SpinelessWench

Dr. Corenman,

Much appreciated for the quick reply. I did fail to denote that I currently have standard X-rays of my lumbar spine, taken a few days prior to the MRI. I’ll send those along with the MRI materials… The X-rays are lateral and AP views, but do not include flexion images. I’ll request a few by my attending PM anesthesiologist.

While neither surgeon mentioned arachnoiditis or other related conditions, sagittal views of the MRI seem to indicate hypertrophy of the ligamentum flavum, as well as the attendant spinous structures and processes at the L-5/S1 level. From what I can readily see, there is significant encroachment on the cauda equina at this level that doesn’t appear to be related to metallic instrumentation. The majority of operative “trauma” at this level, from numerous surgeries and fusions, has likely resulted in arthrosis and degeneration that would be expected. Given that 70% of my severe pain is located in the lumbar and sacral region, I’m somewhat surprised neither surgeon focused on this area as the culprit. Instead, both seemed scope-locked on the levels above, especially those mentioned on the radiologist’s report (L2-3). In the exact words of surgeon #2, “Look, this is all I do all day, every day. I look at MRI images. And I’m good at it. And I’m telling you, I see nothing that the radiologist claimed to see.”

I appreciate this surgeon’s confidence in his abilities, and I also fully appreciate his extensive training and expertise (which he reiterated 14 times during the visit). Yet, while he did have the images up on the screen for me to see, he never diverted away from the sagittal views. He was adamant that, “Axial views are much less reliable, and most radiologists rely too much on them when looking for stenosis.” He never focused on the hypertrophy of other spinous elements, nor did he offer to really take a close look at the area below L-4.

His diagnosis of Failed Back Syndrome was, I think, made in light of an absence of something else to tell me at that point. He rushed through my images, and while “this is what he does all day”, I think he likely missed the forest in the presence of the trees. I’m sure he sees a fair share of “surgery seekers”, “pill seekers”, and “doctor shoppers”, all of whom tend to challenge his opinions and assessments. I’m neither of those; instead, I’m a patient whose quality of life is diminishing, and whose career may be cut short due to a degenerative condition. I can appreciate, and accept, that yet a 6th lumbar surgery is futile and wouldn’t help. But if stenosis or arachnoiditis, or even cauda equina syndrome do exist, I’ll be a little more than angry that no one took an extra 10 minutes to look for it, and find it.

Neurostimulators have been discussed. I’ve conducted extensive research (both corporate and academic) into these devices, as well as the morphine pumps, taking into consideration my job and hobbies. It seems the morphine pump is more conducive to my needs, and would allow for operation during my biggest enjoyment, which is riding my Harley-Davidson. Stimulators are not to be activated while driving, riding a motorcycle, or operating machinery. I have a consult tomorrow, in fact, to discuss the pros and cons of each. Plus, morphine pumps decrease the physio-psychological side effects of oral opioids, so teaching in a more lucid state would be welcomed as well.

ONE QUESTION: With arachnoiditis, is bowel or bladder dysfunction a necessary symptom? I don’t have either, nor do I have tingling, pins/needles, or parasthesias in the legs. Only a throbbing pain… I do, however, have the sudden sensation of a taser gun or cattle prod hitting me in the area of the upper buttocks and hips, as well as the midline lower back.
I’ll refer to your site for sending images… Much appreciated, again.

S.W., NC