Recommendations

48yo female with history of back injury 5-2001.Series of 4 epidural injections with the last also having a nerve block at L4-L5 level.  These were in every 2 weeks x 4 injections. Depo Medrol and Omnipaque were used.Good relief for about 3-4 weeks with last injection. Pain continued to increase.  It started in low back, radiated across buttocks to hips and legs and occasional feet.  Elected to have laminectomy in 12-02.  Had lami of L4, L5, and minimally of L3 with neuroforaminotomies L4-L5, L5-S1.  Initial improvement postoperatively.  Some increase in pain when started PT 1-02-03, with pain progressing over next 6 weeks to a debilitating level.  There is low back pain, but primary complaint is hips, bilateral legs, and feet.  It is constant, debilitating, and becomes worse with activity despite Oxy Contin and Oxy IR.  MRI in April showed some clumping of nerve roots at L4 level, facet arthropathy L4-L5, L5-S1.  Diagnosis at this time is Possible Arachnoiditis,DJD, Arthropathy L4-L5, Herniated L5 causing no significant stenosis.  Recommendations are to try facet block, epidural steroid injection, proceed with EMG to see if changes. (It was normal pre-op) or myelogram to better evaluate arachnoiditis.  Presently having urinary urgency, occasional incontinence, inability to achieve orgasm, and have been unable to move bowels without enema since this became worse post op despite Metmucil, Sennokot, plenty of water.  Given this information, would you agree symptomology was due to arachnoiditis?  What would your recommendations be for treatment? Thank you for your time.

[CCF-Neuro-M.D.-CS]

Your symptoms could be due to arachnoiditis, and the description of the MRI would be consistent. If this is aracnoiditis, then a comprehensive pain management program would be the best course of action. The myelogram would only be to confirm the diagnosis. Perhaps a second opinion at a large spine center, such as the one at the Cleveland Clinic, would be reasonable, especially since you are having symptoms in addition to pain. This would allow you to obtain a firm diagnosis and recieve a comprehensive treatment plan. Good luck.

[rn55]

I also forgot to mention that I take neurontin as well for the nerve pain.  Thank you for you time