[JBoz]

#22860

Hello Dr. Corenman

I had a 3month follow up MRI of my thoracic spine. The swelling is still present, as well as the myelomalacia still showing moderate to severe at T4 and T5. There is still mild cord flattening at the same level. The image appears more crowded, but the report shows the condition unchanged. My pain doctor told me to see a surgeon, because he said treatments will not help. I have been told there is no more surgical intervention by the surgeon who oversaw my surgery. This has been 4 years now of severe chest pain, and the surgery sadly didn’t help. We are now just over 8 months out. I feel an increase in symptoms, so I’m concerned it could get worse.

Is this the type of condition that needs to monitored with MRI’s every few months?

Do you understand why a pain doctor would be concerned about treating the area with the swelling and myelomalacia, he was frankly surprised the swelling was still occurring.

Thank you again Dr. Corenman.

[JBoz]

#22934

Hello Dr. Corenman, I figured it would be better to post the actual report. It was confirmed to be myelomalacia and not fluid build up.

TECHNIQUE: Sagittal T1, T2, STIR and axial T2-weighted images of the thoracic spine were obtained without contrast. 10 cc OptiMARK was given. Postcontrast Tl -weighted axial and sagittal images were obtained.

FINDINGS: There is a smooth physiologic thoracic kyphotic curve. Vertebral heights appear generally maintained. Disc degeneration is mild from T4-5 through T8-9 ar.d at T10-11 .vitfi. dehydration and narrowing. There is a moderate-sized vertebral hemangioma to the right posteriorly at T7. There are laminotomies at T3-4, T4-5 and TS-6. There appears to be a posterior fusion at T4-5, No worrisome marrow replacing lesions are seen. The extraSpinal soft tissues appear normal. These findings appear stable.

T4-5 demonstrates a 2 mm left paramedian broad disc protrusion with a peripheral annular fissure. There is mild spinal cord flattening to the left with stenosis and midline AP canal diameter of 8 mm. No hypertrophic facet DID. No foraminal stenosis. No significant change.

T10-11 demonstrates no significant disc bulge. Facet DJD is mild on the left and mild to moderate on the right. No spinal cord flattening or central stenosis. No foraminal stenosis. No significant change.

The remaining thoracic discs do not show evidence of significant bulge, protrusion, or extrusion.

There is moderate to severe spinal cord edema and/or myelomalacia from mid T4 through mid T5, unchanged. The remainder of the thoracic cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. No mass. Following contrast injection, there is enhancing granulation tissue in association with the laminectomies at T3-4 and T5-6 as well as in the posterior midline soft tissues from T3-4 through T10-11, also consistent with postsurgical granulation tissue. No significant abnormalities of intrathecal contiast enhancement are observed.

IMPRESSION:
1. Disc degeneration is mild from T4-5 through T8-9 and at T10-11; laminotomies at T3-T4, T4-5, and T5-6.

2. T$-5 mild spinal cord flattening to the left with stenosis.

3. Spinal cord edema and/or myelomalcia is moderate to severe from mid T4 through mid T5.

4. Allowing for minor variation in partial volume averaging, no definite interval change is lidentified since April 29th, 2016

I should add there was no fusion, and the surgery was only at the T4-T5 level. I only know there is very little information on myelomalacia, and I wonder if most doctors even know about it. This entire battle with my spine has reduced my quality of life tremendously. I cannot function due to severe pain, in both my chest and now my back. It feels like a spear going through me at times. I did file for disability back when my cervical fusion failed, then I had the posterior fusion to fix that, I’m currently in a rock and a hard place, considering my pain doctor will not treat my thoracic spine, due to these findings above, we waited the 3 months, and there was no improvement. I don’t know how to explain this to others, but the problem is more severe than I can put into words. I ended up worse than I was before taking the risk to do this surgery. It was previously a rare herniated disc, causing severe enough chest pain to take the risk. I wish I had some more hope than just time. I don’t know what a second opinion could do, but I may try and get one. I never thought this would be my situation after surgery.

Do you think most doctors have any knowledge on this condition?

I wonder if you have ever treated a patient with this condition, or would you even touch a patient with this condition?

Thanks Dr. Corenman, you have been of great help to me the past couple years. This is directly copied from my report to this page

[JBoz]

#22936

Dr. Corenman, I should add, I’m in no way looking for another surgery, only more information about this condition, so I know what to expect in the coming years. It is very scary to be honest, both the pain, and the unknown.

