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  • Brad bass
    Participant
    Post count: 4

    Can an indirect decompression with interbody fusion, decompress the spinal cord without directly decompressing the herniation by cutting the herniation out?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    It really depends upon what symptoms are present and how the thoracic disc herniation presents. Normally, the herniation is directly removed and the level fused. An indirect decompression is depending upon distracting the disc space to lessen or alter the pressure against the cord or nerve root. It works better for nerve compression than cord compression.

    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.
    Brad bass
    Participant
    Post count: 4

    Thank you Dr, symptoms are mid back pain and rib pain to left and burning sensations, burning flashes in left leg sometimes in right leg, fasciculations in left leg. Pins and needles in left posterior thigh and left posterior thigh numbness. Tingling in left leg and buttock left side off and on.
    Mri reads (T7-T8) level shows large central and left paracentral disc extrusion compressing and deforming the ventral spinal cord. Cord signal is maintained. No neuroforamina stenosis. (T8-t9) left paracentral posterior disc osteophyte complex abutting ventral cord surface. Mild eccentric narrowing of spinal canal at this level.
    (T9-t10) shows mild bilateral facet hypertrophic changes.
    (t10-t11) left paracentral and subarticular posterior osteophyte disc complex, bilateral facet hypertrophic changes without spinal canal or neuroforamina stenosis.
    Impression- Multi level degenerative changes in lower thoracic spine, t7-t8 shows large disc extrusion impingement and mass effect and deformity of the spinal cord.
    So the indirect decompression would not be a good option for t7-t8 disc herniation for decompression?

    Thank you for your thoughts very much appreciated!!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    By the descriptors of this hernation (“large central and left paracentral disc extrusion compressing and deforming the ventral spinal cord”) I would expect you would have long tract signs in your examination and imbalance with standing (see myelopathy https://neckandback.com/conditions/herniated-disc-thoracic-spine/).

    You might be able to “ride this herniation out” with epidural steroid injections if you don’t have myelopathy but if you do have myelopathy, you should consider surgery to decompress the cord and fuse this level. It sounds like an indirect decompression would not be enough.

    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.
    Brad bass
    Participant
    Post count: 4

    Thank you Dr. I appreciate the response sorry I have not responded. I have been really busy seen 3 Dr’s recently and all said I need to have surgery but it is not an emergency. They all said my strength signs are all 5 out 5 both legs but have slight hyperflexia. My pain generally is around a 3-5 most days. They said that it is just a matter of time before things get worse with this disc as it has been on going for years but never symptoms in my left leg until 6 months ago and that it should be surgically removed.
    Not sure if I have myelopathy or not as I can walk fine and don’t have balance issues etc.. just burning flashes and muscle twitching and tingling and numbness in that left leg and some left leg pains, some pins and needles also but not a lot. Just curious if surgery is really the best thing to prevent further problems getting worse or paralysis at this time.
    Thanks a lot.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    It is highly unlikely that you will develop frank paralysis from this herniation but you could develop increasing myelopathy. You could try an epidural injection to reduce inflammation and reduce symptoms. Surgery is the only option to take compression off the cord.

    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.
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