My wife, 51, began experiencing tingling/numbness in RT hand and arm … MRI showed stenosis at c4-5, c5-6, c6-7 … neurosurgeon performed “anterior cervical discectomy and interbody fusion, c4-5, c5-6, c6-7 with bone grafts from the right iliac crest.” Immediately when she awoke in recovery she couldn’t feel her legs. Stat x-ray and CT scan were normal per surgeon. Within a couple hours she was diagnosed with Brown Sequard Syndrome because of RT side motor deficit (arm, hand, leg) and numbness in left side (almost entire body left side). She has made some recovery with intensiive PT (leg is better, but hand and burning/tingling/numbness in arms, hands, and legs is worse).

Two weeks post-op we went to another neurosurgeon for another MRI with contrast. This MRI showed c4-5 (AP diameter of 8.5mm and moderately narrowing of RT lateral foramen) , c5-6 (AP diameter of 7.0 with severly narrowed nerve root exits bilaterally) , c6-7 (AP diameter of 8.5mm, moderately narrowed lateral foramen bilaterally). There was also what appears to be a spinal cord bruise at the surgical site.

I have many questions but I’ll start with these: does a bruised spinal cord heal? If so, will her recovery still be limited by the stenosis? Should we consider another surgery and when?

Doctor Joshua’s Answer:

Generally speaking, damaged spinal cord does not heal. When the trauma is recent, and if there is swelling, stenosis must be treated because it may cause further damage, disturbing blood and oxygen supply to the spinal cord. Once the acute phase is over (as it is in your wife’s case), the stenosis needs to be evaluated according to whether the existing symptoms can be accounted for by the stenosis, in which case surgery may be needed, but if the stenosis cannot explain the symptoms, and the symptoms are clearly caused by the existing spinal cord damage, surgery will not make her better.

Slightly decreased AP dimensions alone are not sufficient to judge whether there is such cervical spine stenosis that would require surgical intervention. You are correct that if the surgery was unsuccesful in relieving the stenosis, a new operation needs to be considered. The judgment is made by looking at the MRI and physically examining the patient. Therefore, unfortunately I cannot comment on whether your wife needs further surgery or not. Her neurosurgeon needs to evaluate the significance of the stenosis. If you wish, you can send me the MRI images and I’ll have a look.

From your description it seems that the complication may have been caused by direct surgical trauma to the spinal cord. The resulting Brown-Sequard-like syndrome (true Brown-Sequard is a rare syndrome caused by spinal cord hemisection) is due to the “bruise”, or contusion of the spinal cord. The neural tissue injured by the contusion will not heal, but her clinical symptoms and motor function will probably get better with time, to which extent, only time will tell, but I am optimistic and certainly hope she will recover well!