Chances of a 4th lumbar surgery aggravating Arachnoiditis

[Mike-P]

    
      Re: Chances of a 4th lumbar surgery aggravating Arachnoiditis
    


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Posted by CCF NEUROSURGERY MD on September 18, 1997 at 13:05:16:

In Reply to: Chances of a 4th lumbar surgery aggravating Arachnoiditis posted by Mike P on September 17, 1997 at 15:04:47:

: Dear CCF Nuero MD:
  I've had a myelogram & lumbar disc removal surgery '73. 2 myelograms and another lumbar disc removed in '75.  A 4th myelogram and lumbar surgery for stenosis removeal & decompression in '84.  I have been PAIN-FREE & symptom-free since the '84 surgery until a serious MVA in January of '97.
  The MVA resulted in a host of problems (broken arm, broken metatarsal requiring open reduction, cracked kneecaps, torn knee cartilage requiring arthroscopic removal, post-concussive syndrome, etc.)
  As the treatment of the other problems progressed, I began experiencing low back symptoms (for the first time since before the '84 surgery.)  Symptoms include: low back pain; foot drop; pain radiating down into buttocks, thighs, lower legs, feet; urinary difficulties; impotence; burning in thighs, lower legs, feet; numbness and tingling in lower limbs; loss of reflexes in right knee & achilles; etc.
  The orthopod prescribed EMG (which showed both chronic & acute nerve problems) and an MRI (wihich indicated Stenosis at L-5 foramen, and Arachnoiditis.  A series of 3 epidurals did not help, so I was referred to a neurosurgeon who recommended a myelogram, followed by surgery (if so indicated by Myelogram).  A second neurosurgeon expressed a similar opinion.
  I reluctantly areed to a myelogram (my 5th, but first since '84) plus CT scan with dye.  Resultant diagnosis: Severe Arachnoiditis, bone spurs, material from herniated disc in spinal canal.  All of the preceeding in approx the same area (L3-4-5,S1).
  Neurosurgeon says that he cannot be sure which symtoms are caused by the Arachnoiditis and which by the bone spurs, disc material, etc.
  He suspects that surgery may alleviate the foot drop, and some of the pain.  He is sure that surgery will NOT help any symptoms being caused by the Arachnoiditis.
  I fear that the surgery may make the Arachnoiditis worse (for which, of course, there is no cure or treatment currently available).  He says that since the Arachnoiditis is INSIDE the "thecal sac", and the bone spurs, herniated disc, etc. are OUTSIDE the "thecal sac" and since he does NOT intend to "open up the thecal sac" that the chances of aggravating the Arachnoiditis are small.
  I DO NOT fear the lumbar surgery.  I DEFINITELY FEAR aggravation of the Arachnoiditis.
  Any opinion on chances of the surgery aggravating the arachnoiditis?  Any other opinions or comments?
  Thank you in advance for your time and consideration.  This forum is invaluable!
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Dear Mike,
Your situation is complicated.  You have had multiple lumbar surgeries in
the past with new worsening of symptoms after the recent accident.
The diagnosis of arachnoiditis seems to be solid based on what you have
written, and is not surprising given your history.  
Your recent accident may have done two things.  First, it may have helped
to extrude more disc material into the canal.  Second, it may have aggravated
the arachnoiditis.  The symptoms you describe seem to be a mixture of the
two.  
Surgery may still be a reasonable option for you, depending on the procedure
that your neurosurgeon has planned.  He may be planning a simple discectomy
and decompression of the L5 nerve root.  If this is the case, know that the
goal of surgery will to be to alleviate pressure on the L5 root.  The symptoms
of foot drop and pain along the side of your leg into the foot are likely
to improve, but there is no guarantee.  The impotence, urinary difficulties,
burning pain and low back pain will likely be unchanged.  The risk of
significantly aggravating the arachnoiditis with the simple procedure described
above is present but low.
You need to decide whether the risk of alleviating part of your pain and
weakness is worth the risk of making things worse.  Given the symptomatic
goals of the above described surgery, some would opt for it, some against.
This is a personal decision.  You must realize that regardless of your
decision, you will likely have to deal with some degree of pain and some
of the neurological deficits described above for the rest of your life.
These issues should be discussed in detail with your neurosurgeon prior to
proceeding with surgery.  
Good luck.