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Thread: Spinal Fluid leakage - how serious ?

  1. #1
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    Spinal Fluid leakage - how serious ?

    Last Wed, 22 Oct 03, we noticed a "ballooned" out area at my injury site (T9-T10). Last year I had this same condition and the original surgeon said it was a hematoba, after 3 draining it went away.

    Today I saw a second surgeon and he drained it partially and said it was blood mixed with possibly some spinal fluid.

    1. During original surgery doctors were very worried about spinal fluid leakage, so I assume it an important event.

    2. I asked today if we could run some tests to see if it was spinal fluid, and the doc said no?

    3. The ballooned out area is about the size of a golf ball cut in half.

    4. Should I be worried if it is spinal fluid leakage and is it possible to run a test to find out if it is spinal fluid?

    Also, the large hump on my back is causing be to pitch forward and it feels like there is some loose bone. The second surgeon feels we should go in and replace the rods and extend them down 2 to 3 inches and straighten the column and thereby getting rid of the hump.

    1. I want to make a model and see if this is possible. Does anyone out there have a beat up spinal column model they would sell cheap? Doc Young provided me with some sites to purchase some models but I don't want pay that much for something I am going to experiment on (unless someone knows of some less expensive ones).

    2. Can anyone provide some sites with good pictures of rod placement on the column?

    EM

  2. #2
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    SCI-Nurse, please advise if spinal fluid leakage is serious, if not I will wait till next year to make the decision...

    EM

  3. #3
    There's no way to test the fluid that came out of the lump on your back to see if it is spinal fluid. To find out for sure they would have to do a myelogram, injecting x-ray dye into your spinal canal and seeing if it leaked out anywhere--that's a nasty test, can give you a monstrous headache and my not find a small leak if it exists. So there's no easy way to determine if it's spinal fluid.

    If it is spinal fluid (which we don't know for sure) then you would be at risk for getting an infection in the spinal canal like meningitis.

    This development of a cyst (that's what medical types would call the lump) is really abnormal. I wouldn't delay too long in deciding to let the surgeon go in and fix things up. I'll ask Dr. Young to comment on this as well.

    RAB

  4. #4
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    SCI-Nurse - thanks a bunch, I will give the doc a call today and see what we can work up.

    EM

  5. #5
    RAB, thanks for bring this to my attention.

    EM, based on your description, it seems likely that it is an arachnoid cyst, a cyst that balloons from the spinal arachnoid/dura that contains cerebrospinal fluid (CSF). This is not uncommon in people with spinal cord injury, particularly people who have had laminectomies (removal of the back bony cover of the spinal canal). By itself, it is not particularly dangerous and people often have such cysts for many years, even decades, without any neurological or other problems. It probably formed because of a combination of reasons, including some weakness of the arachnoid/dural structure, a laminectomy, and adhesions between the spinal cord and arachnoid covering that is forcing cerebrospinal fluid flow into the cyst. On the other hand, many surgeons do try to fix such cysts, particularly when they are enlarging and are close to the skin surface where they can be pressed, develop leaks, and get infected. Arachnoid cysts typically are fluctuant (feels soft and moves under the finger) and are usually not tender.

    Fixing the cyst is not easy. The reason is that simply draining the cyst will result in the cyst filling up again within a few days. If an effort is made to sew the base of the cyst, the original condition that led to the formation of the cyst will result in the cyst forming again. The repair itself, because it involves passing a suture through the walls of the cyst, may also result in a cerebrospinal fluid leak that may be hard to stop. Some surgeons may prefer to expose the spinal cord, clear out the adhesions, place a dural graft, and try to achieve definitive closure.

    It is not a good idea to do a transcutaneous puncture to obtain some cyst fluid for testing because this may lead to a cerebrospinal fluid leak and possible infection of the cyst. Because the cyst is likley to communicate directly with the cerebrospinal fluid of the spinal cord, an infection would be catastrophic. Besides, a careful physical examination combined with a good MRI scan should be able to rule out a hematoma. Most hematomas are not fluctuant (because they tend to clot) and the MRI usually shows a different signal from the contents of the cyst, compared to a hematoma.

    I am confused by your description of the "large hump" on your back causing you to "pitch forward". A golf-ball size cyst should not be sufficient to do that. You must be referring to some other hump. Do you have scoliosis?

    Finally, regarding cerebral spinal fluid (CSF) leak. It is possible that you may have a spinal fluid leak but, if so, it must be mild or minimal. By the way, if you have a serious CSF leak, you would probably know it. By the way, the central nervous system produces approximately 0.35 ml of CSF per minute and probably about half of that goes down the spinal cord. This means that you are producing over 20 ml of CSF per hour or over 500 ml of CSF per day. If even 5% of the fluid is leaking into the cyst and out of the cyst, that comes to 25 ml per day. So, if there is a leak, it is probably very small.

    In the end, the major decision that your surgeons have to make is whether or not to operate and fix this cyst. If they decide to do so, the next question is whether or not scar tissue around your injury site is occluding CSF fluid and this is the reason why the cyst is forming. If so, a simple repair may not result take care of the problem.

    I hope that this is helpful.

    Wise.

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