I had surgery on 2/9/05 for an intradural spinal tumor and a tethered spinal cord. Since surgery I have had an increase in numbness to my right leg on the outside potion. The numbness has now moved up into my buttocks and I am having trouble urinating. I cannot put much weight on my right leg as it causes tremendous amounts of pain in my lower back, more so on the right than the left. I am unable to walk without the assistance of a walker. I am also currently doing aqua therapy. My neurosurgeon ordered an MRI and I have received the results from the imaging center. It says bone alignment and marrow signal are maintained. The conus medullaris is abnormal in appearance. The conus extends to the level of the L4/5 disk interspace, and has a stretched appearance, with apparent tethering to the dorsal aspect of the thecal sac, asymmetric to the right at the L4/5 level. Prior surgical changes are noted with L4 laminectomy and resection of a portion of the L5 spinous process. The upper lumbar levels are unremarkable in appearance. At L3/4, no disk herniation, root displacement, canal stenosis, or forminal stenosis is observed. Post contrast imaging demonstrates no evidence of abnormal intradural enhancement throughout the lumbar region. At L4/5, there is a mild disk bulge noted. Facet arthropathic changes are noted with posterior element hypertrophic change, resulting in bilateral lateral recess stenosis. Ventral mass effect upon the thecal sac is observed, without demonstrated proximal L5 root mass effect. No significant foraminal narrowing. At L5/S1, a mild disk bulge is noted without lateralizing herniation, root displacement, canal stenosis, or forminal stenosis. I need you to please explain what all of this means, as I have not idea what any of this information means. Please email me back and tell me what all of this means. My neurosurgeon has not contacted me as of yet to set up an appointment to discuss all of this. Can you please suggest any treatments that may help me and any questions that you feel I should ask my physician when I meet with him

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Dr. Joshua’s Answer:

Adult tethered cord syndrome is rare, and is often accompanied by pain, leg weakness, and urinary problems. It’s difficult to treat. Was the tumor an intradural lipoma? What symptoms did you have before the surgery? Did you walk better before surgery? Was the pain relieved at all by surgery? The MRI says there is no evidence of tumor left inside the spinal canal. It appears from the MRI report that the cord is still tethered. At the level of the 4th and 5th lumbar vertebra, there is joint disease which causes narrowing of the nerve root passageways on both sides.This could potentially cause leg pain, but in your case, the situation is very complex. The rest of the MRI report has nothing of particular note.?

Questions you should ask your neurosurgeon: Was the cord succesfully untethered? If not, should another operation be planned to untether the cord? Can something be done for the pain? Surgery for adult tethered cord is usually effective for the pain, less effective for urinary problems. Why are you still in pain? Is there something else that could be done for the pain? Which nerve root does the pain come from? Is there nerve root compression that could be released by microdecompressive surgery? What is the rehabilitation and follow-up plan? If you feel you are still left with unanswered questions, you can always get a second opinion from another neurosurgeon. If you do, bring the original MRI pictures with you.