epidural man

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Jun 3, 2007
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Any suggestions?

History - Anterior lumbar disc replacement gone bad - IVC was torn, gallons of blood loss, etc. He survived. Now he has horrible pain in the bottom of his feet, weakness, and loss of propioception. Post surgery scan shows severe epidural adhesiolysis around the nerve roots posteriorly (where no surgery took place) and imaging signs of arachnoditis (but neurosurgeon doesn't think that is cause of symptoms due to lack of other arachnioditis symptoms). Thought is that blood pooled in the posterior epidural space causing current problem

Neurosurgeon thinks he should attempt a surgical adhesiolysis. He was anxious for us to try some other modalities before proceeding.

We attempted RACZ with hypertonic saline and hyaluronidase with no benefit. I trialed him with SCS, but lost foot coverage after day one and with multiple programing attempts, was unable to recapture the painful area (bottom of feet). With placement, I put the leads all over the place (from T8 to L1) without good coverage, eventually trolled down from T8 (lead on, pull the lead down to try and capture the area). I don't remember where it ended up finally - I think around T11.

anyway, any thoughts on how best to capture the bottom of the feet?

His pain is worse on the right. I have considered peripheral stim.
 
Last edited:

lobelsteve

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T10-T11 with pulse width at 400+
Retrograde and enter at L2-3 and put lead tip at L4 pedicle laterally.
 
OP
epidural man

epidural man

ASA Member
10+ Year Member
Jun 3, 2007
3,029
702
49
San Diego
Status
Attending Physician
T10-T11 with pulse width at 400+
Retrograde and enter at L2-3 and put lead tip at L4 pedicle laterally.
Thanks. Good tips. I've never done a retrograde placement. this may have to be my first. Do you find that the coverage persists with time?