Arachnoiditis

Fort Lauderdale was wonderful.  Weather, friends, food, doggies.  But the seven hours sitting  each way on the plane seems to have caused some problems.  In FL I found I was having trouble not only with neuropathy on the soles of my feet but numbness and pain continued to expand down from my butt through the backs of my legs.  When I returned to Seattle, the pain was even worse, so I spent Wednesday at the University of Washington's ER having an MRI done of my lower spine.  Then Friday I went back for an MRI of the upper spine.

The good news is that the disk bulging (which include all the lumbar disks) is not caused by tumor growth pressing on the lumbar spine.  The bad news is that they don't know what causes it and it is extremely rare. 

Here is the preliminary MRI report and the final MRI report, which differ significantly:


PRELIMINARY REPORT BY THE NEURORADIOLOGY FELLOW - FINAL REPORT TO FOLLOW:
MRI LUMBAR SPINE WITHOUT AND WITH CONTRAST, 3/28/2012.
INDICATION: Cauda equina symptoms with NSCLC.
TECHNIQUE: Sagittal T1, T2, STIR. Axial T1, T2. Postcontrast sagittal and axial T1.
COMPARISON: CT chest, abdomen and pelvis, 10/17/2011. Lumbar spine, 2 views, 3/28/2012.
FINDINGS:
Mild (grade 1) anterolisthesis of L5 on S1. Bone marrow signal is normal. No evidence of acute fracture or focal bony lesion.
No abnormal enhancement within the spine or cord. No epidural mass. Paravertebral soft tissues are normal.
Conus ends at L1 and the conus and nerve roots are normal in appearance.
Multilevel disc dessication. L1-L2 diffuse disc bulge with superimposed left lateral recess / far lateral disc protrusion resulting in
mild narrowing of the left lateral recess and neural foramen. Diffuse L2-L3 disc bulge resulting in mild narrowing of the left neural foramen.
Diffuse L3-L4 disc bulge resulting in mild bilateral neural foraminal narrowing. Diffuse L4-L5 disc bulge resulting in mild right neural foraminal narrowing.
Diffuse L5-S1 disc bulge without significant cental canal or neural foraminal narrowing. Multilevel ligamentum flavum and bilateral facet DJD.
Large cystic structure in the pelvis is incompletely visualized and better demonstrated on prior CT.


IMPRESSION:
No evidence of metastatic disease to the lumbar spine or cord compression.
This is a preliminary report by DG.


_____________________________________________________________________________________________________






FINAL REPORT:
Final Findings:
The final report differs from the preliminary report, as discussed below. Findings were conveyed by Dr G to Dr S at time of final dictation.


No central canal stenosis is seen at any level. No paraspinal or epidural mass is seen. The intrathecal and exiting nerve roots from L3-S1 are slightly enlarged in caliber and demonstrate clumping, as well as abnormal enhancement. Findings are consistent with arachnoiditis. No other abnormal enhancement is seen.


Final Impression:


1. No paraspinal/epidural mass or central canal stenosis at any level.


2. Findings consistent with arachnoiditis in the lower lumbar spine.
3. Multilevel degenerative changes of the lumbar spine, as described.
 
 
So there we have it.  I will go in this week for a lumbar puncture to see if the spinal fluid can reveal any hints as to what is going on.  I am the proud possessor of a 4 prong cane.  I guess the one Jay gave me in college for shin splints won't do the trick anymore.  It's really hard to sit, so I am lounging a lot, rather like Madame Recamier, only not so gracefully or in such nice clothes: