SCI: Spinal Cord Injury -Inthrathecal Baclofen Pump Experience Part II

12/21/2009

After my baclofen pump surgery as described in part I and part II, I experienced some post surgery complications. I developed a spinal fluid leak. Yeah, crazy.

Apparently it is not unusual because of the way the surgery takes place.

PROCEDURE

The day of surgery I arrived at 5:30am, where I put on the 'high fashion' hospital gown, got hooked up to an IV, and within an hour was wheeled off to the executioner looking table where they perform surgery.

I WAS NOT AWAKE

The Anesthesiologist put some good stuff in my IV while we were talking, and then I was out!

When they implant you with an intrathecal baclofen pump, they implant either in your lower left or right abdomen belly fat, or (as in my case) the upper buttocks region a device the size of a ice cream cookie sandwich, see above image. then they run a catheter from the device through your lower spine around L-5/L-6 and directly along the spinal column puncturing and going into the spinal canal directly next to the spinal cord. They thread the catheter up to the desired location up your spine canal to (as in my case) about T-4/T-5 (depends on the injury) See above image also.

They then anchor the catheter to your spine bone somewhere, staple you back up and off you go.

POST OP

When I woke up, aside from having the usual post-surgery High (Awesome) I wasn't in any pain really. Probably the Morphine though. There was some soreness as expected and I could not twist or bend. The doctor was adamant about me laying down, so believe it or not, they released me to go home the same day about 2 hrs after the procedure. They wrapped me in a gurdle to keep pressure on my back and to keep me straight, and they told me to very careful when moving. In retrospect, leaving so soon was not a good idea.

When I got home I laid down the first couple of days. I got up a few times here and there and noted my head would hurt some, but then soon laid down again. Around day 3-4 I would sit up and after going from horizontal to vertical I would feel a deep ache in my head, I would feel a bit dizzy, and the pain would slowly increase until I laid down. I pushed it more later that day and well into the next day when I figured it was simply because I was hungry or thirsty. Soon after I noticed that the pain increased until it was literally unbearable and I was forced to lay down, or feel as if I would pass out from the pain.

I called the Dr. office, and they advised me to go directly into the ER because it appeared I had a spinal fluid leak?

Freaked out I went into the ER, and was immediately seen because I couldn't stand.

During the surgery, when they inject the catheter into the spinal canal, they puncture the spinal 'sac' which contains the spinal fluid. If the spinal fluid leaks, the pain is caused because spinal fluid flows up your spinal cord, around your brain, and then is later flushed down your spinal cord from your head. Yes, your head literally expands and contracts like a balloon at various intervals. Weird eah.

In the case of a spinal fluid leak, the fluid escapes around the puncture area and as such, it flows into the surrounding tissue, or in some cases outside the wound and externally. This drop in fluid creates a drop in pressure as well, so essentially the pain is caused because your brain begins to rest on the bottom of your skull due to a deficiency in "Cerebral Spinal Fluid" (CSF). Hence the term CSF leak.

The doctors gave me a CAT scan, and a blood test. The remedy in this situation is mandatory bed rest, an IV, and LOTS of fluids and LOTS of 100% flat time on your back for 2-3 days. If the leak heals then they will send you home with the recommendation not to twist or bend AT ALL, and lay down as much as possible for another week. OR, if it does not heal, then they would have to cut you open and re-investigate where there may be a spinal leak. In my case that did not happen.

DOCTOR FOLLOW UP

About a week after my surgery was my doctor follow up where the staples were removed. Surprisingly it didn't hurt. It felt like someone pinched your skin a bunch of times, but I wasn't grimacing at all. Having the staples severely restricted your movement but was good in some ways because it was a reminder of your bend/twisting limitations.

CURRENT STATUS

It has been a few weeks since my initial surgery, and I still have to be careful bending and twisting. If I bend or twist I will feel a pinch in my lower back, and/or a headache will soon follow. If I am to active (walking, or working around the house/etc) I will get a headache. I did not initially receive the baclofen in the pump because it takes several weeks to verify there is no infection, and your body tolerates the pump and catheter before they inject the medicine in you.

I go tomorrow 12/22 to have the Baclofen injected. I will update Part III after that!