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in reply to: Spinal Axial View #4743
A schwannoma is typically a benign nerve sheath tumor of the schwann cell. The schwann cell is an insulating cell for the peripheral nerve and creates the myelin sheath. This tumor normally does not involve the spinal cord but in certain locations, the pressure from this tumor can cause injury to the cord.
Either by the original compression of the tumor or occasionally the surgical removal, a scar can occur on the cord that shows up as a white spot on the T2 images on the MRI. Ask your surgeon if it is a scar or possibly something else (unlikely but still make sure).
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.in reply to: L5-S1 Extruded Disc #4741You mention a herniation at L5-S1 which I assume is pressing on the S1 nerve. This nerve innervates the calf muscles (gastroc-soleus group) that pushes the foot down against the ground when walking. This muscle group is responsible for “push-off” at the end phase of gait and important for climbing stairs and also in your case, ladders. You mention weakness of these muscles. That by itself would be a consideration for surgery as decompression of the nerve root allows the best chance for strength recovery of a weak muscle.
If the muscle weakness is not significant or you can live with it, surgery is then considered for pain relief. If you can live with and manage the pain with medications, therapy and occasional injections, you do not have to undergo surgery. However, if you have the pain for longer than six months without surgery and eventually decide to have surgery, the success rate for surgery is diminished by waiting so there are timely decisions to be made.
Will surgery cause problems? There is a slight chance but the success rate should be at least 90% in most cases for relief of pain. You theoretically could have an infection, nerve injury or dural leak but these should be exceedingly rate in the hands of a good surgeon.
There should be no difference between a good spine surgeon and a good neurosurgeon, so pick the surgeon who you feel most confident with if you choose surgery.
Good luck on your decision.
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.in reply to: Chiari malformation hemangioma #4738Arnold Chirari malformation is a problem with the brain stem at the base of the skull. The cerebellum is the part of the brain at the lowest aspect of the skull and has two paired structures, the cerebellar tonsils that are right above the foramen magnum- the hole at the base of the skull that the spinal cord exits from and arteries enter to supply the base of the brain.
In a case that these tonsils descend or are “pushed” into the foramen magnum to crowd the spinal cord, this is call an Arnold Chirai type 1 malformation. This may or may not be symptomatic. The type 2 disorder has more of the brain stem that is pushed down to crowd out the spinal cord and is more associated with symptoms.
Symptoms include balance problems, arm and leg weakness, paresthesias (pins and needles) and numbness, swallowing, tinnitis (ringing in the ears), nausea, vomiting, headache and base of the skull pain. A condition called syringomyelia can occur which is a collection of fluid in the spinal cord- associated with the type 2 problems.
The “size” of the Arnold Chiari disorder depends upon how “congested” and deformed the brain stem is and what signs and symptoms are associated.
The “hemangioma” found in the thoracic spine may or may not be a problem. Benign hemangiomas are quite commonly seen on an MRI of the vertebral body and generally do not cause problems but there are rare hemangiomas that can be troublemakers. You need a good consultation to determine the significance of both.
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.in reply to: Spondylolisthesis slippage at L5-S1 #4733I am not clear if your mother had a degenerative spondylolysthesis or an isthmic spondylolysthesis (see website for specific details). You also don’t reveal your mothers activity level which can be important for surgical planning. Did she have strictly back pain or did she have leg pain or both prior to the operation? All these can make a difference with surgical planning. You don’t reveal if she had a decompression surgery or decompression with fusion for the first surgery which is important to know.
It sounds like she developed a form of foraminal stenosis (again- see website) after the first surgery with leg pain that occurred with standing. This fits if there only was a decompression or a decompression/fusion that did not rebuild the disc height and the ensuing collapse allowed nerve compression.
She then underwent a second surgery and you don’t reveal if it was from the front (through the abdomen) or another one from the back. Again, the information is spotty but you report she may have developed an infection at the surgical site. If she developed a deep infection (in the spine itself) and not a wound infection (the skin incision only), then antibiotic pills will generally not work.
The way to diagnose a deep infection is with a new MRI and some laboratory tests as well as some blood cultures. She really needs to see an experienced spine specialist to help with diagnosis and treatment sooner than later.
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.in reply to: Spinal stenosis #4732Cervical spinal stenosis is significant narrowing of the spinal canal that the spinal cord occupies. The problem with spinal canal narrowing is that the canal changes in diameter with bending the neck forward and backwards. Forward bending generally increases the size of the canal and backward bending reduces the canal size. A fall and blow to the forehead can cause a backwards bending force that causes cord compression and possibly injury. The typical injury is a central cord syndrome (see website for description) which is not rare in falls with mountain biking, skiing and climbing in patients with cervical stenosis.
The problem we have as surgeons is that we don’t know how many people have the condition and fall without developing an injury so the risk is not quantifiable. You can’t be told that you your risk is 1% or 00.1%.
Your surgeon told you to look out for signs of myelopathy (see website for description) which is a “chronic pinching” of the cord. The cord needs to be surgically decompressed if that condition develops.
Tingling in the shoulder and arm is generally not from cord compression but from nerve root compression (see website for cervical foraminal stenosis). Strengthening the neck muscles in light of cervical stenosis can be helpful and if the tingling symptoms become annoying, epidural spinal injections can be helpful.
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.in reply to: Help Interpreting Mri #4731Please contact my office at 888-888-5310 to talk to one of my nurses. They can explain how your MRI can be viewed at the office.
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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