The Case History of Mike
Mike's history dates back to age 14 when he was discovered to have scoliosis, that is, a curvature of the thoracic or mid-spine that frequently is noticed by an accelerated growth during the teenage years. He underwent surgery back East, with metal rods placed alongside the entire back of the spine, and with fusion of the spine in a more normal position. Over time, though, he gradually began to notice some loss of feeling in his right hand, and muscle spasms in his right arm and leg, as well as an inability to perspire over the right side of his body. Spasms and painful numbness of the right leg increased after he developed acute appendicitis and had an appendectomy. Because symptoms continued to get worse and his spine had fused long ago, the metal rods were removed in the hope that this would permit better imaging of the spinal cord. A myelogram-a sophisticated type of X-ray that includes an injected dye, was performed followed by an untethering procedure of the lower tip of the spinal cord. Nevertheless he continued to get worse, with symptoms of numbness and burning in his lower extremities, as well as tightness and muscle spasms in his legs that gradually progressed to involve his hands as well.
When Mike was first seen at UCLA, his examination showed a loss of reflexes in the right upper extremity as well as increased lower extremity reflexes, and diminished sensation in the right arm and in both legs. His MR (Magnetic Resonance) scans demonstrated formation of syringomyelia. A new myelogram showed an abrupt change in the width of the spinal cord at the midthoracic (T 6) level, the kind seen in patients with arachnoid cysts of the spine, with evidence of a syrinx cavity below this area. His operation consisted of a laminectomy over this area of the spine and excision of the web of arachnoid that had formed the cyst. The operation was particularly difficult because of his scoliotic spine deformity and prior bony fusion.
Ulrich Batzdorf, MD