Got operative report, Dr did cut the Dura,, Wise I need you.

[maryonwheels46]

Most of you have been keeping up with my post. But, three yrs ago I had the rods taken out because they were hurting my back. I am still glad I had them out. I'm a T9, 10 and L1,L2 complete. They also did a laminectomy at T10.
Before surgery I had pain in my legs but could lay down and it would go away and never was bothered with it at night.
After the surgery the only pain that bothered me was a sharp pain in the T10 area and thought over time it would go away but it still hurts. I spent a lot of time changing the back of my wc thinking that the scoliosis was getting worse since the rods were out. But it wasn't the scoliosis at all. Two months after the surgery, I noticed my toes were getting numb which I never felt my feet at all. In the last yr and a half I started having so much pain in my legs and the numbness had moved up to my hips and it felt worse like your feet falling asleep (pre sci). Also, I was hurting at night that I would take two 10mg Valium to fall asleep but would wake up with my legs hurting like darts were sticking all over them and I started being driven crazy with this very, very fine vibration or you could call it very fast thumping up to my waist and sometimes it would be all over my body. But it was inside my body I couldn't see it because I had relatives fill my legs to see if they could feel it. I even felt A current running through my legs.

I know it sounds crazy but sci pain is hard for me to explain. Because I was 42 when I got hurt so I was use to normal pain not sci pain. I always thought when a person was paralyzed you couldn't feel anything, boy was I wrong, it's out of this world. I have people all the time ask me how can I feel pain. I went to an Orto Dr and he said that it looked like L2 was not fused. I have a lot of bones popping in the lumbar area. I don't know if it matters.

For the last six months the pain is so bad that I even have dreams of being in so much pain and wake up and I am. I'm tormented even in my sleep. So, the last month I can barely leave the house. I wonder where did I go and is this what my life is going to be like. I use to go all the time. OK, sorry. Now for the operative report.
2/8/04
The ct myelogram showed that there was some compression at T10 level. We decided, at the same time to do the T-10 laminectomy to see if it helps with the pain.
The patient was taken to the operating room, general anesthesia was given and the patient was intubated. The patient was transferred to the op. table and positioned prone on a Wilson frame. The C- Arm Flouroscopy was brought in and the level was confirmed. Then I was prepped and draped. The previous incision was cut with a knife and carried down with a cautery through the subcutaneous tissue and the fascia. Then the para-vertebral muscles were dissected bilaterally all the way from T7 to L3 and the instrumentation was exposed. Because the system used before was a synthes system, we had difficulty with removing the instrumentation, but we were able to gradually with drilling around the screws and bone around the rods. We were able to remove the rods and screws. I should mention that there was not any obvious instability and the patient seems to have had good fusion. After removing the hardware, then I decided to do a laminectomy at T10, that was done with the Leksell and Kerrison, and also by using the drill to drill to some part of the Lamina. While I was opening the scar tissue below the T10, we made a small tear in the Dura that was closed by 4-0 Nurolon. After removing the hardware and the laminectomy, the incision was irrigated and homeostasis was done. We placed some Fibrin glue in the muscle over the Dura tear. Then the long story about how they closed me all up. Transferred to recovery room.
Questions: Can the tear to the Dura be the cause of all this 24/7 pain that I have now? What about more scar tissue? And the stabbing pain I still am having where he did the lamenectomy after three yrs post surgery? I really don't know what else to ask except for you opinion on the surgery and what your opinion is about what can be going on and is there anything else to do?
I go to the Physiatrist on Tuesday and he is suppose to order a ct and refer me to the top NS at LSU. What ever good that will do. I don't know what else to ask him. And let me add that the NS at LSU that did the surgery. I never saw again. At my two wk check-up he had been transferred to California. So I saw an associate.
Dr Wise, I hope you read this and get back to me and just give me your best advice on what happened, where to go from here and will the scar tissue and pain get worse.
Thank you so very much, Mary

[firesmurf]

