*Thoracic* disc herniations and myelopathy, anyone?

Whee. In 2006 and again in 2007, I had a microdiscectomy/laminotomy/foraminotomy on L5/S1 after the disc essentially blew apart during child birth. I’d had problems with it before, but pregnancy and delivery destroyed it. I knew that if it failed again, I’d be looking at a fusion. In the years since then, I’ve been stiff, but that excruciating, immobilizing pain has never returned.

But in the last year, my health has gone to crap. We’re still trying to get a clear picture of what’s going on. Best we can tell after ALL the blood work (mercy, mercy me–believe me, I have been tested for everything from lupus to Lyme’s to heavy metal toxicity to…you get the idea) and MRIs and lumbar puncture is I have 1) Hashimoto’s thyroiditis, an autoimmune thyroid disease (that now appears to be controlled); 2) Fibromyalgia, which is decidedly NOT controlled; 3) Chiari malformation type 1, that according to two specialists does not appear to be behind my collection of neurological symptoms; and most recently, 4) herniated thoracic discs at T6-7 and T8-9. Those I find intriguing. While the herniations are small–3-4mm or so–they are clearly impeding the spinal cord.

From what I understand, herniations at the thoracic level are rare, and ones that are symptomatic, more rare. However, mine are pressing into the spinal cord (pretty obviously on the MRI) and bending it a touch to the right. I’m wondering if this is behind some of my neurological symptoms, like the loss of temperature sensation in my lower right leg. While I can feel pain and touch, if you touch that leg with an ice cube, I can tell you’re touching me, but not that it’s cold. Ditto heat. Additionally, that leg also sometimes feels “heavier,” for lack of a better description. While I think I can still walk normally with it when it’s like that, it just feels…odd.

I have multiple other neurological symptoms as well–I have a mild positive Rhomberg’s test (can’t stay balanced with feet together and eyes closed; I start to sway then fall), hand tremors (worse in left side), weakness in the left side, pins and needles shooting up each side of my head (never both at the same time), down the arms (usually right, but sometimes left, never both), and along the outside of the right leg, blah blah blah. It does keep going (boy does it), but I’ll spare you.

The radiologist described my symptoms in the MRI report as simply "myelopathy,"which from what I gather is defined variably as disease of the spinal cord, malfunction of the spinal cord, and the like. Eek. :o I don’t want my spinal cord having ANY issues. At least in the lumbar region, you just have to deal with nerve roots, not the cord itself.

I’m a bit concerned about what may be next. I assume probably physical therapy first–having been down the bad back treatment path before–but microdiscs at this level are much more rare as it’s far more risky and complicated. I also worry a fusion may be in my future with all the problems down in the lumbar region (I also have a herniation at L4/L5 that was about 3-4mm at last measurement, 6 years ago or so).

I also wonder if with all this mess I have any business being on the back of a horse at all. :frowning: But I am getting into driving, mercifully. My little 36" mini may just be my equestrian salvation.

Has anyone been there, done that with this? Or really offer any sorts of experience, advice, insight, encouragement? :frowning: This has really worn me down, but I’m still pushing through and living life each day best as my body allows me to.

I feel bad you haven’t had anyone chime in. Yours sounds like a unique situation. Is there a community somewhere online where you can share your experience?

I am a fellow teacher, so I also just wanted to ask you how you are coping. :o

When I had problems with my back, in the same thoracic region, I too lost the sensation of hot and cold but could still feel pressure. I had a laminectomy, but no fusion as my Dr. said the thoracic area is the most stable part of the spine. Be careful not to scald your leg in the bath, and driving is probably more sensible for now.

Aw, Bristol Bay, you’re so sweet–and such a teacher at heart, not wanting me feeling left out. :wink: I do have communities I belong to for my spinal issues, but I came here looking for that special equestrian take on my unique situation. Thoracic issues are rare to begin with, so it is a bit of a longshot here.

csaper58, interesting take. Glad the surgery helped you, and it’s relieving to hear a fusion isn’t necessary since the thoracic is so stable. What other problems did you have? Why did they determine surgery was necessary?

The neurosurgeon I saw this week did not feel I’m a good candidate for surgery at this time–basically, my symptoms aren’t severe enough to tip the risk/benefit scale that direction. But in the last week, I’ve started getting feelings of cold (like the pants leg is wet) in my lower right leg, and I woke up today with numbness in the top-back of the right calf.

My referring neurologist said I’m more than welcome to get a second opinion, and I’m debating if I should. The neurosurgeon I saw wants a lumbar MRI and a follow up in 2mos. :confused:

Laururuffian,

I have very similar injuries and am happy to discuss.
Mine, were the result of a bad riding accident. Thoracic fractures at T4, T6, T7, and T8. Coexisting herniations at each, spinal confusion, nerve damage.

Initially, after the injury I did have a lot of sensory disturbance. Ie sensations, hot, cold, numbness. From my thoracic area downward, I get the “heavy” or weighted feeling. The intensity tends to be directly correlated to time on my feet.

Could your symptoms be related to what is found on imaging? Unless proven otherwise, I’d have to guess yes.

