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View Full Version : symptoms back after just 3 months -- looking for post-op feedback


Squirrellypete
01-16-2007, 11:32 PM
Hi all. I am happy to have found this place. I ran aross it over a year ago I guess just before it closed down because I couldn't find it again until now. Sorry if this is a long intro but I'm concerned about some recurring symptoms so soon after detethering:


My fiance (26 years old) had a myelomenincocele repair when he was an infant. The surgery was successful however he required a detethering operation at age 12 and another at age 15. The surgeries apparently relieved the worst of his symptoms but like many patients he was left with bladder/bowel dysfunction and partial desensitization in his buttock, legs and feet. Other than that he has led a normal and physically active life -- you'd never know anything was wrong with him to look at him. That is until a couple of years ago when he developed debilitating back pain out of the blue. We had an MRI done and went to see his child-hood neurosurgeon who told us there was nothing to worry about. After a year and a half of living with this pain and unable to do most any activity other than walking he developed a rapid onset of leg weakness, spasticity and leg pain. After doing some more research I concluded it was probably TCS and was horrified to learn I seemed to know more about the condition than his childhood neurosurgeon. I was also surprised to learn that the surgeon was unable to completely release it the last time around 10 years ago.

We found a neurosurgeon at Johns Hopkins who was experienced with adult TCS and opted for surgical detethering. The outcome sounded promising despite the risks. The surgery was successful as far as releasing the cord which I know is the most important part to stop progressive deterioration. Once he had recovered from the surgery itself his pain was virtually gone, his legs had regained much of their strength. Some leg pain remained but not nearly what he experienced prior to surgery. He's had a couple of CSF leaks which our surgeon said should heal on their own in time. He was correct and they seemed to resolve.

Now, approximately 2-3 months after surgery and his vast improvement, all of his symptoms he experienced prior to surgery have rapidly returned and are just as bad if not worse than before. My first thought was that it had retethered. We've been back for a couple of post-op visits and have been told there's nothing remarkable on the MRI to explain the recurrent symptoms (leg pain, back pain, leg weakness). There is a fluid pocket/pseudomeningocele but our surgeon doesn't think it's significant enough to cause the symptoms and believes that will go away on its own in time. He says the cord is not retethered and everything is where it's supposed to be. I want to be patient and not jump the gun if this is just an ongoing part of healing after a major spinal surgery but there appears to be no improvement going on. He's done nothing to reinjure it physically. It's now been 5 months since surgery. I asked the surgeon if perhaps there was just too much nerve damage done before the detethering but he said if that was the case we wouldn't have seen the immediate improvement we saw following surgery. Basically we got an "I Don't Know" and "Wait and see" which is a little disheartening.

I'm at a loss as to what to do now -- does anyone have any input or similar experience? Thanks for any help. Sincerely, Danielle

CathyE
02-26-2007, 11:22 AM
I noticed this forum is a little small. I came here to find out if it is something I could have. But if I have it, I don't have the symptoms tat I have read about.

Anyway:
I asked one of the moderators of Chiari Connection International if it also is for tethered cord. This is her reply!
------------------------------------------
It sure does. They have recently discovered how
often there is a connection to TC and CM (Chiari/Arnold Chiari Syndrome) and this is pretty much a "hot topic":.

Has this person's fiancée' been screened for Chiari
by someone with a clue about it?
-----------------------------------------
Me:
Also, Braintalk’s Chiari forum might be a bit more active than the tethered cord forum.

But Chiari Connection International is VERY active!
---------------------------------------------------
Here is the link to join:
http://health.groups.yahoo.com/group/ChiariConnectionInternational/?yguid=124775342

Press join this group.

Good Luck to you and your fiancée
Cathy

Squirrellypete
03-04-2007, 01:06 AM
Hi Cathy, and thank you for the information. I will check out the link but I am afraid we probably know what is causing his problems. The surgeon out of the blue (seemingly tired of our questions) finally told us my fiance probably has a rare, debilitating and permanent condition called "Arachnoiditis". Surgery cannot fix this -- surgery (or multiple surgeries) were likely the cause even though no one ever mentioned this condition as a possible risk to us. We recently went to see someone who could hopefully confirm or disprove the surgeon's suggestion. This new doctor supposedly specialises in diagnosing this disease as well as pain management for coping with it and he meticulously went over all of his old MRIs that were taken both before this last surgery and after. He spent hours with us and literally image by image showed us the progression of the disease. While we are seeking one more opinion just for the hell of it, we are actually confident that this Arachnoiditis specialist is correct. It's a very bleak and frightening prospect to say the least and it was not the answer we were hoping for.