Hi mary,i know you want to hear from Wise,believe me,i would too,but i just wanted to mention from what i have experienced with my spinal cord surgery ,i really dont think that just a simple tear in the durs alone would be the cause of your ongoing symptoms.it really does sound from what you have described that your pain is most likely coming from the actual damage to your cord and the other structural issues you are currently dealing with.when they cut into my actual spinal cord,then after the cavernoma was mostly removed,closed me back upagain.it just heals naturally and usually(and i have no idea why either as i have been kind of waiting for this to actually happen but it has not)without the normal scar tissue crap you end up with with other surgical procedures?i know i personally have a ton of really thick scar tissue in my c spine area and it was actually that bad only 9 months post op from my first surgery.so i naturally had these huge fears about getting that same scar tissue crap inside my cord or actually just on it at some point,but it still has not done that and it has been almost going on four years now.i don;t know if the cord just isnt capable of this or what but my incisions(all of them all the way down thru the many layers)have healed perfectly from what my NS told me and the other tests i have actually had.

i really don't think that a tear in the dura would be even able to create that type of pain you are having since the actual dura,as far as what i have researched,actually has no real nerves in it.but then again,who knows when it comes to the spinal cord.i too have had some of the most godawful totally off the wall crap happen that i never could have possibly have imagined the human body was even capable of creating.

I am just wondering tho,do you remeber if you had someone there in surgery who was doing the actual monitoring of your motor and sensory functions during your sugery at all?they would have introduced themselves to you pre op and explained what their job was going to be if this was actually done.the reason i am asking is when i had my surgery,for some bizarre reason,the actual reason that they stopped my surgery was because they had hit and lost a nerve to my legs that never came back on the monitor,not because they had actually removed all of the cavernoma.but when i obtained my op report done by my NS,there was amazingly no mention of this hit and lost nerve in it.i was a bit shocked at that.this also did not bode well for my chances of obtaining disability benefits either since i had told them about the effect this lost nerve had on my body but yet it was no where to be found in my op notes.

well,thats when i was able to actually track down that neurophysiatrist who actually did my monitoring and got ahold of his op notes,and there it was right in HIS report along with other monitoring issues that arose during my surgery.i had to actually obtain this report from HIS neuro office as for some odd reason(hmmm?) this report was not anywhere to be found in either my central medical file or anywhere in the hospital.but yet it should have been filed along with my NSs report.it took some detective work on my part but i was soo glad to see that report with everything i needed to prove my injury to my cord.

i am just wondering if you would be able to get more info if this was actually done on you too.i just don't know if they monitored you for your type of surgery or not.but it IS most definitely worth looking into.just a thought.

hopefully you can find out at some point just exactly what is the cause of the worst problems you are having.it sounds tho like the motor and sensory nerves are definitely still attached but possibly damaged despite the actual cord injury itself.believe me.my nerves a running amuck in here.good luck mary,Marcia

[maryonwheels46]

Thanks Marcia
I know that there is nothing that can be done. Maybe I'm grabbing at straws.
Was just wondering why all this crap is happening now, that is uncontrollable.
But the CNS is a very technical system. I appreciate you taking the time to respond.
Mary

[firesmurf]

I cannot remeber exctly where i read this,but i do know it appears to be true with me,that SCI patients,once the cord has been damaged in some way,certain chemical changes start taking place in there which can cause a host of other issues.for some reason,it can take up to and over a years time for these 'changes' to occur,but they can cause alot of big changes in your overall symptoms.

i can sooo relate to that part of things.no two days ever feel exactly the same for me.something is always different from when i went to bed the night before,and will either just be there when i wake up or slowly pop in over the course of the day.like some pain turns into a new sensation or the sensation is now becoming painful?its just bizarre really.but it appears to be in constant flux,not static by any means.some of the crap you are feeling is probably realted to just this very thing and who really knows about the other stuff.we are such unbelievable messes inside our bodies now.i honestly feel like a walking freak show sometimes.in your particular case tho mary,i think those structural back issues combined with just what happenes in SCI are also playing a big part in your ongoing symptoms.

as humans,we just naturally need reasons for things that happen in our lives and when we don't know,well it can be pretty scarey at the very least ya know?i have learned sooo freakin much about neuro anatomy and spinal tracts and the SNS,all just in an attempt to try and really understand and explain somehow just what in gods name is going on inside me.it has been quite the learning experience for me.but one big thing i have found in doing this is that just getting a simple(sometimes not so simple)explanation for this insanity really helped me to feel less scared and more in control.its the loss of control that scares us the most i think.hopefully you will be able to get some reasons and answers for whats going on.hang in there mary,Marcia

[betheny]

I always wonder if the new weirdness is part of aging w/ an sci too. The docs say sci adds 10 years, felt more like 25 to me. Of course I got an autoimmune disease 4 years after SCI...more aging? Stress? Who knows.

