Intramedullary thoracic cord lesion

Posted by cornhusker1 @cornhusker1, May 26 7:56pm

Anyone have surgery for a solitary intramedullary thoracic cord lesion @ T7-8 with a differential diagnosis which includes ependymoma or astrocytoma ? According to my latest MRI. I have no pain but my gait is very challenging. I look like a balloon on a used car lot. I bobble along. The spine surgeon doesn’t think lesion is cause. The neurologist does. I’m stuck wondering what next?

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@cornhusker1 Welcome to Connect. This is a concern for sure. I believe what your neurologist says because spinal cord compression often does cause an uneven gait. I am a cervical spine surgery patient, and I experienced an uneven gait with a limp because of spinal cord compression. I was working with a physical therapist at the time, and my spine was shifting with muscle spasms and the vertebrae were slipping past each other by 2 mm. That was enough to cause the limp because essentially that decreased the diameter of the spinal canal, and when my physical therapist realigned my spine, I could walk normally again. It was intermittent because the spinal stenosis hadn't progressed far enough yet to cause further pressure and my PT could relieve the pressure.

Essentially, you have a similar situation of cord compression. How are you discussing this with your surgeon? Even if the surgeon doesn't think the symptoms are related, there is still a tumor on your spine that needs treatment. The differential diagnoses they gave you are a bit scary with a possible malignancy, and I hope it is not that. Some spine tumors can be benign, but you wouldn't know until it is removed and biopsied. My husband went through a similar situation having a lump removed (not on the spine), and it turned out to be benign. He has had a cancer diagnosis from a melanoma on his skin, so we have to be vigilant about any new lump or skin lesion.

Will you be getting a second opinion from another spine surgeon? My preferred specialist would be a neurosurgeon because this is a tumor on the spinal cord or it's covering. Your neurologist may be able to help with recommendations for specialists. Surgeons have to be careful not to promise results unless they are fairly certain this would be the outcome, so this may be why the surgeon questions the link to the uneven gait. Spinal cord compression can also cause bladder and bowel dysfunction.

Do you have a followup scheduled?

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Thanks for your kind reply. My tumor is the size of a pearl inside my spinal cord. Both spine surgeon and neurologist said surgery is very risky and I could come out worse than going in. I am currently working with PT and she is trying to strengthen my core and back muscles as I tend to lean backwards and to the right. I can drive perfectly fine as it just seems to be in my trunk. My legs are strong as well as my arms but I am developing bladder incontinence. I am 74 and have always been very active. I am an established patient at Mayo’s as I have Achalasia and have done very well there so I’m thinking of going there to get some ideas and second opinions. Surgery sounds so scary at this juncture and the recovery even worse. I go back for MRI in two months to see if tumor has grown. You certainly have given me a lot to think about. Thanks so much.

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@cornhusker1

Thanks for your kind reply. My tumor is the size of a pearl inside my spinal cord. Both spine surgeon and neurologist said surgery is very risky and I could come out worse than going in. I am currently working with PT and she is trying to strengthen my core and back muscles as I tend to lean backwards and to the right. I can drive perfectly fine as it just seems to be in my trunk. My legs are strong as well as my arms but I am developing bladder incontinence. I am 74 and have always been very active. I am an established patient at Mayo’s as I have Achalasia and have done very well there so I’m thinking of going there to get some ideas and second opinions. Surgery sounds so scary at this juncture and the recovery even worse. I go back for MRI in two months to see if tumor has grown. You certainly have given me a lot to think about. Thanks so much.

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@cornhusker1 Getting an opinion at Mayo is an excellent idea. Mayo has the Proton Beam and they did use it to successfully treat a brain tumor in a child. That was in the Ken Burns documentary about Mayo. My spine surgery was at Mayo with Dr. Jeremy Fogelson. He is excellent. Certainly, you have a difficult situation. I hope Mayo can offer some help that doesn't cause further damage elsewhere.

Jennifer

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I don't really know what to advise. What do these 2 doctors want you to do? And perhaps you need second opinions.

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@meg8

I don't really know what to advise. What do these 2 doctors want you to do? And perhaps you need second opinions.

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Neither one gave any advice except see you in two months (neurologist) and MRI in 6 months (spinal surgeon). I guess I need to be proactive on my own.

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