JBoz

Dr. Corenman,

This is the list called (Name Of Procedure) from my surgical report. The indications were the severe chest pain, and disc protrusion causing it, after 2 years of cardiac, GI, and lung tests.

1. T4 laminopslsty with decompression of the spinal cord, nerve roots, including medial facetectomies and foraminotomies.

2. T5 with decompression of the spinal cord, nerve roots, including medial facetectomies and foraminotomies.

3. Microsurgical intradural exploration.

4. Resection of the T4-T5 herniated nucleus pulposus.

5. Usage of operative microscope for microdissection.

6. Usage of fluoroscopy.

7. Complex surgery.

Upon review of the recent MRI, my pain doctor will not work on the T4-T5, as I mentioned. He said he felt I would not get any relief from treatments, he was concerned with the swelling still going. I did confirm it was not fluid build up with the surgeon who did the surgery a 4 months back. They said it was damaged tissue, and the finding was worsened, yet the hygroma was resolved. I came out of this surgery with the severe chest pain, it was very severe after surgery, so I knew they hit on the right spot. The chest pain then went to off and on. Now it has returned to being constant. The new back pain is very severe, and goes from both left to right. It feels like a sword going through me. I mentioned in a earlier thread that the surgery began at the wrong level. It was then closed up, and done at the correct level. Only the incision was made, not a surgery on the lower level. Still, this had to put pressure on the balance of the surgery.

I’m concerned that the radiologist thinks there is a fusion in this last report. Its been 8 months since surgery, and my condition feels worse, I took the risk, because my chest was so very bad. I never had the severe back pain, until after the surgery, along with the right leg being on fire 24/7. I did find a video about myelomalacia, by a Ken McKim talking about the condition, it all seems very serious in nature… explained by this video. There is just not a lot of information out there. I do hope it will one day improve, but at this point it causes pain to be active, and it would be near impossible to do any type of work, even part time. The one time I do feel relief is in the pool.

I am seeking a second opinion, but finding anyone who works on the thoracic spine is a challenge. My concern is how I explain this to a normal doctor at this point. I don’t even understand what is going on in my spine, I only know this pain is extremely hard to cope with on a daily basis.

Perhaps the surgery notes above will help shed some light on the findings in the MRI I posted. I feel like I’m having a 24/7 heart attack Dr. Corenman, I have been this way for just over 4 years now. The new back pain, I guess that is the risk we take with any surgery. The overall outcome is devastating as a single father. I feel helpless against this cord damage, and what appears to be very difficult to fix at this point.

Thanks again Dr. Corenman, I’m truly grateful for your time. I see a doctor for disability soon. I have had all my doctors compassion for my claim. I can only pray he has some understanding of the spine, and will understand this condition.

Jboz

Hello Dr. Corenman, I figured it would be better to post the actual report. It was confirmed to be myelomalacia and not fluid build up.

TECHNIQUE: Sagittal T1, T2, STIR and axial T2-weighted images of the thoracic spine were obtained without contrast. 10 cc OptiMARK was given. Postcontrast Tl -weighted axial and sagittal images were obtained.

FINDINGS: There is a smooth physiologic thoracic kyphotic curve. Vertebral heights appear generally maintained. Disc degeneration is mild from T4-5 through T8-9 ar.d at T10-11 .vitfi. dehydration and narrowing. There is a moderate-sized vertebral hemangioma to the right posteriorly at T7. There are laminotomies at T3-4, T4-5 and TS-6. There appears to be a posterior fusion at T4-5, No worrisome marrow replacing lesions are seen. The extraSpinal soft tissues appear normal. These findings appear stable.

T4-5 demonstrates a 2 mm left paramedian broad disc protrusion with a peripheral annular fissure. There is mild spinal cord flattening to the left with stenosis and midline AP canal diameter of 8 mm. No hypertrophic facet DID. No foraminal stenosis. No significant change.

T10-11 demonstrates no significant disc bulge. Facet DJD is mild on the left and mild to moderate on the right. No spinal cord flattening or central stenosis. No foraminal stenosis. No significant change.

The remaining thoracic discs do not show evidence of significant bulge, protrusion, or extrusion.

There is moderate to severe spinal cord edema and/or myelomalacia from mid T4 through mid T5, unchanged. The remainder of the thoracic cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. No mass. Following contrast injection, there is enhancing granulation tissue in association with the laminectomies at T3-4 and T5-6 as well as in the posterior midline soft tissues from T3-4 through T10-11, also consistent with postsurgical granulation tissue. No significant abnormalities of intrathecal contiast enhancement are observed.

IMPRESSION:
1. Disc degeneration is mild from T4-5 through T8-9 and at T10-11; laminotomies at T3-T4, T4-5, and T5-6.

2. T$-5 mild spinal cord flattening to the left with stenosis.

3. Spinal cord edema and/or myelomalcia is moderate to severe from mid T4 through mid T5.

4. Allowing for minor variation in partial volume averaging, no definite interval change is lidentified since April 29th, 2016

I should add there was no fusion, and the surgery was only at the T4-T5 level. I only know there is very little information on myelomalacia, and I wonder if most doctors even know about it. This entire battle with my spine has reduced my quality of life tremendously. I cannot function due to severe pain, in both my chest and now my back. It feels like a spear going through me at times. I did file for disability back when my cervical fusion failed, then I had the posterior fusion to fix that, I’m currently in a rock and a hard place, considering my pain doctor will not treat my thoracic spine, due to these findings above, we waited the 3 months, and there was no improvement. I don’t know how to explain this to others, but the problem is more severe than I can put into words. I ended up worse than I was before taking the risk to do this surgery. It was previously a rare herniated disc, causing severe enough chest pain to take the risk. I wish I had some more hope than just time. I don’t know what a second opinion could do, but I may try and get one. I never thought this would be my situation after surgery.

Do you think most doctors have any knowledge on this condition?

I wonder if you have ever treated a patient with this condition, or would you even touch a patient with this condition?

Thanks Dr. Corenman, you have been of great help to me the past couple years. This is directly copied from my report to this page

Dr. Corenman, I understand.

I wish I could better describe the details. I think my primary concern is the spinal canal has less room now than before. I’m concerned that the radiologist had to call the surgeon the same day, and that is shows edema worsened from one month after surgery. I fear this is getting worse, I base that off the pain and symptoms of my chest pain and the new back pain. I seriously was hoping for healing to be taking place, but as you said it could possibly be damage or injury to the spinal cord.

The one thing left out on the report is how it impacts my cord. The other MRI said severe flattening. this just says 2cm vertically of moderate to severe edema, and or the myelomalacia.

Again I appreciate you taking the time to answer my questions. I think I need to wait for my surgeon to get back to me. I don’t know how serious this is right now, and that is the single most frustrating part. I thought it was serious because my surgeon had to be called. I have done a lot of images in the past, that has never occurred.

Thanks again,