I'm real sorry, Mary.

[maryonwheels46]

Your right Marcia, SCI changes all the time. I wake up and never know what I'm going to feel today. But for the past two days I have had better night and days. I changed from Neurotin to Lyrica. I'm taking 100mg 3 times a day. I don't know if it's that or not but I have had better nights. I thank the Lord.

Betheny. Yes, it does make me feel older and look older "sometime." But you look pretty good. I don't look to bad if I wear my corset, sp, my I say stomach girdle. I Will turn 50 on the 27th so I guess age is catching up. lol

I was hoping Wise would respond a little about it. Guess he's busy.
Mary

[Wise Young]

The ct myelogram showed that there was some compression at T10 level. We decided, at the same time to do the T-10 laminectomy to see if it helps with the pain.
The patient was taken to the operating room, general anesthesia was given and the patient was intubated. The patient was transferred to the op. table and positioned prone on a Wilson frame. The C- Arm Flouroscopy was brought in and the level was confirmed. Then I was prepped and draped. The previous incision was cut with a knife and carried down with a cautery through the subcutaneous tissue and the fascia. Then the para-vertebral muscles were dissected bilaterally all the way from T7 to L3 and the instrumentation was exposed. Because the system used before was a synthes system, we had difficulty with removing the instrumentation, but we were able to gradually with drilling around the screws and bone around the rods. We were able to remove the rods and screws. I should mention that there was not any obvious instability and the patient seems to have had good fusion. After removing the hardware, then I decided to do a laminectomy at T10, that was done with the Leksell and Kerrison, and also by using the drill to drill to some part of the Lamina. While I was opening the scar tissue below the T10, we made a small tear in the Dura that was closed by 4-0 Nurolon. After removing the hardware and the laminectomy, the incision was irrigated and homeostasis was done. We placed some Fibrin glue in the muscle over the Dura tear. Then the long story about how they closed me all up. Transferred to recovery room.
Questions: Can the tear to the Dura be the cause of all this 24/7 pain that I have now? What about more scar tissue? And the stabbing pain I still am having where he did the lamenectomy after three yrs post surgery? I really don't know what else to ask except for you opinion on the surgery and what your opinion is about what can be going on and is there anything else to do?
I go to the Physiatrist on Tuesday and he is suppose to order a ct and refer me to the top NS at LSU. What ever good that will do. I don't know what else to ask him. And let me add that the NS at LSU that did the surgery. I never saw again. At my two wk check-up he had been transferred to California. So I saw an associate.

mary,

In my opinion, a dural tear is not the reason for your pain. The dura is often opened in neurosurgery and pain does not ensue. The surgeon clearly went to some lengths to not only stitch the dura close but also place muscle with fibrinogen glue over it, in order to prevent a CSF leak.

It is very common to tear the dura at the injury site. This is one of the reasons why, for example, I have decided that we are not going to re-expose the spinal cord at the injury site because the are often adhesions between the dura and surrounding tissues. Attempts to remove the tissues tear the dura. Tears of sometimes difficult to repair.

Let me remind you. Neuropathic pain does not have to have a cause. It happens.

Wise.

[maryonwheels46]

Thank you Wise for responding. I knew you would have the answer. Just wonder, you told me a long time ago that I had scar tissue. Of course, you were right but how are they ever able to remove it if they need to?

