Diagnosis
Thoracic osteochondrosis complicated by a sequestrated intervertebral disc herniation at T9–T10, causing spinal cord and nerve root compression. Severe deformative spondylarthrosis. Status post-surgical intervention in 2016: decompressive laminectomy T9–T10, discectomy T9–T10, and posterior spinal fusion with transpedicular screw fixation spanning the T9–T11 vertebrae.
Patient:
Male, 50 years old, Kazakhstan
Physician:
Dr. med. Andrey Bitter, Neuwerk Clinic
Clinical Course & Patient’s Complaints:
Following primary surgical intervention, new neurological deficits emerged, manifesting as severe paraparesis. To date, sensory function has been restored in both lower extremities. Mobility in the left leg has partially recovered (with independent flexion capacity across all joints), whereas motor functions in the right leg remain severely restricted. Pelvic organ function is diminished but controllable. Pronounced muscle spasticity is present in the lower limbs. The patient is currently dependent on a wheelchair for mobility.
Patient’s Inquiry:
- Is a second surgical operation indicated, or should I continue with active rehabilitation in the hope of further neurological recovery and restoring my ability to walk?
Expert Opinion by Spine Specialist Dr. Andrey Bitter:
A repeat surgical intervention is unlikely to yield functional improvement in your current condition. Should a revision procedure be considered, it would require a transthoracic (transpleural) approach through the chest cavity. Procedures of this complexity carry substantial surgical risks and could potentially cause a temporary or permanent decline in neurological status.
Therefore, my clear recommendation is to focus entirely on intensive rehabilitation, particularly given that the provided MRI scans confirm stable positioning of the previously implanted transpedicular fixation hardware.