Subject: Re: what exactly is going on
Forum: The Neurology and Neurosurgery Forum
Topic Area: Arachnoiditis
Posted by CCF NSG MD /gsh on February 27, 1999 at 16:49:32:
In Reply to: what exactly is going on posted by Reddy on January 20, 1999 at 02:36:16:

I am a 47 year old male who had a 'bilateral hemilaminectomy with right and left discectomy with foraminotomy' ( procedure described in the operative report) for a large right sided herniated disc at L5-S1 level in May 1996. The surgery appears to have ran into some serious complications as it took the doctor 1hr and 15 min to find this huge fragment.
I was not able to walk any significant amount of distance after the surgery as my right leg would quickly cramp up with excruciating stabbing pain in the foot. Some time later I began to experience the same stabbing pain in my left foot also. Although, initially I was able to sit for some decent periods of time, now it quite limited. I am now not able to bear pressure on my low back or feet for any significant amounts of time.
I experience severe burning pain in feet and back during night time and am not able to maintain a fixed posture very long even when lying down. Often I feel chilly/feverish.

The MRI done in 9/96 showed a small disc fragment and some of the doctors seeing these scans told me that there was lot of scar tissue and fusion of nerve roots ( but not the radiologist).
The EMG report of 12/96 said '..examination of right leg shows significant denervation and chronic neurogenic changes in L5-S1 innervated muscles.' and left leg muscles were normal.

I tried two epidural shots in late 96 which only worsened my symptoms and further reduced my endurance to walking. I tried physical therapy which did not help either. My back continued to worsen. Recent MRI (2/98) shows involvement of L4-5 disc also, confirmed by discogram studies (moderate pain generated at both levels).

The recent EMG report on 01/98 states "1...moderate acute and chronic denervation in the right medial gastrocnemius unassociated with evidence of denervation in the right tibials anterior, extensor digitorium breivs and abductor hallucis. While the absence of denervation in the abductor hallucis is unexpected, these findings are nonetheless most compatible with presence of a right S1 radiculopathy.
' 2. EMG evidence of moderate acute and chronic denervation in the right rectus femoris, unassociated with denervation in the right tibials anterior, compatible with the presecnce of a right L3 radiculopathy.'

I have seen a few doctors both neurosurgeons and orhtopedic with the following diagnoses.
- discogenic pain with segmental instability, nerve damage and recurring radiculopathy.
- spinal instability becuase of substantial bone loss in both L5 and sacrum during surgery and lot of scar tissue surrounding nerves and roots and nerve damage
- arachnoiditis and nerve damage
- early stages of arachnoiditis and lot of scar tissue, disc fragments, nerve damage

I was recommended a bone fusion for instability. But I am not sure how to address the arachnoiditis. I have not come across a proper treatment plan for this condition. What about the nerve damage.
My questions are:
1. Looking at the same set of results why so many different observations.
2. Although EMG results indicate nerve damage only in the right leg I am loosing a lot of muscle mass in both legs. Is there an explanation for this. Could it be arachnoiditis. The only findings in my left leg are diminished ankle and knee reflexes.
3. My inability to sit, walk or stand - is it due to instability, nerve damage, arachnoidits or everything.
4. are there any medical developments for treating nerve damage.

Please forgive me for this long story. I would greatly appreciate your help.
Thank you in advance

_

These situations are difficult to treat. From the surgical standpoint a surgeon must evaluate two things, compression of neural elements and spinal stablity. The history, physical examination and studies done provide information in that regard. Also, spine surgery is a very fickle thing and different surgeons can have vastly different ways of managing patients with similar problems.

It is difficult to discern what exactly the problem is here without seeing the films. It sounds like you still have problems referable to the previous surgery, but whether another surgery is warranted is unclear. Arachnoiditis may contribute to your present problems, but does not completely explain your predicament.

You should seek the advice of an experienced spine surgeon in this matter. You may have already done this, but to give further advice without actually seeing the films and examining you is not appropriate and may lead you to improper conclusions. You hsould have a discussion of the problems with your surgeon so you understand what is going on and what is the best course of action at this time.

Good luck.

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