giant pseudomemingocele

[chmski]

In February of 2013, during an attempt at a thoracic/lumbar myelogram/ct scan, it was discovered that I had a 12 cm, by 5 cm, by 2 cm calcified pseudomemingocele the entire length of the lumbar spine.  It is palpable, painful to the touch, and may be leaking into the right side gluteal muscle.  Back in 2009 I sustained the second of two fusion surgeries, an Alif/Plif from L1 to S1 with osteotomy at L4/5 which was the likely cause of the lesion.  The GP was described by two radiologists as “fluid” and “undulating”.

I had consults with two neurosurgeons.  One local and one from a large medical school and medical center where the surgeries were performed.  Both said that a giant pseudomeningocele (GP) is a VERY COMMON OUTCOME of spinal fusion surgery.   The symptoms that sent me to the doctor were pain and progressive weakness in my legs and the inability to stand up straight or walk without assistance of crutches.  I believe these symptoms are at least partially due to the GP because of the large volume of nerve and muscle tissue that was bathed over 3+ years.  BMP may be a factor as it was used during this surgery.

The NS recommended nothing, not even draining.  Thoughts..............?

[chmski]

Thank you for taking the time to comment.  I would consider going to someone else, but clearly my frustration is that I can't find someone who knows how to treat this even if it is found in a timely manner. never mind 3 years later,  The radiologists had never seen this before and wrote detailed reports to be given to the NS.  Frankly, they really had me quite concerned.  Then the first NS said it's a biproduct of surgery using BMP.  Not at all helpful. Didn't know whether or not something should be done.  Second NS didn't even mention th GP in his written report.  Made it look like I was there for a different reason altogether.  I don't know if I could stand another brush off.  I know there are very few NS who have treated GP's and fewer yet are in the USA.  Would be happy to send you the radiologists reports.

[S. Kaul, MD]

Hi there!

Well, it would be difficult to comment on the situation without knowing the relevant clinical details or a detailed clinical evaluation. It is true that pseudomeningocoele could result from fusion surgeries, though management in such cases could be conservative or surgical depending on the side, neural compromise, comorbid conditions, symptoms etc. If two neuro-surgeons have preferred a conservative approach, it is likely to be the best suitable management at this stage; though your may consider a third opinion if the symptoms are debilitating and there is no improvement with conservative management.
Hope this is helpful.

Take care!