Re: Can a 5th myelogram aggrevate arachnoiditis

Posted By Mike P on July 13, 1997 at 11:52:36:

In Reply to: Re: Can a 5th myelogram aggrevate arachnoiditis posted by CCF Neuro MD on July 13, 1997 at 08:53:25:








I had a Myelogram and disc surgery in 1973; 2 myelograms and disc surgery in 1975; a 4th myelogram and surgery for stenosis & decompression in 1984.  I had no back pain nor associated symptoms since then until about 2 months after a serious MVA in January of '97.  Besides broken bones & cartilage removal from the MVA, I have been diagnosed with ARACHNOIDITIS by both an orthopod and a neurosurgeon.  while both agree that the Arachnoiditis cannot be helped by surgery, the neurosurgeon feels that surgery may alleviate the FOOT DROP (which is only one of the many symptoms.)  He suggests a MYELOGRAM to determine if surgery is indicated.  MY FEARS: Is another myelogram likely to aggravate the Arachnoiditis?  If surgery is indicated to relieve the foot drop, could this surgery (in the L5-S1 area) aggrevate the arachnoiditis?  CAN ANYONE HELP with a valid medical opinion??  Since my career has moved me from coast to coast (15 moves in the last 30 years), I have nowhere to turn for medical advice.  PS: I am a 50 year old male.



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: Dear Mike:
I can understand and sympathise with your unfortunate back problem. Reading your story, I guess that MRI has been excluded as a diagnostic option, probably because of screws or other hardware in your back. With regard to the risks of a myelogram, the chance of developing arachnoiditis with the currently used non-ionic contrast media is very low. Hence, I feel that a fifth myelogram in your case, if appropriately indicated, and if performed by competent personnel, has an acceptable risk. While still another surgery on your back may indeed be indicated for a variety of reasons, your footdrop, more likely than not, may not be dramatically benefited from the surgery. This prognostication is based upon common experience, and upon some basic principles of nerve regeneration and reinnervation. An electrical test called the electromyogram (EMG) may help resolve some of these issues. You may already have had an EMG.
If you wish a second opinion, and live near the Cleveland area, I suggest that you consult with a neurologist at the Cleveland Clinic specializing in neuromuscular disease (I suggest Drs. Levin, Mitsumoto, or Shields), as well as a neurosurgeon specifically interested in the spine (Drs. Kalfas and Bingaman), and possibly undergo a complete diagnostic evaluation here. In case you live elsewhere, I suggest visiting academic neurology and neurosurgery departments in a reputed medical center near where you live.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options of your specific medical condition.
Dear CCF Neuro MD:
Thank you for your reply!  May I add a few points and ask your thoughts???
I have 'hardware' in left foot (from MVA injuries) but NOT in back.  A recent MRI of lower spine led to the Arachnoiditis Dx.  I have many symptoms in addition to foot drop, but Neurosurgeon thinks they won't be benefited by surgery, only possibly the foot drop.  I've heard that just the insertion of the needle for myelogram (regardless of type of dye) may aggravate the Arachnoiditis.  I've similarly heard that any surgery in the sacro-lumbar area may aggravate it.  If surgery is NOT likely to help, Can you see a reason to have the 5th myelogram???  Do you have other comments?? Do I need a REFERRAL from MD to go to CCF???  ( I live in north suburb of Pittsburgh, so a trip to Cleaveland would certainly be possible, only a 2 to 3 hour drive.)
Thanks again!!!