SM Shunt Information

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SM Shunt Information

Postby tnglitter » Wed Jan 14, 2009 12:17 pm

I decided to start this new thread for people who are considering having a shunt placed to drain their syrinx. (I felt like I was hijacking other threads and wanted to keep all this info together, as we seem to be in the minority and I think it's important to be able to find this information if it applies to you.)

I'll be moving my other posts over here and keeping this thread up to date for all to view. I hope someone can find answers here if they're considering the same surgery. I had SO many questions going in to surgery and as the idea of the surgery itself is so daunting, it would have been nice to know some things in advance. Things I didn't have anyone to ask about.

These are my experiences with the syringomyelia shunt surgery, placed into my thoracic syrinx. I have no CM, no tethered cord, no other obvious cause for this syrinx. My NeuroSurgeon is Dr. C (Dr. Capocelli), in Fort Smith Arkansas, who has done over 300 of these shunts, so he HAS the experience. He also trained side by side with Dr. Milhorat at TCI. This is a knowledgable surgeon, who I trusted with my life (obviously).

I've been through the doctor-mill, as have so many others on this message board. It is direly important to be seen by an expert NeuroSurgeon for a good, solid diagnosis before even considering undergoing any type of procedure for your syrinx. There are only a handful of these experts among all the NS's in the world. If you are looking for one in your area, post on the board that you are looking and where you are located. We have our own resident expert who keeps track of the NS's who are "in the know" about SM/CM and can be trusted with a diagnosis. She will make sure you know where to go in your area to be seen. Most NS's will tell you they are up to date in treating these conditions. Most NS's are NOT up to date - they just don't know it.

A syrinx in your spinal cord is a life-altering condition. You must prepare yourself for major changes in your life style. This is extremely difficult to do, but if you stick with this website message board and the good people on it, you will find so much help and support that this transition will be so much easier to deal with. We've all been there, done that. You are not alone - you have support. There are many of us out there, many who do not yet know what they have or how to deal with it. This is the place to begin for help.

Please feel free to post in this thread with your own experience(s) with syrinx shunts. That's what this thread is all about - information.


GENERAL ADVICE:

You will need MRI's done of your brain (with and without contrast), and all 3 sections of your spine: Cervical, Thoracic and Lumbar.

For all future postings, please break up your post into paragraphs. Most of us have a tough time reading long posts without a break in there. :wink:

#1 - Get an appt with one of the NS's on the list that Roz posts for you. This is VERY important! They are all up to date on CM/SM and KNOW that you're in pain and it's the syrinx/CM. Anybody else is going to think you're nuts and/or a hypochondriac. They are a waste of your time & money. We've all been through several of those before finding our "prince". Not what you need to be dealing with now. Many NeuroSurgeons will tell you that they know all about CM/SM, but they DON’T! The NS’s on Roz’s list are “proven” to us and all truly know about your condition.

#2 - Educate yourself. Knowledge is power and will keep the fear at bay. There are several websites with very good information on your condition and you can trust the information you find there.

http://www.asap.org (the homepage to this site), has excellent info for you.

http://www.conquerchiari.org also has a wealth of information on their site.

Also http://www.chiariinstitute.com is the website for The Chiari Institute in New York, where most of the research is coming from. They have excellent patient information videos that are extremely easy to understand and are very informative. For the videos, click on “videos” on the left hand side of the web page and then “Patient Information Videos”.

#3 - A list of DON'TS! (while you’re waiting for your appt. with the specialist NS)

No heavy lifting (they say nothing heavier than a gallon of milk, but we all know you can't get through daily life following this one.) Just keep the weight you're lifting to the bare minimum. Nothing heavy!

No motorcycles, rollercoasters, 4-wheelers, horses, skiing, boats - anything that can jar your spine or skull. Whiplash injuries could do you in.

No Straining. This includes pushing or pulling heavy weights, straining to reach something and even straining with your bowel movements. If you tend to be constipated, take daily fiber. Straining of any kind will cause your syrinx to grow.

No spinal taps, or other tests involving manipulation of your spine.

