Pseudo cauda equina from anesthesia?

Tagged: Cauda equina syndrome after an endoscopic microdisectomy

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anna
Participant

November 29, 2019 at 6:36 pm

Post count: 15

#31595

Dr C,
Thank you for responding again. I spent the evening reading through the other cauda equina posts in your forum to educate myself further. I thought I should bring up that I did not appear to have all the classic symptoms of cauda equina. My bladder issues were short lived and I’m for the most part back to normal. I never had any pain down my legs and groin. I did have some weakness in my right leg and toes upon awakening from the surgery, but it has now improved to where my gait is almost normal. I can also raise up on both toes and walk on my heels. My balance is much improved as well.

However, my remaining concern is the saddle seat deadness. Plus, I’m very distressed to add sexual dysfunction to my list of symptoms. I am very worried this will be permanent. :(

Could I indeed be recovering from a partial case of surgical induced cauda equina or something else masquerading as cauda equina?

Do you think I should ask my new orthopedic doctor for an MRI (along with steroids of course) when I see him next week? If yes, do you have any tips on the type of MRI you think would be best?

Thank you so much.

anna
Participant

November 29, 2019 at 7:33 pm

Post count: 15

#31596

One more thing…I don’t know if my inability to void was also influenced by catheter use. I was administered a catheter during my surgery and then a second catheter overnight after my surgery. I was able to void 8-10 hours after the second catheter was removed.

Donald Corenman, MD, DC
Moderator

December 5, 2019 at 6:23 am

Post count: 8660

#31635

Catheter use can cause some problems with urination after removal but in your case, I think you had a temporary neurological bladder (the nerves to the bladder did not work properly) and you needed to be recatheterized after surgery due to cauda equina syndrome.

Your symptoms are classic for cauda equina syndrome and based upon your current recovery, I think you should resolve most or all your symptoms within a year, including sexual dysfunction.

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.

anna
Participant

December 6, 2019 at 9:29 am

Post count: 15

#31654

Dr. C,
A HUGE thank you to you! I have an update. I took oral steroids (Medrol dose pack) for 1 week as you recommend & found my saddle seat numbness/heaviness slowly lessened. I also followed up with a retired orthopedic surgeon yesterday & he completely agreed with you that I had cauda equina symptoms & immediately ordered an MRI with contrast. The radiologist report found…

“L5-S1: There is mild disc height loss, stable since prior study. There is evidence of left-sided laminectomy with tissue enhancement involving the laminectomy bed. Dural & bilateral perineural spaces left greater than right consistent with granulation tissue. No findings to suggest recurrent &/or residual disc. The conus is normal in configuration & signal intensity ending at T12.”

My orthopedic also called & spoke with the radiologist this morning. He said the radiologist admitted he was puzzled as to why I had tissue granulation on the right side when my surgery was left sided. The radiologist also confirmed he did not see any thing to explain cauda equina symptoms.

My orthopedic recommended Voltaren 75mg daily & an epidural injection down the road. Like you, he expressed relief that my saddle seat numbness/heaviness was slowly centralizing & lessening. However, he is bothered by the tissue granulation & that it is also on the right side. He admits he has rarely seen tissue granulation after a micro-D & is not an expert on tissue granulation so he cannot say if it’s a normal amount.

Dr C where do you recommend I go from here? If the cauda equina symptoms continue to lessen over time should I live with their medical mystery? Same with the tissue granulation? Or should I consult with another tissue granulation expert (radiologist, neurosurgeon, orthopedic) if one exists?

Donald Corenman, MD, DC
Moderator

December 7, 2019 at 10:18 am

Post count: 8660

#31660

Unfortunately, we will probably never know what actually happened in surgery but right sided granulation tissue indicates that there was some manipulation on that side during surgery. This could help explain the temporary cauda equina syndrome.

At his point, I think it is OK to just give this more time to resolve. There is nothing that can be performed surgically based on that MRI report that can help you. It is simply a matter of time.

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.

anna
Participant

December 14, 2019 at 6:23 pm

Post count: 15

#31688

Dr C,
I return to see the original neurosurgeon who performed the endoscopic microdisectomy on my left L5 next week. After my new orthopedic surgeon (retired) called the neurosurgeon with my latest MRI results of uncommon tissue granulation on the right side, the neurosurgeon’s staff called me practically begging me to come in. They reassured me the neurosurgeon thought everything looked fine with my new MRI, but that he just wanted to follow up with me. I told them I really hope he will have some explanation for my new post surgery cauda equina symptoms and right leg weakness (I’m unable to do heel raises on my right) other than his “I dunno” when I saw him the day after my surgery.

Do you think I have any chance of regaining my calf muscle strength if the MRI does not show there is anything to be removed surgically? Would physical therapy possibly help?

Meanwhile, the oral steroids you recommended really seemed to help my saddle seat anesthesia, but since I stopped the last steroid pill it appears my anesthesia has also stopped decreasing. I know you’ve mentioned epidural injections. Could one possibly help in a situation with anesthesia and weakness but without pain?

I will be sure to update you on my meeting with the neurosurgeon. Thank you from the bottom of my heart for hosting this forum and answering our questions.
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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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