Mlinton

Mlinton post=6703 wrote: Update: Hi Dr. Corenman I have a update for you and questions that I hope you get soon!
I was checked into the hospital for a Nero-Radiologist to put in some type of contrast to see where the CSF Leak was coming from and they actually did not do the procedure. The Radiologist said that he went over all of my MRI’s and Cat scans with my current doctor and that they came to the conclusion that I do have a CFS leak in the Lumbar region. The Radiologist said that the procedure was to risky and could cause another CSF Leak. So I just went to see my surgeon a few days ago and I am very confused. He explained to me that he didn’t really know what to do because he is unguided of where the CSF Leak was and then he said you could get another doctors opinion if I wanted to. I did not now at that moment what to say! I am in excruciating pain and this is my second doctor already. The weird thing was he just looked at me for an answer???? I asked him what about a revised surgery and he said that they could do that but there is still a chance of not finding the CSF leak. So we made the decision to do a revised surgery and I hope I am not making a Huge Mistake by doing this. You had said before that you take out your drain tubes within 3 days after surgery since the doctor that did my surgery waited over a week to take out the drain tube do you think that that is the most possible possible place where the CSF Leak could be coming from? What do you think about a revised surgery? I am also wondering if there was a way for you to go over the information that was gathered since my surgery last year (Oct. 2013) and see what you think should happen. Thank you in advance I look forward to hearing from you….

I apologize Dr. Corenman for not getting back to you earlier as I have been in and out of the Hospital. I am still in a significant amount of pain!
So, here is what happened: I had A Discectomy and a Laminectomy Surgery from L4-S1 last October 2013. I have had 2 Mri’s within the last 2 months and there has been Drastic changes and more pressure and Pain.
Here is what the first and second Mri (a month apart) so that maybe you can understand what is going on:
MRI March on March 13th 2014: Findings:, The Lumbar Lordis is preserved. No compression deformities or suspicious focal marrow lessons in the lumbar spine. There is susceptibility artifact from L-1 through S-1 related to surgical hardware as described below. The conus terminates at L-1. No abnormal signal in the conus.
There is evidence of Laminectomy, right-sided facetectomy, discectomy, and posterior fusion from L4/S1 Consisting of bilateral transpedicular screws, posterior vertical stabilization rods, and a single posterior horizontal connecting rod at L4/L5 and Metallic disc implants are present. There is no significant spinal stenosis at L4-5 and L5-S1, and no significant foramina stenosis within the limits of the exam which is degraded by Susceptibility artifact. Suspect scar tissue surrounding L5 nerve which may be thickened. A post-operative fluid collection with thin rim enhancement is sen in the dural soft tissues measuring up to 2.5cm and maximal AP diameter, 9.6cm is maximal craniocaudal extent, and 6.4cm in maximal transverse extent. The collection abuts the dorsal theca sac at L5 without significantly compressing it. Ill-defined enhancing soft tissue in the dorsal paraspinal soft tissues probably representing post-operative scar tissue.

Impression:

Post-surgical changes from L4 through S1 as described above without significant spinal stenosis or definite foramina stenosis within the limits of this exam. There is suspected scar tissue surrounding the exiting right L5 nerve root which may be thickened. Post-operative fluid collection with thin rim enhancement is seen in the dorsal soft tissues extending to the dorsal aspect of the theca sac at L5 without compressing it. This could represent a bland or infected fluid collection; correlate with fluid sampling if clinically indicated.
Second Mri 4/25/14: History of prior spinal fusion. The patient has no recent trauma, however complaints of severe low bad pain radiating to both legs, right greater then left.
FINDINGS:
Fluid collection within the posterior elements extends from the superior endplate of L4 to the inferior endplate of s2 abutting the thecal sac, is smaller. Normal alignment . No evidence for acute fracture. the collection measures 8.4 CM in craniocaudal by 3 CM in t AP parentheses at the superior endplate of L5), by 5 CM in transverse dimension at the inferior endplate of L4. There is still a peripheral ring enhancement. Differential considerations include post-op changes with normal granulation/scar tissue versus infection. Correlate clinically and if indicated fluid sampling may be additional benefit to exclude infection.
L1L2-L3-L4: No significant spinal canal stenosis. There is hypertrophy of the L4/L5 facet joints, without significant foraminal stenosis.

L4/L5: Although there is some degradation from metallic artifact, there does appear to be significant spinal canal or foraminal stenosis. There is moderate facet joint arthropathy.
L-5-S1: This area is partially degraded by metallic hardware. I suspect there may be some right neural foraminal stenosis. The left appears widely patent. There is some increased signal on the sagittal STIR images along the lateral margin of the left L5-S1 disc, which may represent metallic artifact versus edema versus inflammation/infection.
FINAL, IMPRESSION: Stable L-4 fusion when compared to the most recent exam from 3/13/2014. The hardware degrades evaluation of the spinet some degree, althoughI do not see an area of severe neural foraminal or spinal stenosis. I do suspect there may be some stenosis or scar tissue abutting the exiting nerve L5-S-1 level (best visualized on the sagittal images).
The perviously described fluid collection within the surgical bed along posterior elements extends from the superior endplate f L-4 to the inferior endplate of S2 abutting the thecal sac, is smaller. There is still peripheral ring enhancement. Differential considerations include post-op changes with normal granulations/scar tissue versus infection. Correlate clinically and if indicated fluid sampling may be of additional benefit to exclude infection.

I apologize for my long reply but I just wanted you to understand what is going on. The last time I was in the hospital they took a sample and there is a slow growing Bacteria in the fluid in my back. The bacteria I think is called “Propionibacterium”. I have a lot of pressure and pain above the buttock and there seems to be like a “Bubble” in my back. The fluid moves side to side depending on which side I am laying on. I have an appointment with Nuclear Medicine to see if there is a leak in my back. Do you think this is some type of leak as it is filling up more space in my back? I also have an appt. with an Infectious Disease doctor to take care of the slow growing bacteria in my back. Does this type of bacteria cause pain? What do you think is going on as I am in excruciating pain? Should this Fluid on my back be Drained? If so, how? Thank you for you expertise and I hope to hear from you soon.