No Chiropractors! They can really mess you up right now and most do not know the basics or new info regarding Chiari/SM.

When your body says STOP, stop.

When your body says REST, rest. Try to get a nap every day if possible.

If you get a massage, make sure they stay AWAY from your spine and leave the deep tissue massages for someone else.

If it hurts, STOP.

#4 – And …..

Keeping a daily diary of what you do and when the pain hits and where, is an excellent tool for the right NS, once you get to him/her. Also record all of your symptoms and keep an updated list of all your medications (including vitamins, herbals, and OTC meds). You should have a copy of ALL your medical records, including your MRI’s, CT’s, etc. Take all this with you to your NS specialist.

There are some excellent ideas and links on this message board under the title of “Equipment/Accessibility”, for help managing your symptoms.

Will you be filing for disability? Check out the message board again under the title of “Disability Insurance Issues”.

You are in the right place for understanding and information. If you need to vent, do it here - saves your loved ones from hearing it and WE UNDERSTAND - they don't. So don't go away - we're your new CM/SM family and we're here for you.

Thanks for being so supportive, everyone. I love you all!

Rhonda
Last edited by tnglitter on Fri Jan 16, 2009 1:15 pm, edited 2 times in total.
T Spine SM T8-T12 (9 mm) Syringopleural Shunt & Laminectomy T10/T11 5 Jan 09
C spine Disc bulges/canal narrowing/DDD
L spine Spondylosis/DDD

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Re: SM Shunt Information

Postby tnglitter » Wed Jan 14, 2009 12:20 pm

Okey - syrinx surgery. I can now say that I've been there, done that and survived!

Dr. Capocelli placed my syrinx shunt on Jan 5th and I'm home healing now. While he was in there, he evidently did some extra work under my right shoulder blade (which has been a real painful area most of my life), and performed at least 1 laminectomy (I would assume it was in the cervical area). The reason I'm not too sure about all this is because I wasn't with it when he spoke to me and my mom after the surgery and she was lost in the lingo. My followup is 21 Jan, so will get more details then. Or from the surgical report if I can get ahold of a copy before then.

In the meantime, what I CAN tell you is that I have a permanent shunt placed - temporary shunts DO NOT WORK - the syrinx just fills up again so due to pressure issues in the spinal canal you have to have a permanent shunt placed to keep the syrinx drained. (This is how it was explained to me anyway...) I have 20 staples going down my thoracic spine and 17 staples closing another incision under my right shoulder blade.

I had the surgery the morning of the 5th and left the hospital the afternoon of the 8th. I had a BM like a good girl and got to come home a day early. (I think my mother's behavior had something to do with that decision as well - she pressed the CODE BLUE button looking for a light dimmer. Yeah - no kidding.) I can't take her anywhere.

My restrictions are no lifting above 5 pounds, no lifting anything over my head, no car rides, no driving (mega-meds!), rest when tired.

So far I am ahead of the game considering I faced paralysis very soon without this surgery. I woke up able to move my toes. I am still numb from the waist down, but can still walk - if that makes any sense. It's like when your leg falls asleep - you're numb there but you can still feel a little bit. Enough to walk slowly. The cane helps. Not to get into TOO much detail, but I cannot feel my butt. So bathroom visits are a bit of a challenge right now. I'm getting someone to pick up some baby wipes for me.

I have a shower chair already - certainly a MUST after this surgery. I am tending to my pets and doing little things around the house. Try to be up as long as I can to keep the circulation going in my legs. I know that I'll get some feeling back once the swelling from the surgery goes down. I'm not looking to regain it all though. The way I look at it is, I'm already way ahead of the point where I'd be had I not chosen surgery at this time.

I hope some of this helps someone else out. Please feel free to ask if you've got any questions - I know there's not many of us out here that have had the syrinx shunt surgery for JUST SM (no CM). I'll post again soon with updates. In the meantime - it's bedtime for Bonzo again....

