Arachnoiditis with CSF leak as well

Tagged: arachnoiditis, CSF leak

Viewing 4 posts - 1 through 4 (of 4 total)

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Bridget
Participant

February 23, 2018 at 9:44 am

Post count: 2

#27679

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

February 23, 2018 at 12:17 pm

Post count: 8660

#27688

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

February 25, 2018 at 3:00 pm

Post count: 2

#27701

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

February 26, 2018 at 5:30 pm

Post count: 8660

#27723

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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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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