[Ahyc]

#29228

Hi Dr. Corenman,

I had syringomyelia at spinal cord T9. Laminectomy and lysis adhesion of spinal cord and nerve root was done on early May 2018. Both upper and lower limbs were in full power and control (5/5) before the operation.

Post-operation:

-UL : full power and control (5/5)
-RLL: 2/5, I can move my toes and ankle, knee is under moderate control while hip is under mild control
-LLL: 0/5, foot drop, I can slightly move my toes occasionally, but I cannot move my ankle. Knee and hip are under poor control
-Involuntary LL movements, especially when I fall asleep
-Suddenly increased LL muscular tension when motion changed, e.g. Sit-to-stand
-LL muscle fatigue easily
-Reduced sensation (temperature & light touch) below T9
-Urinary incontinence at night occasionally
-Post-operation MRI done on late May, doctors said it looks good and the operation was successful

Seems doctor has no clue about my case, I am extremely worried and helpless. May I ask if there is any examinations that can be done to provide further clues for doctors and what I can do to improve the recovery?

Thank you.

[Donald Corenman, MD, DC]

#29229

My first question is why you underwent the surgery if you had normal strength and “control” which I assume meant proprioception (good feedback from your legs while walking)? What was assumed to be gained by undergoing the surgery? Was the syringomyelia expanding? Did you have a tethered cord?

Operating on the spinal cord (as opposed to decompressing the canal and not “touching the cord”) is fraught with potential complications as you note above. How does the surgeon note that the surgery was a success?

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.

[Ahyc]

#29235

Dear Dr. Corenman,

I do not have tethered cord. In addition to laminectomy and lysis adhesion of spinal cord and nerve root, laminectomy for decompression was performed and somatosensory evoked potential monitoring was used during the surgery on May 2018.

Other than the current one, I had 2 surgeries before, thoracic syringomyelia with thecal peritoneal shunting in 2006; Hx of T9 AVM with T8-T10 laminotomy and excision of AVM in 1999.

I sometimes get fall in the past year before the surgery. I was expected to be discharged from hospital within a week and everything goes well as last surgery in 2006. I trusted the surgeon whom I have consulted in the past 19 years without questioning. He told me there is a sign of progression of syringomyelia up to cervical cord level compare with previous MRI done in 2015. I did not aware such a surgery is complicated and dangerous; therefore, I underwent the surgery without hesitation.

In looking at the post-surgery MRI, surgeons found that syrinxes had narrowed a lot after surgery, and the spinal cord looks “normal”, they therefore considered it as a successful one.

Thank you.

[Donald Corenman, MD, DC]

#29273

Well obviously the surgery was not a success by your new disabling symptoms. The advancing syringomyelia is a cause for new surgery if your symptoms were advancing but they sound like the were not advancing. You have no options now other than to wait to see if you develop some recovery over 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.

[Ahyc]

#29402

Dear Dr. Corenman,

I just had another post-surgery MRI on 20/9 (post-surgery 136 days). The report as below, seems the syringomyelia is getting worse after the surgery, surgeon said my recovery progress is slow and ask me to back home instead of staying in rehabilitation hospital. I am age 29, I do not want to spend my entire life in a wheelchair, may I ask if there is any treatments or surgeries could be help in this case? Thanks again.

================
Report:
Contrast MRI whole spine

Protocol:
T2 TSE SAG WS, T1 TSE SAG WS, T2 MEDIC TRA C2-T4, T1 TSE TRA C2-T4, T2 MEDIC TRA T4-L1, T1 TSE TRA T4-L1
Post-Gd: T1 TSE SAG FS+C, T1 SE TRA FS+C

Findings:
Correlation is made with previous MRI performed on 28/5/2018.

Evidence of previous spinal surgery at mid thoracic T10 laminectomy noted. The signal change and enhancement at right para-sagittal location of the paraspinal region, could be related to previous surgery and presence of surgical materials (e.g. Duraplasty). The extent shows no significant interval change. Otherwise no obvious large intraspinal collection seen.

A tubular low-signal intensity area is noted within the posterior aspect of syringomyelia at T8 level, may be due to previous surgery. It is similar to old study.

The syringomyelia now extends from lower C3 to T12/L1 level (previously upper C2/3 to T9/10 level). The dimension of the syringomyelia at C6 level is measuring about 5.0mm(TS) x 2.0mm(AP) {Vs 5.9mm x 3.4mm in last MRI} and the dimension of the syringomyelia at T8/9 level measures about 11.8mm x 8.4mm {Vs 6.8mm x 4.4mm in last MRI}.

As compared with the previous scan, the syringomyelia has decreased cranial extent and increased caudal extent. The upper part of syringomyelia (above T8) shows decrease in dimension and the lower part (below T8) shows increase in dimension.

No definite significant contrast enhancement is demonstrated in the syringomyelia.
No extramedullary mass lesion is noted within the spinal canal.
No intradural serpiginous signal void structures in spinal canal is noted.

[Donald Corenman, MD, DC]

#29408

Syringomyelias are supra-subspecialty issues. That means that they are treated by neurosurgeons who are specifically trained and highly experienced in these disorders. I understand how to diagnose this disorder and can refer patients for treatment to the appropriate referral surgeons but I personally do not treat this disorder. I do believe that extension of this syringomyelia indicates incomplete treatment and I would advise another consultation from someone who has great experience with these. Your paresis from the previous surgery and continued loss of function should be commented on by another expert.

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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