Rhonda
Last edited by tnglitter on Thu Jan 15, 2009 3:04 pm, edited 1 time in total.
T Spine SM T8-T12 (9 mm) Syringopleural Shunt & Laminectomy T10/T11 5 Jan 09
C spine Disc bulges/canal narrowing/DDD
L spine Spondylosis/DDD

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Re: SM Shunt Information

Postby tnglitter » Wed Jan 14, 2009 12:22 pm

Janice wrote:
I thought Dr. C. was going through your stomach, since he went through your spine, please keep us posted on how long the pain in your spine lasts.

Hi All! Really good to be back - at least a little bit a day.

Janice, I thought he was going in through the stomach area as well - that's what he told me. I can only guess that the change in plans occurred right before surgery, when I was out. I had the EKG and chest scan done at the VA Hospital, which evidently weren't in a format that the surgery hospital could read. So I know that the EKG was repeated in the OR and they were planning on doing another scan before beginning as well. I remember the EKG - nothing after that.

I'm thinking that he decided to do the laminectomy as well, so just went in through the back. Glad he didn't go in through my stomach - turns out they use that area to give anti-biotic shots directly to the spinal area. I have black and very dark green blotches all over my stomach from each shot - looks horrible but I really don't feel them. They look like they would hurt though.....

Don't worry anyone - I'm not overdoing for sure! This is one surgery recovery I definitely don't want to mess around with. I'm following doctors orders. Even have friends stopping in and keeping me company and doing for me.

The meds are AWESOME! I do have some pretty bad spinal pain in between doses, I try to catch that though. Just have to watch the clock sometimes. Not too bad under medication though. I can sleep through the night, etc - just wake up needing the meds 1/2 hour before getting out of bed. That's the easiest way to handle the spinal pain.

The one thing that really bugs me is that I can't feel my butt. I can't possibly describe this to anyone. It's very, very weird!

I'll keep everyone posted.....

Rhonda
SOOO GLAD TO BE BACK!
Last edited by tnglitter on Thu Jan 15, 2009 3:05 pm, edited 1 time in total.
T Spine SM T8-T12 (9 mm) Syringopleural Shunt & Laminectomy T10/T11 5 Jan 09
C spine Disc bulges/canal narrowing/DDD
L spine Spondylosis/DDD

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Re: SM Shunt Information

Postby tnglitter » Wed Jan 14, 2009 1:23 pm

This morning when I woke up, I could feel pain in my right hand. I didn't realize it was partially numb before I guess. I wonder where else I'm numb that I don't know about???? Anyway, this particular pain was from the IV they had put in my right hand. Also I felt wrist and lower arm pain where I've had pain before the surgery.

I'm sort of getting used to the numbness in my legs and lower body. I don't feel as though it's going away yet. Just trying to keep circulation going as much as possible by walking around (carefully with the cane), until I get tired.

My new sleep comfort bed has been a life-saver for me. I put the feet up and massage on while I'm in bed watching tv or just resting. As low as the massage feature is, I still feel as though it helps in keeping the circulation going. It's also great to be able to raise my head up just a bit while sleeping. And I no longer worry about hip pain (as if I could feel it anyway right now), since I control the softness of the bed since I HAVE to sleep on my sides.

A good thing to have is a long body pillow to tuck behind you. It's easier to relax your back muscles when you know you can't roll over from your side onto your back. Just that extra bit of support is nice.

Keeping my meds beside the bed is a new one for me, but makes it much easier to take them on time. I can take my morning meds before I get out of bed, which makes it a much less painful morning. I use one of those pill holders - weekly am and pm compartments - that I "refill" every week. That helps because I can frequently forget if I've taken meds or not yet. Then the ones I have to take 3 or 4 times a day are beside the bed as well in their bottles.

I've set up an extra large nightstand space by placing a large tempered glass cutting board on top of my nightstand. Gives me lots of extra space for remotes, pills, phone, water, etc. If I were to do it again, I think I'd purchase a big butcher block cutting board instead, simply because things tend to "slide" around on the glass - wood would be a much better surface I think. My cane also resides beside the bed - VERY handy for getting in and out of bed without too much twisting (a BIG no-no), or effort. A walker there would be a good idea too - for the same purpose.

