Adhesive Arachnoiditis

[hopefulgasman]

---

Members don't see this ad.

I have an older patient with a history of right L4-L5 hemilami who was getting lumbar epidurals and RFAs in the past with good benefit from another pain doc. I met him for the first time the other day and his most bothersome pain generator is left lower extremity radicular pain (L3/L4 distribution). His PCP had ordered an MRI a few months prior which read abnormal clumping of the cauda equina nerve roots displaced along the periphery of the thecal sac distally consistent with adhesive arachnoiditis. I looked at his MRI from a year before that and there was the same thing - abnormal clumping of the CE nerve roots. He saw a neurosurgeon about a month ago who noted that they didn't think the nerve root clumping was the source of his pain, but rather junctional deterioration at the level of the previous surgery and adjacent segment disease. Neurosurgeon sent him back to me to talk about SCS which the patient is interested in. He wants to avoid surgery at all costs. Because I just met him, I want to try to treat his left radicular pain one more time with an ESI and then +/- get neuromod going.

I've never had someone with chronic adhesive arachnoiditis and was wondering if there is any reason why I can't do another left L3 TFESI or ILESI/caudal? Surgeon made no mention of yes/no regarding more injections.

 

[Ducttape]

no reason not to.

will it work? well generally speaking data suggests less likely to, but he had benefit so inject away.


i would do transforaminal approach.

 

[lobelsteve]

Do what works for the patient. When it stops working, change.

 

[paindoc007]

scs