July 2019 Edition. Volume XIX

Disc Herniation Producing Cauda Equina Compression in a 15 year old girl


Shown above are some remarkable MRI scans of a 15 year old female high school student demonstrating classic evidence of JDD and associated degenerative changes.  A large disc herniation at L4-5 level has produced marked compression of the nerve roots of the cauda equina, as shown on the right. This student’s mother also had JDD and unsuccessful spine surgery earlier in her life.  At the time of decompressive surgery on this patient segmental instability was documented at the L4-5 level and restorative spine surgery using a single posterior titanium cage and dorso-lateral strut stabilization was carried out.

Disc Herniation Producing Complete Foot Drop and Bladder Impairment

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R. M. is a 48 year old police chief with a history positive for back pain over 20 years due to a genomic spine condition.  He underwent discectomy in 1977 and in February 2002 developed complete foot drop on the right associated with bladder problems.  At the time of this discectomy dorso-lateral autologous bone was placed from L3 to the sacrum to address the multi-level segmental abnormal movement which was present.  A 3-D reconstruction CT image performed 1½ years following surgery is shown.  Patient experienced complete recovery of motor and sensory function and for the first time in many decades was free of back and leg pain (see questionnaire).  This is an example of restorative the utilization of restorative surgical techniques rather than the placement of pedicle screws and rods as a means of providing long-lasting and more physiologic answers to a underlying genomic condition.

The Potential Tragedy Lurking For Those With Genomic Disease

D.K. is a 50 year old whose multi-level genomic disease process was finally documented in 2003.  Like many patients with genomic problems D.K. experienced herniated lumbar discs for which he had surgery in 1984 and 1986. Because of continuing back pain he was seen by a scoliosis/deformity spine specialist who performed a rigid 3 level pedicle screw instrumented posterior and an interbody fusion in 1996.  Patient’s pain and disability were not improved and he was referred to a Pain Management Clinic where a morphine pump was implanted in year 2000.  Because the intrathecal catheter caused thoracic adhesive arachnoiditis producing catheter obstruction the morphine pump and catheter had to be removed.  D.K. remains incapacitated and continues to take strong narcotic medications to help him make it through the day.

The case presented above is true.  Unfortunately, this story is not a  unique one.  The on-going failure to properly diagnose and  appropriately treat multi-level degenerative problems associated with  genomic conditions has been responsible for many similar treatment disasters.

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