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Thread: Brown Sequard - after ACF ???

  1. #1

    Brown Sequard - after ACF ???

    My wife, 51, developed tingling / numbness in her right hand - no other symptoms. After a couple months we had an MRI that showed stenosis at c4/5, c5/6, c6/7. We then went to a neurosurgeon that had performed 5-6 thousand ACF without any significant problems. When she woke up in recovery she could not move her right leg or arm and had numbness on her keft side. Surgeon said it was Brown Sequard Syndrome.

    My question is this: how often does someone go into surgery without Brown Sequard and come out of surgery with it? Did something go wrong?

  2. #2
    Senior Member mr_coffee's Avatar
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    jeiland,

    It depends on how serious it was intially. I'm saying if she felt only numbness in her right hand, and came out having brown sequard then yes that isn't good.

    How long is she post operation? She may still have alot of swelling on her spinal cord which can lead to paralysis but once it goes down it can be regained. But if he screwed up, and messed up some nervous or caused scare tissue on the spinal cord then thats a problem.

    I would definatley ask questions and ask him why she is doing so much worse now than before going into the surgey. I've know alot of people who went into a routine back sergiery and became paras or quads.
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  3. #3
    Thanks ... her surgery was 12-6-06 , supposed to be a 1 night stay & go home the next. She was not discharged until 12-12-06. She is now 3 weeks post-op.

    She has regained some use of her right leg/foot but the right hand is almost no use.

    Is there any way to determine if the cord was bruised, pinched, or nic'd (MRI? CT scan?) and if it's getting any better?

  4. #4
    Unfortunately, it is fairly common to have residual impairment (often worse than what was present pre-operatively) after surgery for vascular problems, spinal stenosis or other types of non-traumatic spinal cord lesions. We see 5-6 patients a year at my center who have had less than ideal outcomes from spinal stenosis surgery, often with much worse outcomes (often complete rather than incomplete injuries such as you describe).

    The spinal cord area is very small and delicate, with a fairly vulnerable blood supply, and it is easy (often unavoidable) for blood supply to parts of the cord to be disrupted with surgical interventions. The cord is not quite as sensative to loss of blood supply as the brain, but any disruption for more than about 15-20 minutes can cause often permanent damage. This can occur due to clots of the blood vessels caused by the surgery, by compression of these vessels, or by tears or cuts in the blood vessels. Often the actual mechanism is not known. This should have been explained pre-operatively as a possible complication of the surgery. What were you both told about possible risks of the surgery?

    This happens. It may not be related to any negligence or malpractice on the part of the surgeon, although of course if you have issues in this area you should see an attorney who would then need to get records and have other expert surgeons review the case to see if proper procedures were followed.

    At this point, it is still very early after the surgery. She may get some return, sometimes even full return. Only time (up to 2 years) will tell. Meanwhile, she needs to be getting inpatient acute rehabilitation at an expert SCI rehabilitation center that is either a Model System SCI Center or a CARF accredited SCSC (spinal cord system of care). Where is she currently? Is this being arranged or is it already in place?

    (KLD)

  5. #5
    Thanks ... pre-op we were assured this was routine ... Barbara specifically asked the surgeon if he had ever had a patient paralyzed after this surgery - he said he had stopped counting at 5,000 and never had any serious problems. Another neurosurgeon checked on Barbara the weekend she was still in the hospital: said he had never had this happen.

    The night after surgery an anestesiologist (not Barbara's) stopped by late in the night to check on her ... then the next night Barbara's stopped by ... both said this was the first time they had seen this ... why would they be so interested? Do they pre-position the patient before the surgery?

    We went to another neurosurgeon 1 week after returning home ... he looked at the MRI that was done a couple weeks before surgery and the post-op CT scan: he said he was surprised. We then did another MRI with contrast that day for comparison. He pointed to a white-ish area in the middle of the cord - said it looked like a bruise. Asked how this would happen, answered: I don't know. The bone spurs encroaching on the cord pre-op are still there post-op. Asked him why: said he didn't know. He was a little puzzled it seems ...

    Should we followup with any other more specific tests? I understand things can take a while, but I don't want to wait 12 months, then start asking questions. I'm not comfortable with the explainations I've gotten so far...