Rhonda
Last edited by tnglitter on Thu Jan 15, 2009 3:05 pm, edited 1 time in total.
T Spine SM T8-T12 (9 mm) Syringopleural Shunt & Laminectomy T10/T11 5 Jan 09
C spine Disc bulges/canal narrowing/DDD
L spine Spondylosis/DDD

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Re: Syringopleural Shunt Information

Postby wendi » Wed Jan 14, 2009 5:48 pm

Rhonda:

Your "beginners" post was most excellent. This would be a good post to keep around for all the newbies coming in. I don't know that they would see it with your title. Maybe you can rename it and place it again in the "All about cm section". You give tons of information that many of us repeat over and over to the newbies. It would be great if when they came in here they had that to read.

I hope those pains you are feeling are a good thing. I would assume so, since you were numb B4. You go girl! I do hope the shunt helps you. Keeping you out of the wheelchair is the main thing right? Is this supposed to help your pain also?

I was happy to hear you are behaving and getting your rest. Sounds like you have an awesome bed. I do love my memory foam bed. It makes me feel better just laying down. It was nice to hear you have yourself all set up in the bedroom. You have everything you need right there. I am glad you are taking care of yourself. And yet, here you are still taking care of others.

We love you too!
Wendi in PA
ACM 7.5mm B4 TCS 2.4mm post op
TC ,TCS @ TCI on 1/3/08,
chronic sacrolitis
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Re: Syringopleural Shunt Information

Postby sarahb » Wed Jan 14, 2009 7:47 pm

Rhonda - thankyou for starting this thread, I have saved it as my NS may find it useful.

One question - as I may need the shunt surgery in the future, how long is the recuperation (sp) period?? I work full time and drive a half hour each way to work, and as I am the only one at my workplace who can do my job - it may be useful for future planning.

All the best for your recovery.

Cheers
Sarah
Syrinx C6-T12 (and growing), Old compressed fracture T4, Disc Herniations T6/7 & T8/9 pressing on the spinal cord, Hemangioma T4, Aneurysm
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Re: SM Shunt Information

Postby tnglitter » Thu Jan 15, 2009 10:42 am

Wendi,
I re-worded and re-posted the "beginner's info" in the other discussion group. Hope it helps. Thanks. :wink:

I'm glad I can help out in some small way. I would have LOVED to have found something like this prior to my thoracic shunt placement surgery. It's extremely scary to be faced with just the surgery, let alone what to expect afterwards. Thanks to the people on this board I finally found my "Doctor Right" and that has meant the world to me. This is just my way of paying it forward or back or whichever way you'd like. :lol:

Sarah,
I have no idea how long the entire "recuperative" period is. My home-rest instructions from my surgeon says until he releases me from restrictions, which I'm assuming will be when I see him on the 21st. So that's 3 weeks right there. I'm not even allowed to ride in a car, so any work would be out (I'm on disability anyway). Not too sure what new ones will pop up later for me and when, but I'll keep this thread updated for you all. I think a large part of it would be determined on an individual basis, what exactly was done in surgery, how extensive it was, things like that.

I know that I'm in no shape at all right now to return to work if I had a job. The painkillers are doing their jobs as best they can, but DO leave me very, very goofy. So unless your job involves circus clowns or the like, there's no way you'd be able to return to work this early in the game. The numbness alone would be debilitating.

Rhonda
Last edited by tnglitter on Thu Jan 15, 2009 3:06 pm, edited 1 time in total.
T Spine SM T8-T12 (9 mm) Syringopleural Shunt & Laminectomy T10/T11 5 Jan 09
C spine Disc bulges/canal narrowing/DDD
L spine Spondylosis/DDD

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Re: Syringopleural Shunt Information

Postby sarahb » Thu Jan 15, 2009 1:46 pm

Hi Rhonda - thanks for that info. As I said earlier, this thread is fantastic.