Again, thank you so very much

JBoz

[Donald Corenman, MD, DC]

#22945

It appears that the compression have been alleviated by the surgery but I cannot be positive (“There is moderate to severe spinal cord edema and/or myelomalacia from mid T4 through mid T5, unchanged…There are laminotomies at T3-4, T4-5 and TS-6..T4-5 demonstrates a 2 mm left paramedian broad disc protrusion with a peripheral annular fissure. There is mild spinal cord flattening to the left with stenosis and midline AP canal diameter of 8 mm. No hypertrophic facet DID. No foraminal stenosis”).

I am unclear as the the surgery performed. Was it a laminectomy (full removal of the lamina which fully opens the canal) or a laminotomy (partial removal of the lamina with continued compression)? The radiologist suggests a laminotomy with continued compression of the cord (“mild spinal cord flattening to the left with stenosis and midline AP canal diameter of 8 mm”).

It also looks like there was surgery from T4-6 which is what I would expect for this surgery. If there is still compression of the cord and/or nerve root (the intercostal nerve) this could explain some of your symptoms. Nonetheless, you do have cord damage (myelomalacia) and this could be causing your symptoms in all or part.

I think an epidural at this level could be helpful-possibly not long-term but it may give some long term relief. You might need a redo surgery or a spinal cord stimulator. Another opinion from a surgeon who has experience and good hands would be in order.

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.

[JBoz]

#22950

Dr. Corenman,

This is the list called (Name Of Procedure) from my surgical report. The indications were the severe chest pain, and disc protrusion causing it, after 2 years of cardiac, GI, and lung tests.

1. T4 laminopslsty with decompression of the spinal cord, nerve roots, including medial facetectomies and foraminotomies.

2. T5 with decompression of the spinal cord, nerve roots, including medial facetectomies and foraminotomies.

3. Microsurgical intradural exploration.

4. Resection of the T4-T5 herniated nucleus pulposus.

5. Usage of operative microscope for microdissection.

6. Usage of fluoroscopy.

7. Complex surgery.

Upon review of the recent MRI, my pain doctor will not work on the T4-T5, as I mentioned. He said he felt I would not get any relief from treatments, he was concerned with the swelling still going. I did confirm it was not fluid build up with the surgeon who did the surgery a 4 months back. They said it was damaged tissue, and the finding was worsened, yet the hygroma was resolved. I came out of this surgery with the severe chest pain, it was very severe after surgery, so I knew they hit on the right spot. The chest pain then went to off and on. Now it has returned to being constant. The new back pain is very severe, and goes from both left to right. It feels like a sword going through me. I mentioned in a earlier thread that the surgery began at the wrong level. It was then closed up, and done at the correct level. Only the incision was made, not a surgery on the lower level. Still, this had to put pressure on the balance of the surgery.

I’m concerned that the radiologist thinks there is a fusion in this last report. Its been 8 months since surgery, and my condition feels worse, I took the risk, because my chest was so very bad. I never had the severe back pain, until after the surgery, along with the right leg being on fire 24/7. I did find a video about myelomalacia, by a Ken McKim talking about the condition, it all seems very serious in nature… explained by this video. There is just not a lot of information out there. I do hope it will one day improve, but at this point it causes pain to be active, and it would be near impossible to do any type of work, even part time. The one time I do feel relief is in the pool.

I am seeking a second opinion, but finding anyone who works on the thoracic spine is a challenge. My concern is how I explain this to a normal doctor at this point. I don’t even understand what is going on in my spine, I only know this pain is extremely hard to cope with on a daily basis.

Perhaps the surgery notes above will help shed some light on the findings in the MRI I posted. I feel like I’m having a 24/7 heart attack Dr. Corenman, I have been this way for just over 4 years now. The new back pain, I guess that is the risk we take with any surgery. The overall outcome is devastating as a single father. I feel helpless against this cord damage, and what appears to be very difficult to fix at this point.

Thanks again Dr. Corenman, I’m truly grateful for your time. I see a doctor for disability soon. I have had all my doctors compassion for my claim. I can only pray he has some understanding of the spine, and will understand this condition.

Jboz

[Donald Corenman, MD, DC]

#22953

I do not understand why the surgeon opened the dura during surgery as any disc herniation is extradural (outside of the dura) and opening the dura has some consequences. Did he or she think there was an intradural tumor (very rare) or that the disc herniation penetrated the dura (extremely rare)?

Did you mean laminoplasty (“T4 laminopslsty”)? This is an unusual procedure if it is a laminoplasty and not a laminectomy or laminotomy. The “roof of the canal is preserved and hinged open in a laminoplasty and can collapse down if the mechanism to hold open fails.

If there is nothing else that can be done, a spinal cord stimulator can be entertained. These devices can be very helpful in some patients.

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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