  6. #6
    Also: we're in LA - that's lower Alabama ... don't know anything about the specific rehab units you mentioned... I've already paid > $75 just to get a copy of our own records - should have them early next week. Hopefully there will be some clues in the records ...

  7. #7
    I don't know what I can add to this, but in Jan., 2004 I had surgery to relieve severe stenosis. I had fallen on 12/11/2003 and experienced a stinger of sorts. I couldn't move my arms/legs for @ 10 minutes.
    I was told that the condition was something that had been building throughout my entire life. I had no choice but surgery or a sudden severing of the cord at about C5 at any moment if I fell again or was bumped in traffic, etc.
    I was in surgery for @ 12 hours. They removed C4 - T1 verterbrae inclusive and replaced them with titanium fixtures. I woke up with Brown-Sequard syndrome - couldn't move my left leg at all and my left arm was seriously impaired, The only hint at an explanation I ever got was that there was swelling early on in the procedure and trouble became evident early on. I was also assured by many medical people aftrewards that I was very lucky!
    3 months at the Kessler Institute in West Orange New Jersey had me walking with a walker and AFO brace.
    Three years later I walk with a single point cane. I can walk short distances without the cane, My left leg and arm have lack of muscle function, especially the leg. My right leg is basically numb but it functions well,
    I work out at least 3 hours per week at gym, swim and occasionally attend PT sessions of different sorts to build core strength,
    I think the spinal cord is just a very delicate thing and certainly in my case, the surgery was radical and I think I beat the odds.
    I think I was also a beneficiary of Dr, Wise's basic work with steroids.

    I wish you and your wife good luck, Find some good therapists for body and spirit. I hope she can improve as much as I have.

  8. #8
    Again, if you have concerns about malpractice, you need to see a malpractice attorney. There is no way that just getting a second opinion will make any difference. It is normal practice for the on-call neurosurgeon to see the patient daily (when the regular surgeon is off duty) while they are in the hospital...in fact it is required. This is also true of a pre-op and post-op visit by the anesthesiologist. Call some attorneys who work in general practice law (if you know any) for a referral to a malpractice specialist. They will help to determine if you have a case or not. It does happen...if you work in SCI rehab, you see a lot of these cases.

    Meanwhile you need to get her into rehab NOW. Don't delay, and don't let them send her to some little podunk rehab center that never sees anyone with a SCI. If you are in Alabama, the ONLY place to go is to Spain Rehabilitation Center at the University of Alabama, Birmingham, which is one of the Model SCI System Centers:

    http://main.uab.edu/show.asp?durki=10712

    (KLD)

  9. #9
    Thanks ... I understand the on-call neurosurgeon and even the anesthesiologists drop by - I brought it up because they (and everyone else) all said that our case was a first: no one involved has ever seen this before... if this is true then it seems to me that something went wrong.

    Barbara has been in aggressive rehab on a daily basis since coming home and she has made what I consider to be great progress. Never the less, we already have a referral to UAB next week.

    Thanks again.

  10. #10
    Quote Originally Posted by jeiland
    My wife, 51, developed tingling / numbness in her right hand - no other symptoms. After a couple months we had an MRI that showed stenosis at c4/5, c5/6, c6/7. We then went to a neurosurgeon that had performed 5-6 thousand ACF without any significant problems. When she woke up in recovery she could not move her right leg or arm and had numbness on her keft side. Surgeon said it was Brown Sequard Syndrome.

    My question is this: how often does someone go into surgery without Brown Sequard and come out of surgery with it? Did something go wrong?
    Jeiland, sorry that I didn't see your post earlier.

    Cervical stenosis is a very dangerous condition. I don't know how bad her stenosis was but it is not uncommon to have some damage to the spinal cord during or even before surgery in people with cervical stenosis. I saw a number of such cases in Bellevue Hospital when I was working there. The spinal cord is probably in borderline ischemic state and any disturbance of the cord may lead to some damage. Did she have multilevel fusion?

    The good news, however, is that she has a Brown-Sequard which is an "incomplete" injury. She should recover a lot of function in the coming months (years). It takes a long time and she needs to work hard on the recovery. Most people recover motor function in both legs but some may retain some sensory loss.

    Wise.

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