myelogram and arachnoiditis?

[Liz]

Has anyone developed arachnoiditis after a myelogram? i read about it here http://www.spineuniverse.com/display...rticle180.html but wanted to see if anyone on here had experienced it; i hope not.

I've read about a few people on this forum that have developed arachnoiditis after ADR and fusions, but i don't recall anyone linking it to a myelogram.

It was suggested that i have a myelogram for my worsening right leg issues by an orthopedic surgeon but i'm concerned about the risks even though of course they are much less than another operation and it's part of a proper diagnosis. I saw a neurosurgeon whom thinks my leg numbness is old L5 nerve damage b/c I waited so long to have my ADR op, so if that's the case a myelogram is a risk i don't need to take.

thanks,
Liz

[2cool4U]

Arachnoiditis, or inflammation of the nerve roots, can occur after any procedure that penetrates the spinal canal, including trauma. It can also occur after systemic infections, particularly tuberculosis and in cancer patients.

Over 25 yrs. ago, myelograms were performed using a contrast agent that was oil-based, and this material would clump in the spinal canal. Indeed, it can still occasionally be seen in elderly patients who had a myelogram many years ago. This contrast agent cause chemical irritation of the nerve roots, or a chemical arachnoiditis.

However, the contrast agents now used are water-soluble and do not induce this chemical reaction. They are eliminated from the spinal canal and the body w/in hours of the injection. The remaining risk of arachnoiditis from myelography is essentially the risk from the needle puncture. While no procedure is risk-free, arachnoiditis is exceedingly rare after myelography today. The most common risks are local bleeding at the skin, a small amount of bleeding into the space around the spinal canal (epidural hematoma of the spine), direct nerve root injection from either the lidocaine or contrast causing nerve root damage (often but not always temporary), infection either at the skin or in the epidural space (rare but serious), and the very commonly reported spinal headache, which occurs when the puncture site continues to leak fluid. Spinal headaches are easily treatable with a small blood patch injected at the puncture site. Another type of headache can occur just after the myelogram if the patient is allowed to lie flat or with the head down. The contrast tracks up into the head, causing a pretty quick, pretty severe headache, but no permanent problem.

Arachnoiditis is so rare after myelography today that I couldn't find an article quoting a number. However, once something occurs after a medical procedure, it is forever documented as a risk, regardless of the rarity.

[Liz]

tconner,

thank you so much for your response and explanation! it's very informative for me and to anyone facing a myelogram. It puts my mind at ease at least regarding the arachnoiditis; still, i'm not looking forward to the test.

if you have any tips please let me know, other than not lying flat, and i've heard to drink tons of water/fluids to try and wash the dye out of your body/spinal canal. I suffer from migraines as it is, so i'm curious if the spinal headache will be any different. If one develops spinal headaches post-myelogram are they typically treated immediately or told to wait a few days to see if it passes before treating it w/a small blood patch as you mentioned? In your opinion is there an increased risk of infection by not sealing up the leak as soon as possible?

I hope you continue to feel well w/your new ADR!

thanks again,
Liz

[Harrison]

T & Liz,

I've been meaning to look into this -- there are a zillion ways to rid the body of wastes -- especially dyes -- with clean, filtered water; chelation; saunas; diet, etc. T, can you tell us more about blood patches? Liz, you know a lot about this stuff already, so what might your ideas be about this? Chlorellas? Bentonite? Other binding agents? I'd also like to know how much of this junk gets "caught" in the liver. I've done some very productive liver cleanses in the past; perhaps they would lend themselves to this kind of cleansing.

Liz, I am really sorry about your situation. I hope that this is not a sign of things to come. I hope to post more about this dye cleansing issue soon...with both findings and questions.

Thanks again to both of you for sharing.

[2cool4U]

The agent used is water soluble. Elimination occurs as it is absorbed from the cerebrospinal fluid into the bloodstream and eliminated by the kidneys. The amounts are negligible, usually 10-20 cc's of contrast total. Unlike barium given for an upper GI or barium enema, they are eliminated by the kidneys, not the GI tract. Unless you have some abnormality of kidney function or are diabetic, absorption of the contrast and excretion are what I would call "non-events" after myelography. The liver only becomes involved if there are kidney issues. Hydration afterwards certainly doesn't hurt, but it's not absolutely necessary.

Keep in mind that in body CT's, doses of 100-150 cc's are often used, and in heart catheterizations or other vascular studies, upwards of 250-300 cc's can be administered. There is a total grams per day of iodine load that the body can handle, and that translates into a different volume of contrast depending on the concentration used. However, for the vast, vast majority of myelography, elimination of contrast is just not an issue.

