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  • Bridget
    Participant
    Post count: 2

    Hello, on January 30th I suffered a spinal injury from my anesthesiologist giving me an epidural injection for pain management. The pain management is necessary because of a failed Fusion done in 2015. She says that The damage was done from a faulty needle. She never actually gave me the injection, she just removed the needle and sent me home. A day and a half later I began suffering from a spinal fluid leak headache. A blood patch was attempted but it failed to help the man or the headache. 10 days later a second blood patch was done. During that blood patch I had the worst pain I’ve ever experienced in my life. It felt as if my brain was going to explode and I started screaming “my head my head”. Researching it on the internet I believe what I experienced was called a Thunderclap headache. I also had an incredible lightning rod shooting pain through my lower body mostly through my entire saddle area, crotch, and down my legs. Following that second shot my suffering increased tenfold. Finally when I began to pass out from the pain in my head and lower body I returned to the ER 1 week later. There, I was diagnosed with arachnoiditis, but they are confused about why I’m having such severe headaches. They said that’s not usually a symptom of arachnoiditis. The arachnoiditis was seen on an MRI done with and without contrast. The neurological side effects we’re so bad that they checked my brain for an aneurysm. Thankfully that one came back clear! I am now on steroids which are taking the edge off of the pain but I am still in a lot of pain. My question for you today is if there is a chance that I might still be suffering from a CSF leak? I know the migraines are from all the inflammation but I’m also concerned that I might have two headaches going on the second being the CSF leak. I know you can’t see me and you can’t look at my records but from what I’ve described is it possible that I still have a CSF leak?
    I am very impressed with the professional and easy to understand descriptions on your site and I feel that I would trust you as my doctor. Unfortunately I live in the midwest in a small town in Missouri. I’m wondering if there is any way you can refer me to a good doctor like yourself that has experience with arachnoiditis here in Missouri? I am willing to travel but I know that there’s no way I could get on an airplane and travel that far.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    I assume this injection was in the lumbar spine along with the “failed fusion” as you don’t indicate location.

    First, I have to be suspicious of the anesthesiologist stating “The damage was done from a faulty needle”. and “She never actually gave me the injection, she just removed the needle and sent me home”. Needles can occasionally be faulty but don’t cause a dural leak due to needle failure unless the needle is in a spot where it should not be. I’ll bet this physician found CSF (cerebrospinal fluid) in the syringe prior to the injection and stopped the procedure as it is “points off” to inject steroid into the dural sac (as this can cause arachnoiditis).

    The second blood patch injection (hopefully not by the same anesthesiologist) was probably in the wrong place too. This injection should cause a “pressure sensation but should not cause your pain reaction. Hopefully the needle tip was not in the dural sleeve where the CSF is located as injection of blood here can also cause arachnoiditis.

    Now, since you have had a prior surgery here, that could have triggered arachnoiditis but you can compare previous MRI scans after the surgery but before this initial injection and then ones after the injection. If the previous MRI (which should be at least a year from the index surgery) does not have arachnoiditis and the current one does, it is reasonable to assume that the original injection caused the nerve clumping.

    I am sorry but I cannot refer you to a local good physician as my list is short and does not cover Missouri.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Bridget
    Participant
    Post count: 2

    Wow, thank you for your quick reply! My original surgery (9-23-2015) was at L5/S1. Tlif with spinal fusion for level 4 Spondylolisthesis and 2 Pars defects. When pain continued I was told it was the hardware because I’m little. 5′ 0″ 106lbs. Pain increased greatly after hardware removal during a second surgery in January of 2017…he also for some reason did a lamenectomy. With pain increased I was referred to Pain Management. I went for a second opinion to a Neurosurgeon. I was diagnosed with failed fusion and now no hardware to support it. I was advised not to have another surgery yet. The next surgery will be much more invasive and require fusion from the front and the back as well as fusing the next level up. I was told I had a 50% chance it would help my pain and a 50% chance it could make things worse. That was October 2017.
    The first epidural injection I received in Oct 2017 helped my pain level by 80% for 8 weeks. It had worn off completely when I returned for a second injection (1-30-2018) and was injured. It is interesting that you say it was not faulty equipment as she claimed. My husband has insisted she was being less than honest about that. Unfortunately I believed her and yes I allowed her to give me the second blood patch that has caused Arachnoiditis.
    I have an MRI from March of 2017 showing no Arachnoiditis…just failed fusion and a couple of bulging disc’s. And now I have this MRI (2-19-2018) showing that I have Arachnoiditis. It even shows the blood patch because it was injected just 1 week prior to the MRI (given with and without contrast).
    I am no longer interested in a referral. I have researched and there is no one in Missouri that has your level of experience with it. I would like to come see you. My husband will build me a pallet in the back of his van and we will drive.
    I am desperate to get a healing plan started. I have read enough in the last week to know that I will probably be disabled. But I have also read that if it’s treated ASAP the progressive nature of the injury could be stopped. I will do anything in my ability to ensure, that future, instead of a hopless one. Honestly I was already disabled so I’m not expecting miracles…but I am going for at least some quality of life more than 80% of my days spent lying down.
    Do you have room for 1 more patient? If yes when should I come?
    Oh and so far the only treatment I have had is a bolus of steroids, IV fluids, and a bolus of Toradol for the severe headache. Then I was instructed that when the headache returned I was to start the pack of methylprednisolone they sent me home with from the emergency room. The headache was back full force in less than 24 hours. Tomorrow will be the last day of steroids, I will have just one more pill to take. I am frightened that the headache will return in full force once the steroids are out of my system. And I’m not sure what treatment will be at that point. No one here seems to know either.
    Also I have Blue Cross Blue Shield and so far they have covered every procedure I have ever had done, including this emergency and all of the procedures required. So I am certain they will cover my visit to you as well!
    Thank you again,
    Bridget

    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    Probably not a grade 4 spondylolisthesis as in a grade 4, the L5 vertebra is right on the edge of falling into the pelvis and would need a front and back surgery. You probably mean grade I in the 4 (5) grade system.

    You then had the hardware removed. I assume there was no CT scan to indicate fusion status beforehand. I don’t know why he did a laminectomy as this is normally done during the initial surgery. The pseudoarthrosis was revealed after the hardware was removed as removal allows increased motion in the case of a pseudoarthrosis.

    You probably do need a revision surgery. It is a possibility that you might need a front and back surgery (called a “360” by some surgeons) but many times, the surgery can still be performed all from the back. It depends upon the cage used and how severe the slip is. I would say that an 80% satisfaction rate could be achieved.

    Arachnoiditis does not always mean severe disability and chronic pain. It really depends upon how injured the nerve really are. I have treated many patient who have arachnoiditis and many of them had no idea they had arachnoiditis.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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