For Dr. W: Diagnoses and Procedures

For my childhood friend who is a doctor, and other interested and non-squeamish parties:

Here's a (possibly) cryptic post to answer your question about the diagnoses/procedures behind all this suffering.

Excerpts from initial report from the MRI Lumbar Spine and Sacrum without Contrast, 1.17.2006:

Large cystic expansile lesion in the mid and lower sacrum, most likely representing and occult intrasacral menigocele... the S2 and more inferior sacral and coccygeal nerve roots could be affected. CT myelography could be performed to evaluate for the presumed connection of the lesion to the thecal sac if clinically indicated.

The lesion is nearly isotense to CSF on all pulse sequences, with mild remodeling of the adjacent sacrum... the lesion measures approximately 5.9 x 3.6 x 7.0 cm.

3.1.2006, First operation preoperative diagnosis: sacral meningocele/intradural cyst
Procedure performed: Sacral laminectomy and excision of cyst wall, microdissection technique, intraoperative nerve stimulation/monitoring.

3.7.2006, Hospitalized a day or two after discharge for treatment of Clostridium Difficile.

12.22.2006, Second spinal operation: Cyst, subanachnoid (intrathecal) shunt with Delta low-pressure valve.

2.13.2007 (happy valentines day), Nose surgery to repair damage done when Littlest One threw himself backwards and broke my nose; I'd had to put off surgery to accomodate spinal surgery, though the assault occurred in early September.

7.11.2007, Third spinal operation: Laminectomy and closure of cerebrospinal fluid fistula, sacral spine.

7.21 - 7.26, hospitalized for excruciating pain; turns out I'd blown the dural patch right off, but despite my 61-day CSF headache, we didn't find that out until...

9.5.2007, Fourth spinal operation: Repair of cerebrospinal fluid fistula with patch, microdissection technique, placement of lumbar subarachnoid drain.

10.10.2007, Fifth spinal operation, postoperative diagnosis: dislodgement of distal end of subarachnoid shunt. Proceedure performed: Exploration of wound, removal of distal cyst catheter tip and conversion to an Ommaya reservoir. On my back for a week with drains in place to moderate CSF pressure to allow wound to heal.

10.17.2007, Sixth spinal operation: Same hospitalization, repeat of most recent surgery, I think... Here I've lost track of operative reports. On my back for a week with drains in place to moderate CSF pressure to allow wound to heal.

12.14.2007, Seventh spinal surgery: removal of cyst shunt/reservoir, repair of dural opening via laminectomy, placement of lumbar subarachnoid drain. Intensive care section of Neuro Unit, spinal drains in place, etc.

12.21.2007, Upon discharge from hospital, transfer to rehabilitation hospital for monitoring, pain management, and therapy to recover from major muscle atrophe after so many days/weeks in bed. Released for good behavior several days early, 12.29.2007.

Currently under home health care and home physical therapy. In a month, maybe I'll graduate to outpatient therapy.