My NS has always said that should I need the surgery - which last visit he was quite adamant that it is more a "when", not an "if" - he would need to go in through my chest so I was surprised and albeit - pleased to read that they went in through your back. From my understanding, any surgery in the thoracic area is extremely difficult - which is why we are leaving my herniations alone at this point.

But - as the last MRI showed that the syrinx is growing, and if the next MRI in April shows the same, I have no doubt that the NS will start reveiwing the surgical options. The syrinx was too thin at the last MRI to even contemplate the shunt option, and it seems to be heading along the path of going through the length of the spinal cord faster than it is widening out. Hope that makes sense!

Sooo - for me it is a case of keeping an eye on things, managing symptoms as best I can, and keeping a close eye on the syrinx.

Rhonda - please keep this thread going with your progess and I wish you all the best for a speedy recovery.

Cheers
Sarah
Syrinx C6-T12 (and growing), Old compressed fracture T4, Disc Herniations T6/7 & T8/9 pressing on the spinal cord, Hemangioma T4, Aneurysm
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Re: SM Shunt Information

Postby tnglitter » Thu Jan 15, 2009 2:09 pm

Besides the numb-butt thing, the other thing that annoys me the most is my feet. I can still "feel" the socks they put on after surgery to keep clots from forming. When I was first out of surgery, my right foot and leg hurt SO BADLY from those stupid socks. They finally let me take them off once I got up and around in the hospital.

I swear on a stack of bibles, that I can still feel those socks on my feet! Even through the numbness. I can feel where the elastic began above my toes when I try to bend my toes. I can feel the heel part that was cut out of the sock even. This is mostly on my right foot (the one that hurt the most), but I can feel the left sock too. Now, is that insane or what? I had the surgery on the 5th and this is the 15th, so 10 days after getting those stupid elastic socks off, I still feel like they're on my feet.

I wonder if this is like "phantom pain" that amputees feel? Although it's not really painful, it's just "there", even through the numbness. The after-effects of this surgery is like wandering around in Wonderland. I keep discovering new and VERY weird symptoms.

No other changes today, just thought I'd post about the strange sock thing. :roll:

Rhonda
Last edited by tnglitter on Thu Jan 15, 2009 3:07 pm, edited 1 time in total.
T Spine SM T8-T12 (9 mm) Syringopleural Shunt & Laminectomy T10/T11 5 Jan 09
C spine Disc bulges/canal narrowing/DDD
L spine Spondylosis/DDD

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Re: SM Shunt Information

Postby tnglitter » Thu Jan 15, 2009 2:32 pm

I copied this post from another thread - excellent information in here about shunts. I'd like to keep this thread as informed as possible and this post really fills the bill. One-stop thread for shunt information. :D Thank you for sharing your knowledge, Cracker !

Rhonda

CrackerNaCl posted:

What to know about shunts...

Shunts have only been in existance for about 50 years (I forget the exact year) But becasue of them patients like me who used to die early in life get a chance at life. Yay! Since their development a number of different types of shunts have been inventied including the Ventricular arterial shunt, Ventricular Peritoneal shunt, and ventricular lumbar shunt, they even now have programable shunts. There are single bubble shunts, double bubble shunts, and shunts with anti siphoning devices.... those are all the ones I can think of. Don't get overwhelmed by that your doctor can share with you the pros and cons of each one and decide which one is best for you/your loved one. I just thought I'd put it out there in case you wanted to look up any specific information about one of them.

What it enables you or disables you to do... the idea of a shunt is to re route the CSF flow when something is causing it not to flow correctly which I have not yet experienced myself in the case of SM but I am told that the idea is the same as the shunt I have for my Hydro which is that by incerting a shunt into the brain and then having the tubing train somewhere like the abdomen it relieves the pressure and fluid build up that is causing the CSF to flow into the spianal cord. If this is successfull it has the possibility of relieveing some symptoms if not all. This is not an instant process but can be achieved. Therefore I guess you could say that it "enables you" to resume more normal life activites without symptoms. having a shunt doesn't really "disable" you from doing anything. The only thing I was ever told I wasn't allowed to do was full contact sports (i.e. boxing) But that is the ONLY thing they have ever told me flat out that I could not do. Comfort wise there are small things i.e. it is hard for me to find helmets and sometimes hats that are comfortable for me to wear because the area where the shunt threads on the outside of the skull is somewhat sensative but this is a minor annoyance. (Don't get the idea that it is PAINFUL, becasue it really is not and is CERTAINLY not as painful as the constant pain and headaches, and preasure that I would experience if I didn't have the shunt)

