday has ordered more MRI scans to be done to see if there is a change to those done a year ago, and EMG and nerve conduction studies. His pin prick test did show loss of sensation in both legs and arms. I have hyper-reflexes in both legs at the knees (not sure about the arms)but loss of reflexes at the ankles. What does this mean?

[Donald Corenman, MD, DC]

#10682

You have had cervical stenosis (narrowing of the canal) with resultant myelopathy. You then underwent an ACDF surgery to relieve the cord compression. This apparently did not help with symptoms indicating that there probably is some permanent injury to the cord. The surgery however was successful in preventing further damage to your cord as the follow-up MRI did not note continuing compression of the cord.

Altered sensation in the arms and legs can be an indication of residual myelopathy or of compression “down the line” (in the lumbar spine). Typically, reflexes are increased in myelopathy so your diminished reflexes can be an indication of compression in your lumbar spine (nerve compression in the lumbar spine can mute the increased reflexes).

If you have increased reflexes in your patella but decreased reflexes in your Achilles tendons, this could indicate a compression of the nerves between L4 and S1 (the Achilles reflex is S1 and the patella reflex is L3-4).

I am not sure that an EMG test will reveal anything as central nervous system injuries (such as spinal cord injury) will not show up on these tests.

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.

[Author]

Posts