Mary

[firesmurf]

hey mary,ya know,if you are talking about any scar tissue buildup that could be over that tear site?from what they did with my cavernoma removal surgery,if for some reason,your scar tissue just had to be removed,i really do think that they would do this the same way they had to remove my cav,bit by bit,tiny piece by tiny piece,working from the top of it down and would most likely have to stop well before they actually hit the dura.since scar tissue tends to actually work its way into certain surrounding structures,it would not be able to just be cut right from underneath,they would most likely have to do any removal very carfully and slowly a tiny bit at a time.as wise mentioned,that dura is rather thin and fragile.this would probably be the only way it would be done.just guessin here,but this would be actually the safest way really.now,if you are talking in between the dura and the cord,well that would be something else entirely.this would be one of those lessor of two evils type of surgery.you know what i mean?this was really what mine came down to,have some definite damage now,but remove the major risk of another bleed that would most likely close off any remaining cord space causing me almost instant irreversable paralysis from the chest on down,OR go into the actual cord,having damage to the fine motor and my legs since those nerves unfortunetly ran directly in betweeen this really tiny space between the cavernoma and the cord wall and would have to be gone thru in order to reach the cavernoma,but remove the major risk piece by piece under heavy monitoring with the option to stop should they lose my functions on that monitor(this was was they did actually).

it would basically be a trade off mary.what are the actual risks of removing something vs leaving it alone,you know what i mean?as wise stated,just opening up that injured area again could cause many more problems than it would most likely solve.if there are indeed adhesions there,just cutting that dura and even trying to actually pull the sides open could cause major damage,mostly because they don't know just exactly what or how far down the adhesions are attached.i wouldn't ever consent again to undergo that freakin hell i went thru in 03.the pain was wayy more than i thought i would ever live thru.trust me mary,you do not want anyone to actually go into your cord space,ever.it was absolute hell for the first two days post op with absolutly no,none pain control at all.the pain was just too much more than any actual narcotic could ever possibly handle.my NS had warned me before the surgery when i asked him about the pain post op that i would,in his words,experience some "pretty extreme pain",and he was NOT kidding.wow.after those first two days of hell and non stop thrashing ,i finally was able to get a handle on it at some level,but there was just nothing that did anything for me as far as any real control the first two days,absolutely nothing.they actually had me in kind of a MS fent/versed type of coma thing there for awhile.that was all they could actually do was just totally load me up and to the point right before it would have knocked out my respiratory drive.nasty nasty nasty pain.they of course were also using alot of steriods and other crap too,but honestly,once you piss off the nerves and tracts in the actual cord,well look out,they really don't like to be touched and will let you know that too.

trust me mary,having actual surgery done on any part of your actual cord is NOT something you ever want to have.i would actually take the possible disabilities or damage than ever go thru that hell again.and in your specific case,well the stakes would be wayyy too high to even consider opening up your cord and even trying to open that incision up,they just do not know what is under it.my cord is now healed and sealed and is going to stay that way.i just could not go thru that again ever.

hopefully you can find ways to deal with that pain.but i would leave sleeping dogs lie.good luck hon,Marcia

[Wise Young]

Thank you Wise for responding. I knew you would have the answer. Just wonder, you told me a long time ago that I had scar tissue. Of course, you were right but how are they ever able to remove it if they need to?

Mary

Mary,

I am sorry for my previous answer. I must have been tired.

My point was that cutting the dura itself is not a cause of pain. If it were a cause of pain, surgeons would be very reluctant to cut the dura. Scar tissue formation is not necessarily bad. In fact, the main complication associated with cutting the dura is the failure of the dura to heal and the development of a continuing cerebrospinal fluid leak. Since over a litter of cerebrospinal fluid flow from the brain down the spinal cord every day, a large amount of cerebrospinal fluid leakage can occur.

A company named Gliatech introduced a product called Adcon-L. This gel prevents the formation of scar tissues. In fact, it is very effective in doing this, so effective that failure of the dura to heal is one of the complications of the treatment. After several patients developed cerebrospinal fluid leaks that would not stop, the FDA stopped the drug, forcing the company to withdraw the drug from the market (Source (http://www.cleveland.com/indepth/biotech/index.ssf?/indepth/biotech/more/10202455711978881.html)).

The company went into bankruptcy. Although the product is the only one on the market that effectively stopped adhesive scarring, I don't think that it has been re-introduced every since. In my opinion, it is a very important and useful product.

Wise.