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Neurology (Expert Forum)
Pro's/con's to decompression
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Pro's/con's to decompression
by Lynn, Oct 19, 1999 12:00AM
Thanks for your help. I have multi-level thoracic HNP's diagnosed almost 4 years ago by myelogram/CT after conflicting MRI opinions. The most concerning level is T7-8. This disc on, myelogram/CT, is compressing the cord to the shape of sqwished heart. It is quit clear where the disc ends and cords begins. I have a progressive myelopathy with loss of temperature sensation and pain on the front of my legs but NOT my toes. This has been for about the past year. The last neurosurg. I saw last May felt that the disc is stuck to the cord and the cord is draping itself around the disc. He felt that decompression was necessary even though it may not explain my s/s but after a full MRI of brain and spine w/wo contrast I was found to have several bright whites lesions in the periventricular areas of the brain and because he feels I have MS also he is reluctant to do surgery because he says MS'er's don't do well with anesthesia. I have since had an LP (normal except low protein) and VEP,BAEP, and SSEP. The only abnormal is both upper and lower extremety SSEP. I was evaluated at the International MS Center at Baylor in Houston by Dr. Rivera. He repeated the brain MRI and no new lesions were found although the time between MRI's was about 3 months. He feels that I do have RRMS but my neuro in town is not yet convinced of this because of the neg LP. I have never really clinically fit the picture of MS.
Now that I have given you the run down, my questions are :
1. Not taking into account whether the severe cord deformity at T7-8 explains my s/s, how dangerous is it to leave the compression since it has been there at least 4 years? Are my chances of becoming paralyzed greater leaving it than removing it?
2. What about the numerous white spots on the brain yet neg. LP? I think I had an active process years ago but at present I feel it is dormant. Does this sound possible?
I have an appointment to see another surgeon, ortho-spine, at the end of this month. I am very concerned about how "irritable" the cord would be if someone tried taking that disc off.
I know this is for my info only and I truely thank you for your input. I know your time is limited and I apologize for the length of this post. Lynn
Now that I have given you the run down, my questions are :
1. Not taking into account whether the severe cord deformity at T7-8 explains my s/s, how dangerous is it to leave the compression since it has been there at least 4 years? Are my chances of becoming paralyzed greater leaving it than removing it?
2. What about the numerous white spots on the brain yet neg. LP? I think I had an active process years ago but at present I feel it is dormant. Does this sound possible?
I have an appointment to see another surgeon, ortho-spine, at the end of this month. I am very concerned about how "irritable" the cord would be if someone tried taking that disc off.
I know this is for my info only and I truely thank you for your input. I know your time is limited and I apologize for the length of this post. Lynn
Doctor's Answer
by CCF Neuro[P] MD, RPS, Oct 19, 1999 12:00AM
Dear Lynn:
Sorry to hear about your symptoms. Whether to have surgery or not depends on the lesion, surgeon, and risk to benefit ratio. I would agree that your symptoms can not be accounted for by the disc at T7/8. However, if the disc seems to be getting worse with compromising the cord, then it would seem that surgery is indicated. If there is really no compromising of the cord the the herniated disc is not progressing then maybe surgery can be with-held for awhile. I would suggest at least a second opinion. Surgery is usually the last resort and filled with possible outcomes that are patient specific. Seek another opinion about the studies and then make an informed decision.
Whether you have MS or not is another question. Changes in the are you describe are common in MS. Having a normal CSF doesn't mean that you can't have MS, only that you are not having active lesions occurring or have not had one in awhile. Maybe you will be in the lucky category and only have one episode.
I hope that I have helped alittle.
Sincerely,
CCF Neuro MD
Sorry to hear about your symptoms. Whether to have surgery or not depends on the lesion, surgeon, and risk to benefit ratio. I would agree that your symptoms can not be accounted for by the disc at T7/8. However, if the disc seems to be getting worse with compromising the cord, then it would seem that surgery is indicated. If there is really no compromising of the cord the the herniated disc is not progressing then maybe surgery can be with-held for awhile. I would suggest at least a second opinion. Surgery is usually the last resort and filled with possible outcomes that are patient specific. Seek another opinion about the studies and then make an informed decision.
Whether you have MS or not is another question. Changes in the are you describe are common in MS. Having a normal CSF doesn't mean that you can't have MS, only that you are not having active lesions occurring or have not had one in awhile. Maybe you will be in the lucky category and only have one episode.
I hope that I have helped alittle.
Sincerely,
CCF Neuro MD
Not seeing the pictures I can really not make a comment. About the medication, you need to come to solution between you and your neurologist. However, brain lost is forever. Maybe a second opinion might help.
Sincerely,
CCF Neuro MD