[Mkilpatrick74]

#9591

Good Evening Dr!

I am a 39 year old woman with 3 prior surgeries. 1 Laminectony/Discectomy @ T11/12 in 2007. One ACDF @ C5/6/7 in 2009 and 1 Redo of the T12 Laminectony/Discectomy in 2012. Over the last 6-8 months, I have experienced increased mid back pain that never goes away. It’s a constant pain that sometimes feels as though it wraps around my chest as well as feels like I’ve been kicked in my ribs or shoulder blades at times. If I don’t take my pain medicine, I literally can’t stand up. There is also pain that radiates to low back for which ESI’s have brought little relief. Over the last 3-4 months, I have noticed increased right leg pain along with bilateral weakness, numbness in feet and toes. At my last visit with my neurosurgeon, after testing my legs for strength as well as my reflexes, he sent me for a Myloegram the following Monday. With tht being said, I would like to submit the findings and see what type of surgery (s) you would perform had u seen a patient with this many disc extrusions and cord compression? I understand this is not to be used as a substitute for my own Drs advice, I’m simply trying to get a feel for what type of Thoracic surgery can be done for this type issue. All the research I’ve done turns up almost nothing due to the rarity of having herniations in this area. I am also curious as to how so much damage could have happened since my last surgery a year ago with no trauma.
It only gets worse and I’m curious what can be done to stop this.

Patient has moderate somewhat focal rotary scoliosis of mid thoracic spine convex toward the right w the apex of curvature at T5-6.

DDD is advanced for 39 years of age, with circumferential marginal Osteopytic spurs particularly T5-T12.

T2-3
There is a small posterior central midline disc protrusion abutting the ventral aspect of the thoracic spinal cord.

T5-6
There is a large right posterior para central disc protrusion which flattens the right ventral aspect of the right thoracic spinal cord, displacing it slightly toward the left and possibly involving the ventral nerve root let.

There is a small posterior central and slightly right para central extruded disc fragment behind the T6 vertebral body, which either migrated inferiorly from T5-6 or superiorly from T6-7.

T6-7
There is a moderately large right posterior para central disc extrusion which abuts and slightly effaced the right ventral aspect of the adjacent thoracic spinal cord.
Similarly, Extruded disc material is behind the T7 vertebral body in the midline an to the right of midline, which probably came up rostrally from T7-8

T7-8
there is a rather large right posterior para central disc extrusion, also flattenjng the right ventral aspect of the thoracic cord, possibly involving the ventral nerve root let.

T8-9
There is a more broad based, moderately large posterior and slightly right posterior para central disc extrusion which moderately flattens the ventral aspect of the thoracic cord and reduces the anterposterior dimension of thecal sac to 7.4mm.

T9-10
There is a moderate sized right posterior para central disc protrusion mildly flattenjng the ventral aspect of the thoracic spinal cord. Likely involving the ventral nerve root.

T10/11
There is a posterior ventral disc extrusion which ascends rostrally behind the inferior end plate of T10, mildly effacing the ventral aspect of the thoracic spinal cord.

T11/12
Postoperative changes are present status post right Hemilaminotomy and partial laminectomy and Facetectomy for surgical micro discectomy. Postoperative Epidural Fibrosis generally should NOT displace, at least classically. What I see here is a probable large recurrent or residual posterior central and right posterior para central disc extrusion centered beyond the posterior marginal Osteopytic spurs flattening the right ventral aspect of the anterior spinal cord to the right of midline and potentially involving the right T11 nerve root. Please see Sagittarius reformatted sequence 20365 #29 and #29 and uou an see that the right T12 and L1 nerve roots do appear to be posteriorly displaced by this recurrent or residual disc.

[Donald Corenman, MD, DC]

#10774

You have several hernations in the thoracic spine with multiple compressions of cord levels. This is a very difficult problem to treat surgically as pain can be generated from discs, facets, rib/vertebra articulations and from nerve root compression.

Interestingly, compression of the spinal cord will not be painful. If there are symptoms of cord compression, examination will reveal long tract signs (hyperreflexia, clonus, imbalance) and symptoms of myelopathy (see website). The pain you experience is not from cord compression but from the above noted possibilities.

You might need a chronic pain program but also might find a surgeon who can meticulously diagnose this disorder and figure out what pain generators to fix. That is assuming you are a candidate for surgery in the first place,

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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