On top of that there is MRI evidence my fiance actually had this condition before this last surgery, in which case we may have chosen differently in regards to his surgery if we had known about it. Further surgeries and/or invasive procedures will only exacerbate it and this last surgery probably did just that. What also angers me is that when we had a post-surgery MRI done at the end of November and flew to Johns Hopkins to see the surgeon about my fiance's recurring symptoms he told us in no uncertain terms that my fiance was not retethered but that he had no clue what was causing his severe pain and symptoms. I just recently acquired the radiologists report that accompanied that very set of MRIs and the very first line of it reads "the conus is again noted to be tethered at the L4 & L5". I don't understand why the surgeon made no mention of this -- he received the radiologists report at the time. Yet he waited 3 months to even mention Arachnoiditis, and that was only done after we got tired of corresponding via e-mail and we called his office to speak with him personally. Just 3 days prior to that phone call via e-mail he said the cause was nerve damage from living with TSC for so long before having this last surgery. 3 days later when we call it's suddenly Arachnoiditis?!?!

Basically it's a different kind of tether that occurs when the Arachnoid layer of your spinal canal (please forgive me if I am using incorrect terminology here) becomes inflammed. Also, the meninges themselves that form your spinal cord become inflammed and begin to clump abnormally together. Then they become adhered to the inflammed Arachnoid layer wall which restricts motion and causes pain. Eventually scar tissue forms inside the spinal canal as a result of this inflammation which constricts the meninges/nerve roots reducing oxygen flow and obstructs normal CSF flow to the lower extremeties. It can be caused by too many surgeries or foreign objects such as needles aggrivating it and it can also be caused by foreign substances being introduced into the CSF fluid such as blood or the dyes that were used with myelograms.

Per his new doctor's suggestion he tried a short round of steroids to see if it could reduce some of the nerve inflammation and relieve some of his symptoms. It doesn't seem to have helped though and now he just started on the prescription Lyrica to help with the neuropathic pain. This is day 1 so I am hoping and praying it improves his quality of life in the near future.

If this doesn't help I don't know what we'll do. He has even started talking about suicide if the pain gets worse.

I hope you can get the answers you need in combating and/or coping with your condition and thank you again for your reply. Take care and God bless. Sincerely, Danielle

anglem98
03-12-2007, 03:03 PM
cathy,
did you have the head shunt or the back shunt? I have had 110 shunts and then I had Chiari surgery 3 years ago and now my headaches have returned and Dr. B. at the chiari institute thinks that I have Tethered cord syndrome. Maybe I can give you some info on the problems you are having.

CathyE
03-12-2007, 03:20 PM
anglem,

Thanks for thinking of me!

I have a head shunt (VP) the Strata programmable/adjustable.

I am going to try to get my NS to order MRI's for me, but I have to see him first. I had an appt. to have my setting raised (to drain less) but it was cancelled due to bad weather causing staff shortages!

Now I am thinking I want to try doing the exercises on a DVD called "Vivetics" for people with chronic pain for a month before I see him.

I can't decide if I should phone and just request my appt. be in about a month or just go if & when they rebook it. (they have bad track record in this matter) :(

Anyway, a few people with Hydro have said that they do feel better if they are doing regular exercises. I've studied the DVD & they give lots of cautions re "dont' do if..."

Anyway, if you want to give me some info, it might help. I already joined Chiari International Yahoo Group. But I'm not keeping up with all the digests!
But I have had some good feedback to my questions.

I am just afraid my NS is going to label me a Hypochondriac if I tell him I want him to check for Chiari. etc. !

When I see him I don't appear very unwell with all my adrenaline running!
However, my GP/PCP saw me in a flare a month ago when I had talked for about 25 minutes to his resident I said "help me, I can't think!" and was sort of panicky!

So thanks for the offer! Sure! Might help!

Cathy

mguillard
01-16-2008, 09:02 AM
Hi,

My partner had de-tethering surgery 8 months ago. He is now 35 and the symptoms had been present for about 7 years before the right diagnosis was made. Symptoms included numbness of the feet, weakness of the legs, inability to run and walk on tip-toes and very frequent urge to go to the bathroom, a bad equilibrium. In addition to that, he was continuously suffering from extreme pain in his lower legs.
One month after the surgery, he was doing incredibly well: no pain, a straighter walking pattern, no need to pee every 15 minutes.
Unfortunately, the symptoms reappeared about 2 months after the surgery and he is now back to the same situation as before the surgery.
We have seen the neurosurgeon again this morning, after a new MRI. He is satisfied with the results of the surgery (no re-tethering) but he cannot explain the bad clinical presentation. To him, my partner is now a "closed case", and he cannot give us any more insight into what we can hope for, in the short or long term.

I would be glad to exchange experiences with other people in similar situation and hope that with time, the symptoms will diminish.

Beate
04-23-2008, 11:02 AM
Hei

I had my surgery when I was 41... and I was ok for almost a year... i recognize all the symptoms that your partner have...
I live in Norway, and they do not know much about TCS here...
They haven't found any chiari og spina bifida so far..
I have problems walking... my balance is not very good....

I write ths just too tell you that he is not alone with this symptoms....

regards Beate