The thoracic spine is a fickle beast. I have learned the hard way. I also know, beyond a shadow of a doubt, that I love walking. The fact that I’m not in a wheelchair is a miracle.
To ride or not is individual. My recovery path has been long, and incredibly painful. The future includes permanent nerve damage. As a whole, I don’t see myself riding the way I used to. The occasional ride on a retiree, sure. It really comes down to “what is it worth?”.

My #1 advice is to get specialists who listen to you. It took 5 second opinions before I got the care needed.
#2 If you are painful, request a referral to Pain Management…preferably someone who is also a Interventional Radiologist.
#3 listen to your body.
#4 get good shoes!! Do not skimp on footwear!!! Wear sneakers when possible.

I’m sure there is much I’m leaving out. Feel free to ask me anything. I’m sorry you are having to deal with this.

Thank you HeatherCCK11. Right now, more than anything, I’m just terribly confused. All of my doctors agree something is going on neurologically, but there is no clear consensus as to what.

The neurosurgeon I saw last week was dismissive of the thoracic herniations, and blamed my Chiari malformation, which he felt was not operable.

My neurologist (who dismissed the Chiari) urgently sent me to the above neurosurgeon because of the findings on the thoracic MRI.

My rheumatologist assumes it’s part of my fibromyalgia.

The rheumatologist, neurosurgeon, PCP, and an earlier neurologist all have voiced suspicions of multiple sclerosis, but they all agree it’s not the case now. The neurosurgeon said the thing about MS is it’s undetectable in its early stages (all of my MRIs, and my spinal tap, show no evidence of it).

It’s just so exhausting. The neurosurgeon wants a lumbar MRI (since I’ve already had 2 surgeries there, may as well rule it out too) and will follow up with me in July…but then suggested I stop pursuing this and take a 6mos-1 year off. He reiterated MS and some other conditions take time to reveal themselves, which I understand.

Right now, my neurological exam–while peppered with definite signs of something going on–isn’t bad enough to concern him. (No clonus, I still have good strength, decent balance, can walk unassisted.) But–there were two new findings revealed in that exam, things not there last month. Minor, again, but still new. Each neurological exam I get reveals something that wasn’t there the previous time, while the previous findings remain.

I woke up yesterday with the numbness in my right leg now spreading from the side of my calf to the upper back of it as well, as well as the top of the right foot by the toes. Maybe it’ll go away as inexplicably as it arrived, maybe not. It’s still there this morning, but I want to wait and see how persistent it is.

My neurologist emphasized getting a second opinion if I’m not comfortable with what the neurosurgeon said, and I guess I was assuming I’d only get a second opinion if the NS wanted to operate. Maybe I’ll get another one after all, just to see, although MAN am I tired of collecting doctor opinions. Treatments would be nice. All we have concluded thus far is something is going on. Sigh.

Have the MRI’s been done with contrast? There are problems that don’t show up if contrast is not used. It really sounds like something is pressing on your spine.

It sounds like you need another opinion, from a Dr. that likes puzzles. Not all of them have the gumption for difficult cases. They are taught to look for horses not zebras and all of that, but if you are the one that is a zebra it’s very frustrating.

I had the best result with a wonderful surgeon at a teaching hospital.

Yes, all of my MRIs have been done with and without contrast. I agree that something seems to be pressing on my spine, I mean, it seems clear to me the spinal cord is being compressed. With contrast, here is the lower herniation (T8/9) and then here is the higher one (T5/6). The doc was unconcerned because there was no sign of inflammation.

Le sigh.

My problems are all neck but can’t they do an EMG and nerve conduction study to determine the cause of your nerve issues?

I assume you have seen the dermatome and myatome charts such as this one:

http://img.tfd.com/dorland/thumbs/dermatome.jpg

I had an EMG back in February, but she was focusing mostly on my upper body/right arm at the time. My left left hadn’t gone numb yet, so maybe we can recheck as I’ve had more symptoms develop sense then. The results were more or less normal (some diminished signal in right arm), so that points to it being a central nervous system problem and not peripheral.

I have seen the dermatome charts, but never that specific for thoracic. It seems thoracic isn’t quite as black and white as, say, lumbar. When my L5/S1 blew out, it was textbook pain according to that map–through the hip, along the outside of the leg, sharp heel pain, etc. This is much more vague. From what I’ve gathered in the reading, when it’s a thoracic/spinal cord issue, symptoms can present anywhere from the impeded spinal cord down.

I’m thinking csaper is right–I need a doc who likes a puzzle. My neurologist seems intrigued by me; maybe I should follow up with her, maybe after a second opinion. My follow up with her was cancelled in lieu of the urgent referral to the surgeon, but with the surgeon feeling “meh,” maybe I should revisit it.

My neurologist in Scottsdale was definitely my puzzle solver. I say go for it. I hope they get things figured out and calmed down for you.

OP, Have the Dr.s considered the possibility that this is a nerve sheath tumor? The symptoms are very similar to what you are experiencing. The symptoms also change as the tumor grows, and changes shape.
www.webmd.com/cancer/neurofibrosarcoma-and-schwannoma

Don’t let ‘cancer’ in the web address scare you, these tumors are rarely cancer. Find a puzzle solver asap.