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Other terminology
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TOPIC: Other terminology

Re:Other terminology 11 years, 9 months ago #330

  • mitsuyo
Dear DocSarah,

It's so great to have you back on the Forum! I hope you are feeling better. We are so grateful for all the answers and information you can provide for us.

Thank you so much for answering my queries on scarring. And your reply to Ang answered some of my NEW queries!
(1) How far can the chemical travel? So, ESIs could remain local, correct? What else could affect the degree of spread? I had Epidural Anesthesia for child-birth three times. Before the first one, an anesthegiologist told me that I would need higher dose than usual due to the scar tissues caused by a previous lumber surgery. First labor ended up with a C-section with even higher dose of the drug and longer administration with additional Morphine injected via the same catheter for post-operative pain.
* amount of chemical administered?
* duration of such administration?
* number of such administration?

(2) Does the \"traveling\" or spread occur over time or in a very short period of time from the point of chemical insult?

(3) Can we assume that scarring will only spread as far as the chemical can reach?

(4) Is scarring the beginning stage of Arachnoiditis?

(5) Is scarring itself different from arachnoiditis?

(6) If AA did indeed spread, would it show up on an MRI of different level/area?

I had a fusion at L5-S1. I believe the Epidural Anesthesia was given at a higher level than that. My myelogram with CT showed clumping of several nerve roots at about L4.
(7) The same myelogram showed ventral extradural defects at L1-L2 through L4-L5. What does this mean? Is this a sign of existing scarring?

(8) I think there are two ways to \"see\" the progression of AA: progression of symptoms, which can be subjective and influenced by many factors, and progression of scarring, inflamation, clumping of nerve roots, etc, which can be seen in MRIs, etc. Can we assume that the latter progression can only be measured by comparing MRIs (CT, etc) obtained at different times?

I would really appreciate getting some answers/input on the above. And I am sorry again for adding more questions. Thanks again for all you do for us.

Best Regards,
Mitsuyo

Re:Other terminology 11 years, 9 months ago #331

  • DocSarah
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Hi Mitsuyo

I will try to answer some of your queries:

1) How far can the chemical travel? So, ESIs could remain local, correct? What else could affect the degree of spread? I had Epidural Anesthesia for child-birth three times. Before the first one, an anesthegiologist told me that I would need higher dose than usual due to the scar tissues caused by a previous lumber surgery. First labor ended up with a C-section with even higher dose of the drug and longer administration with additional Morphine injected via the same catheter for post-operative pain.

* amount of chemical administered? yes

* duration of such administration? yes

* number of such administration? yes



(2) Does the \"traveling\" or spread occur over time or in a very short period of time from the point of chemical insult? for oil-based myelogram dye there could be a fresh spread if the encapsulated droplets are disrupted e.g. by a fall; however, these days, most chemicals spread quickly once administered



(3) Can we assume that scarring will only spread as far as the chemical can reach? not necessarily



(4) Is scarring the beginning stage of Arachnoiditis? no, the first stage is an inflammatory response when the nerve roots swell; second stage, the scarring (fibrosis) begins; third stage the scar tissue sticks the nerve roots together and pulls them out around the dural sac, if severe the clumping may even obliterate the subarachnoid space, impeding CSF flow



(5) Is scarring itself different from arachnoiditis? in a way; what we are talking about most of the time with this forum is the severe form of arachnoiditis i.e. adhesive arachnoiditis; this is the clinically significant form. Asymptomatic arachnoiditis can be present without being a problem.



(6) If AA did indeed spread, would it show up on an MRI of different level/area? quite possibly



I had a fusion at L5-S1. I believe the Epidural Anesthesia was given at a higher level than that. My myelogram with CT showed clumping of several nerve roots at about L4.