As far as the headaches, I tell patients to immediately contact their physician or the radiology department if they have a severe headache after a myelogram. The reason for this is that the treatment, the blood patch, is very quick, easy, and virtually immediately cures the headache. There is no reason to lie around in agony trying to ride it out. For the most part, the anesthesiologists do the blood patches. They take a sample of your blood, add something (lazy answer here, I could look this up), and inject it under the skin at the site of the puncture to seal up the leak.

The reason to not lie flat and to keep the head up is that the contrast flow upwards can also cause a severe headache, and that one is not as easily treated. Symptomatic relief with pain meds until it resolves is the only was to go. Keep the contrast low in the canal until is dissolves out to prevent this headache from occurring. Infections after myelography, while not zero, are also extremely rare.

I knew that I would be committing myself to myelograms after ADR if I needed to look at the operative level, and I wasn't the least bit concerned. If done by someone with experience, they are a 5 minute procedure and are similar to an epidural.

Of course, I hope to never need anything ever again, but that's probably unrealistic!

[Rosie]

Thank you for posting this thread as I am scheduled CT/myelo this coming Friday!!!

[Judy]

You and I so alike I also have numbness/pain but in my left thigh. It appeared after the ADR/fusion surgery. I felt so good with the exception of this and Dr. Yue also want a myleogram done. It was the biggest mistake I made. I did get the spinal headache I have experienced such pain in my life. No on wanted to help me, I called the radiology department who did the test 3 days later and they said of that is normal it will go away in a day or so.

After about 6 days when my husband got home from work I had him take me to the ER. We waited for 5 hours and no one saw me so I left, I had an appointment with Dr. Yue the next day. When I talked to Dr. Yue and explained the pain he mentioned the blood patch, called the ER and had it all arranged and told me to go right there. Well I did and finally saw me 4 hours later and woud not do it. So I suffered another 3 days with this, it was the worst pain in my life I could not function all I wanted to do was lay down and close my eyes hoping to sleep just to make the pain be gone for even an hours. Well the diagnosis was arachnoditis. Something I have to just live with.

If you have any questions please feel free to e-mail me.
Judy

[Harrison]

Tconner, your entire post is very helpful. I took note of this point you made:

“…The liver only becomes involved if there are kidney issues. Hydration afterwards certainly doesn't hurt, but it's
not absolutely necessary…”

Does this mean, if a patient’s kidney’s are working fine, then the water-soluble contrast is efficiently evacuated from the body? This must be the case, given our collective experiences and your succinct explanation.

To me, it’s a no-brainer to drink TONS of clean water after the procedure. But your statement is reassuring….fer sher.

Rosie, good luck on your procedure. Given your long struggle, I wish you superlative diagnostic results. You deserve clarity and confirmation on your next steps.

Judy, I am so sorry about the arachnoiditis diagnosis, though I am confused how that came about and when? I noticed from your signature that it was diagnosed in 06?

All: sorry for being the late bloomer in the class, but I still don’t get the blood patch. So I looked it up and found my homework for tomorrow: http://wiki.noblood.org/Epidural_Blood_Patch

PS: Nice job Dr Loubser on this wiki definition.

[2cool4U]

It's the low total volume of contrast used for a myelogram that's the key. It diffuses out of the cerebrospinal fluid slowly, and the amount is so low that excretion is not a concern in a normal patient. Of course, hydration never hurts, as long as you're not prone to fluid overload conditions. Remember 20cc's is approximately 1 fluid ounce. Not much for normal kidneys to handle.

This stands opposite to all of the recommendations to drink plenty of fluids after CT's to help flush the kidneys or in Upper GI's and Barium Enemas to avoid constipation. In diabetic patients or patients with known renal damage, fluids and diuretics are often given before procedures requiring contrast to help the kidneys, although there is some controversy in the literature as to whether this really helps.

In a patient in renal failure, IV contrast (or myelogram contrast) is eliminated by the liver and appears in the gallbladder. This is called "vicarious excretion." It usually doesn't cause liver problems. It can cause worsening of the renal problems.

In general, the contrast agents used for imaging studies have a somewhat undeserved bad reputation and are generally very safe when used appropriately. Many patients report being "allergic" to contrast and end up compromising their studies when in actuality they experienced nausea, a warm flushing of the face, or a tingling feeling, none of which are actually allergies. These patients then refuse to have contrast for future studies and end up getting suboptimal tests because of this misunderstanding. Often, their own doctor reinforces this, making it impossible for the radiologist or technologist to otherwise convince the patient that it is safe to give contrast.

But I digress. Again. As is my nature. Too much free time, apparently.

[Judy]

Rich, After my surgey i was just about pain free with the exception of this left thigh numbness/pain and that is why Dr. Yue wanted the myleogram done. The results of the test showed this.
In April 2007 I was involved in a minor fender bender and my live of pain started nce again. Not nearly as bad as the past but a lot of pain none the less. I have been in PT for almost 2 years and this keeps me funtioning. Other than that I able to do some things but not most.

Judy