[MQ]

#23274

Hi, three years ago I started to have severe lower, mid, upper back pain. The pain migrated and became a burning sensation on my left side of my abdomen and top of my left leg thigh. The pain would come and go but persist more when I sit, either on a chair or in the car. About a year ago, I was beginning to have heel pain and went for physical therapy as the original diagnosis was plantar fasciitis. The leg pain persist during the heel pain. About six months ago, I started to feel parts of my left leg become numb. The numbness would go away when I laid down, but about 3 months ago, the entire left leg became numb and it wouldn’t get better. About two months ago I noticed that I had the urge to urinate more often when I was sitting in my car. The urge would be sudden and there were many times I felt that I couldn’t hold it in and had to release. The urgency to urinate comes and goes when I sit. I don’t have the urge when I am standing or when I’m laying down. My urge to defecate has been more sudden as well in recent weeks, typically after I have already gone once, then when I go for a run or drive for some time, I feel the need to go again. I do not have weakness in my leg muscles nor do I have problems with balance and strength. I have leg spasms both in my left and right leg. More so in my left leg when I’m stationary for some time and I feel a build-up of tension in my muscle and I have to release it. I work out regularly 2-3 times a week. I had three lower back MRI’s that cleared and an MRI for my thoracic and neck region. The thoracic area showed that I have a ventral spinal cord herniation at the T4 Level. The herniation is caused by a small hole in the front ligament and making a “kink” in my spinal cord. I have seen two surgeons and all recommend surgery, but none have surgically worked on a case like mine as they said its rare. The question I have is what is the risk of surgery? It appears I had this at birth and my symptoms are getting worse over the years. No surgeon can say if after surgery that my symptoms will improve or become worse. I am torn with going through the surgery with such an unknown outcome. I have a snap shot of the MRI that I can provide if this would aid in your response to my question.

[Donald Corenman, MD, DC]

#23280

It is difficult to contribute all your symptoms in your lower extremities, abdomen and bowel/bladder to this disc herniation in the upper thoracic spine. You should have obvious long tract signs (hyperreflexia, clonus, abnormal sensation tests with the pinwheel and even Babinski’s signs) in your lower extremities upon examination. Also, rectal tests (tone, sensation and contractility) may be abnormal.

This area of the spine is difficult to approach. An anterior approach has to go through the chest wall and move the heart/great vessels to the side. A posterior approach is even more difficult (if the herniation is midline anterior) but easier if this herniation is on the side. Nonetheless, the approach does put the spinal cord in jeopardy as the cord will not tolerate retraction.

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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