[Jellyhall]

#28771

Dear Dr Corenman,

I have just had an appointment, after 10 years since my lumbar fusion, and nearly 6 years since my double cervical ACDF. I am having problems and pain again in my arms, legs, neck and back.

They are particularly worried about the lowest level of three herniated discs in a row, T9/10, where the cord is being impinged. The scan report says “left posterolateral disc protrusion with anterior medullary impingement and probable compression of the left T9 rootlets.”
T7/8 also has “left posterolateral disc protrusion with anterior medullary impingement”
and T8/9 has “Right paramedial disc protrusion with anterior medullary impingement”

I was told that my left legs, arms and hands are weak
I have hyper reflexes in both my right leg and arm
I have no reflex in my left knee and only a weak reflex in my left ankle

Some scans have been ordered to see how things are progressing since my last MRI scan that was viewed.

These tests are :
A new thoracic MRI to see if things have got worse.
A CT scan of my neck and lumbar spine because artifact is obscuring the images around my metal hardware
Flexion and extension X-rays of my neck and lumbar spine.

A friend has told me that CT scans can also have artifact. Is this true when there is titanium hardware present?

I was also told that if my thoracic scan is worse than a year ago, or if I start to have falls or problems with bowel or bladder issues, I will have to have surgery. They have said that this surgery would be a very big surgery and that they would need to make an incision in my chest wall at the side, deflate a lung and remove a rib to get access to the spine and discs. This same friend has told me that I should ask to have a laminectomy from the back because it is a far less serious surgery. I am imagining that the consultant I saw has weighed up the position of the disc and feels that entering through the side of the chest is the only suitable surgery.
I can see that posterior entry would mean going in through the back, removing the lamina, but then they would have to work around the spinal cord to get at the discs.

* I would really like to hear your view on this please?
* Also, do you think they would do all three discs at the same time while they are doing the surgery, even though they say they aren’t as bad as T9/10?
* Do you think they would have to do a fusion as well to stabilise the spine?

Looking forward to your comments Dr Corenman.

[Donald Corenman, MD, DC]

#28774

An “anterior medullary impingement and probable compression of the left T9 rootlets”. can cause myelopathy and T9 thoracic radiculopathy. T9 radiculopathy will cause left pain and numbness radiating from the upper portion of the lower back around to your umbilicus (belly button). Myelopathy will cause imbalance in your legs (trouble walking) with strange paresthesias (pins and needles) in a non-dermatome pattern also in the legs.

With myelopathy, the reflexes in your lower extremities would be greater-not lesser, in the 3+ range. You would also have clonus on examination.

Now for your symptoms. Your complaints of “I was told that my left legs, arms and hands are weak” don’t fit as the thoracic spine has nothing to do with your arms. Again “I have no reflex in my left knee and only a weak reflex in my left ankle” does not fit. Finally, “I have hyper reflexes in both my right leg and arm” does not fit as the arm would have nothing to do with the thoracic spine.

Good CT scanners should minimize titanium artifact.

I am unclear if you really need this surgery but assuming you do, here is the discussion. Depending upon the position of the herniation, posterior surgery can be performed (called a transpedicular decompression). This would require a fusion as it is a destabilizing surgery, but generally a transthoracic decompression (what your surgeon was talking about) would also require a fusion. There are circumstances where the only surgery should be transthoracic (depending upon the position of of the herniation).

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.

[Jellyhall]

#28778

Thank you for your speedy reply Dr corenman.

I wonder if damage to my spinal cord that I was told occurred previously before surgery, could still be causing symptoms in my arms now, after the ACDF surgery. I do know that the two levels below my ACDF levels of C3/4 and C4/5, are compressing the nerve roots.

In the past, I have had brisk reflexes in both legs, but this time she couldn’t produce a reflex in my left leg.

I do feel encouraged by your reply that I may not need thoracic surgery, which is something I have hoped for several years. Another symptom that I have that could well be from the thoracic spine is stiffening spasms (Spasticity) every morning in bed as I wake up and begin to move and also when I stand up after sitting for a long time, such as at the cinema.

I wonder if the reason that I have been told about the transthoracic surgery is because the central disc out of the three thoracic discs is to the right, where the upper and lower discs are to the left. Could this make a more invasive surgery be necessary.

Thank you for responding to my questions. I really appreciate it.

[Donald Corenman, MD, DC]

#28780

If you previously had brisk reflexes in both legs and now one of the four (right/left patella and achilles) is diminished, it is possible that you have a root compression of that reflex level. That is, if the achilles reflex was very brisk and now the reflex is diminished, you could have compression of the S1 nerve root which will diminish this reflex in the face of cord compression. Now if both the patellar and achilles reflexes were brisk on one side and now are diminished, that would require unilateral compression of both the L4 and S1 nerve roots which would be much more unlikely.

Where are your spasms located when you wake up?

If you don’t have significant stenosis (narrowing of the spinal canal) but only have effacement of the cord (pushing on one side of the cord without the entire canal being “tight”), you probably do not need surgery. You could consider an epidural steroid injection in the canal at the largest herniation level which can yield relief. In addition, relief in the first three hours will give you an idea of what symptoms these herniations are generating. See https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/ and https://neckandback.com/treatments/diagnostic-vs-therapeutic-injections/

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.

[Jellyhall]

#28788

Thank you again Dr Corenman,

My MRI scan report from last July does state that “at L3/4 there is a broad based posterior disc bulging and bilateral hypertrophy of the ligamenta flava are superimposed on a constitutionally narrow central spinal canal (*Does that mean congenitally narrow canal?), with circumferential compression of the theca/cauda as well as asymmetrical copression of the exiting right L4 nerve root.
That doesn’t explain why there is no reflex at the knee and only slight reflex at the ankle though! I definately do have nerve / sciatica type pain in both legs, but in slightly different positions.

The L4/5 and L5/S1 levels are obscurred by artefact from the metal hardware.

The report also mentions at
C2/3: Broad-based left paramedial sagittal post posterolateral disc protrusion without neural impingement
C3/4 and C4/5 Bilaterally patent central spinal canal and foramina, although there is artefact from the metal hardware obscurring the images
C5/6: Broad based bulged disc and bilateral hypertrophy of the Luschka joints with mild bilateral foraminal stenosis and low probability of bilateral impingement on the C6 rootlets.
C6/7: Broad-based bulged disc without secondary neural compromise

T2/3: Broad based posterior disc protrusion with milk bilateral foraminal stenosis and probable bilateral impingement on the T2 rootlets.
Then the three T7/8, T8/9 and T9/10 levels I have told you about.

My spine sounds a bit of a mess!

This morning, I had the neurosurgeon phone me to confirm that the appointment I received a letter about was intended for me and that I should attend. At my appointment the other day, she was surprised when I showed her the letter, and told me not to go unless I was told it was meant for me.
This is for a Nuclear Medicine Bone PET CT Scan. I asked her this morning on the phone if the scan was to check for bone cancer and she said no.
Can you tell me anything about this scan Dr Corenman, and do you use them?
I think I will be injected with a radioactive tracer before the scan.
I am trying to find out what this scan will show them.

It is good to hear that an epidural injection might help me.

[Jellyhall]

#28789

The spasms that I experience as I wake up each morning are in both legs and feet, especially my right foot where the big toe sticks up. Sometimes the spasms cause my back to arch up off the bed which causes my neck to bend backwards.

If I am standing when I get these spasms they are in both legs, again causing my right foot to turn sharply inwards and the big toe to stick up. When standing, I also feel them around my abdomen and they often cause me to make a sound as the air is squeezed out of me.

[Author]

Posts