Spine-Pain

I received a lumbar puncture.

My CSF Protein value of 57 which was flagged as abnormally Out Of Range of the MG/DL 12-45 Within Range levels.

I found the following research.

* Total protein levels in CSF are normally very low, and albumin makes up approximately two-thirds of the total. High levels are seen in many conditions, including diabetes, bacterial and fungal meningitis, tuberculosis meningitis, multiple sclerosis, polyneuritis, cancer, tumor, injury, or any inflammatory or infectious condition.

* Lumbar disc herniation with sciatica may be associated with increased CSF total protein.

* Inositol and creatinine were reduced in patients with disc herniation.

My previous blood lab reports have indicated my creatinine levels flagged as abnormally low.

The symptoms of burning sensation affecting the feet, thought to be due to a distal small-fiber x neuropathy (DSFN) affecting somatic unmyelinated fibers, are usually accompanied by vasomotor or sudomotor changes suggestive of involvement of autonomic fibers. We therefore examined the relationship between pattern of anhidrosis and DSFN and its etiology, comparing patients with “pure” DSFN (with normal nerve conduction) to those with clinical DSFN (minor conduction abnormalities). We reviewed 125 cases with a clinical phenotype of DSFN. These patients had distal burning discomfort, variable sensory deficits, and intact motor function. All had undergone assessment with thermoregulatory sweat test (TST), autonomic reflex screen (ARS), and nerve conduction studies and electromyography (NCS/EMG). TST showed a distal pattern of anhidrosis in 74%. The quantitative sudomotor axon reflex test (QSART) was abnormal in 74%, with 80% of those having a length-dependent pattern of anhidrosis/hypohidrosis. In total, 93% of patients had a distal pattern of abnormality on QSART or TST. The Composite Autonomic Severity Score (CASS) was used to quantify the severity and distribution of autonomic deficits: 98% had CASS abnormality (sudomotor, 98%; adrenergic, 43%; cardiovagal, 35%). EMG was normal or showed unrelated abnormalities in 75%. The most common etiologies of DSFN were idiopathic (73%), presumed hereditary (18%), and diabetes (10%). Sudomotor examination is thus a highly sensitive detection tool in DSFN. Autonomic involvement is mainly distal, and additionally may involve adrenergic and the long cardiovagal fibers.

http://cat.inist.fr/?aModele=afficheN&cpsidt=17900365

A MRI with and without contrast might reveal scar tissue as the source of pain.

For a patient who has already had spine surgery, the contrast agent has traditionally helped in differentiating a recurrent or remaining disc herniation from scar tissue.

Scar tissue and pain after back surgery

Effects of scar tissue on back pain and leg pain

The formation of scar tissue near the nerve root (also called epidural fibrosis) is a common occurrence after back surgery—so common, in fact, that it often occurs for patients with successful surgical outcomes as well as for patients with continued or recurrent leg pain and back pain. For this reason, the importance of scar tissue (epidural fibrosis) as a potential cause of postoperative pain—commonly called failed back surgery syndrome—is controversial.

http://www.spine-health.com/Topics/surg/scar/scar01.html

The prevalence of peripheral neuropathy is about 2% in the general population, but it rises to 12% and 17% in people with one or two recognised risk factors.1 Diabetes is one such risk factor and the most common cause of this disorder—about half of patients who have had diabetes for 25 years have peripheral neuropathy. The early symptoms of diabetic neuropathy and other peripheral neuropathies are due to degeneration of small somatic nerve fibres, which may remain the only nerves involved.2 However, “small fibre neuropathy” may not be detected by traditional physical, neurophysiological, and neuropathological tests. In the past decade, skin biopsy has become a popular method for investigating small nerve fibres.3 It allows general practitioners and non-specialists—such as diabetologists and specialists in orthopaedics—to diagnose neuropathy (thereby avoiding delayed or incorrect diagnosis), to investigate its aetiology, and to focus treatment, in particular for neuropathic pain.

http://www.bmj.com/cgi/content/extract/334/7604/1159

Watch out for digital nerves

Skin biopsy as indicated above carries a high risk of causing a digital nerve injury leading to a neuroma causing chronic pain, which may require reconstructive surgery. If volar digital skin biopsies are required then it is much safer to harvest these in the midline of the finger, but patients should be warned of the potential nerve injury and neuroma risk as important nerves are only a few millimetres under the skin surface.

Discography or a discogram is a type of x-ray used to view the intervertebral disc space. The abnormal disc is injected with an illuminating fluid under x-ray. The fluid injection may replicate the patient’s symptoms, which may include leg pain. Abnormalities related to disc function or anatomical disorders might be determined by discography.

A discogram is a diagnostic test that has been recommended by your doctor.  This test will be performed by your doctor at the hospital at a pre-arranged time.

The doctor will insert usually 1 to 3 needles into your back into the lumbar discs.  Dye will then be injected into the discs.  Your doctor will then take x-rays to observe the dye inside the disc space.  He will also ask you what level of pain you have when each disc is injected.  This will help your doctor identify the painful problematic disc.

You will be awake for this procedure, but a nurse or anesthesia doctor will give you medicine to relax you.  Following the discogram, your doctor may have a post discography CT Scan done.  This test in non-painful.

The results of the discogram and CT Scan will take several days to compile.  Your doctor will see you back in the office 1-2 weeks afterwards to discuss the results and to formulate a treatment plan.

Your back pain may flare up for a few hours after this testing, but your doctor will send you home on some pain medications.  This should resolve within 12-24 hours.

http://www.kyspine.net/HTML/glossary.html