(7) The same myelogram showed ventral extradural defects at L1-L2 through L4-L5. What does this mean? Is this a sign of existing scarring? it may reflect scar tissue inside and/or outside the dura, causing damage to the dura either distorting it or even compromising it's integrity



(8) I think there are two ways to \"see\" the progression of AA: progression of symptoms, which can be subjective and influenced by many factors, and progression of scarring, inflamation, clumping of nerve roots, etc, which can be seen in MRIs, etc. Can we assume that the latter progression can only be measured by comparing MRIs (CT, etc) obtained at different times?
it is important to remember that MRI findings often don't correlate well with symptoms. This holds true of all MRI appearances, not just for arachnoiditis. Also remember, MRIs are a static picture that doesn't show what happens when the patient sits/stands/walks


Hope that helps!

regards

DocSarah
[b]DocSarah

Re:Other terminology 11 years, 9 months ago #332

  • DocSarah
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glad to help Ang

All the best to your sister

DocSarah
[b]DocSarah

Re:Other terminology 11 years, 9 months ago #334

  • mitsuyo
Dear DocSarah,

Thank you so much for answering my questions. As you can tell, I keep coming up with more questions! It's not that your answers are insufficient. Your answers actually help me see what I don't understand, because quite often I don't even know what to think or ask.

Anyway, referring back to my question (1) and (2): I believe I received higher dose than normal for Epidural Anesthesia all three times. It did take longer for me to \"feel\" the full effect of the drug. My first labor lasted almost 24 hours though I can'r remember at what point I started on the anesthesia (at least 12 hours), then I had to continue on Epidural for C-section and postoperative pain relief. For the second and third ones, I was on Epidural A for 3-7 hours each time (luckily no C-section).

I was lying pretty much flat during the Epidural administration, but the amount of chemical, duration and number of administration were high. I am wondering if the scarring is widespead in my case, but presenting only mild symptms.

My question (a) : How far could the chemical have traveled in these circumstances? As wide/far as oil-based dyes on tilted table? Or could it be still quite local (up to few spinal levels)? Could the ventral extradural defects I mentioned be the evidence of the extent of chemical spread?

Even with widespread scarring, could the symptoms be still mild?

(b) Referring to the question (3): So, we can't necessarily assume that scarring will only sread where the chemical reach. How else, can scarring \"spread\"? Does scarring occur only as a result of inflammation due to some kind of insult to the area? Can scarring form without any \"insult\"? (I guess surgery is a different kind of insult than a chemical one.)

(c) Referring to the question (4): Can the clumping of nerve roots progress to become \"severe\" over time?

(d) When doctors (and we) in general talk about \"scar tissues,\" are they referring to the scarring we are talking about here that occurs after inflammation of nerve roots?

My brain can't think any more today. Thanks for helping me out, DocSarah with my on-going queries. I hope you are indeed feeling better these days!

Best Regards,
Mitsuyo

Re:Other terminology 11 years, 8 months ago #336

  • DocSarah
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Dear Mitsuyo,

I'm afraid there are no definitive answers to your questions. I don't know all your details for a start (would need your medical records and to examine you etc.) but in principle, you could have widespread scarring on MRI with only mild symptoms.The ventral extradural defects may be related to arachnoiditis, but could be due to epidural scarring (outside the dura) distorting the dural sac.
IN answer to your query about spread, in some people, it seems that scarring does spread and I think this may be due to an autoimmune response. This can happen in people who have predisposition to autoimmune conditions such as rheumatoid arthritis, lupus etc. (maybe a family history). I think chemically induced arachnoiditis is more likely to cause this effect.
As to progression: that again is difficult to answer. Generally, people tend to 'plateau out' and become quite stable apart from a pattern of flare-ups and remissions a bit like in other inflammatory conditions. But another mild trauma ( a fall, accident, surgery) can trigger an exacerbation.
Scar tissue is a general term which can be used to mean epidural or intradural (arachnoid) scarring when used by non-experts.

Hope this helps!

Regards,

DocSarah
[b]DocSarah

Re:Other terminology 11 years, 8 months ago #337

  • Ang
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Hi DocSarah

When you mention a \"plateau\", I know everyone is different, but in what type of time frame does this usually happen. Specifically, one year after last invasive procedure before AA diagnosis finally made, could the progression \"plateau out\"

Also, new MRI shows AA in L4,L5 with extensive fluid buildup in disc space, what could this mean in your opinion, doctor is following up with blood work to rule out infection.

Thank you so much for taking the time to answer my questions.
Regards,
Ang
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