Why so many revisions... The number of shunt revisions that people have (when they have to go in again and fix a part of the shunt) is really quite variable. I have known of people in their 40's shunted their whole life with no revisions at all, and the most dramatic case I know of is an 11 year old girl who has 126 revisions. I know this isn't really a helpful answer but there are so many variables that are unique to a persons very specific case. Shunt placement and longevity can depend on a persons unique anatomy as well as the make up of thier CSF (the proteins etc.) What I can say is that the reason for the shunt revisions no matter how frequent they are is usual due to a number of factors either a) a blockage which is when "debris" clogs the shunt so they have to replace part of the tubing, 2) sometimes when a shunt gets old it becomes brittle and can actually break from normal wear and tear, this often happens in the neck due to the amount of bending and twisting that goes on. 3) Infections, infections are really only a major risk around the time of surgery, as far as I know it is pretty rare to ever have an infection that appears even a year after surgery, I am pretty sure the statistic is that usually if they are going to they appear withint he 2 weeks after surgery. None the less I wanted to mention it because it is aways a possibility.
T Spine SM T8-T12 (9 mm) Syringopleural Shunt & Laminectomy T10/T11 5 Jan 09
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Re: SM Shunt Information

Postby tnglitter » Sat Jan 17, 2009 2:09 pm

12 days post-surgery

I am getting feeling back in my fingers and hands now. I can feel the pain in my finger joints that I had before the surgery. This is good. I "feel" a tightness in my back around the staples closing the incisions made during surgery, but not any real pain there yet. I still have the pain in my spinal cord (which is being fairly well managed by Lyrica and Neurontin). I still cannot feel my butt and had a BM yesterday. I can't "feel" the BM and don't know when I'm done, so end up sitting there for awhile afterwards. The baby wipes help alot since I can't feel where I'm trying to clean up. (Sorry to be so graphic, but this may help someone else in the future.) I still "feel" those d***ed socks on my feet that aren't there. Such a strange feeling.

I received my copy of the surgery records yesterday. The decompressing laminectomy was performed at T-10 and T-11 (I'm thinking that's where they routed the shunt tubing out of my syrinx.) The surgical cut beneath my right shoulder on my back was to route the shunt tubing to an area between my lungs and rib cage. I think they attached it to one of my ribs to hold it in place. It is 8 inches long, and drains the CSF from my syrinx to that area in my body where my body will just absorb the CSF. So they did have to open up that area to route the shunt tubing.

What I have is a T-Tube Shunt otherwise known as a Syringopleural shunt. The way it was described to me prior to surgery was exactly what it sounds like. The shunt was placed inside the syrinx and opened up on 2 sides. So there are 2 "drains" inside the syrinx, going into a single tube to drain CSF out of the syrinx continuously. The arachnoid space was cut into carefully and the nerves "hooked" to the side while the shunt placement procedure was taking place. I still don't know why he didn't go in through my chest area and chose going in through the back instead. Unless he figured that since I would have to have a good-sized incision on my back to route the draining tube, he might as well make the incision to the spine from the back as well. I will ask him that question when I see him on the 21st of Jan.

My spinal pain is still well-managed and I imagine the fact that I am numb there helps a great deal as well. I'm noticing the feeling coming back in my hands and fingers when they start to hurt again (as they have always hurt before). The good news is that the numbness DOES seem to be going away very slowly - but going away.

I'll post later with updates as they happen..... :)

Rhonda
T Spine SM T8-T12 (9 mm) Syringopleural Shunt & Laminectomy T10/T11 5 Jan 09
C spine Disc bulges/canal narrowing/DDD
L spine Spondylosis/DDD

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Re: SM Shunt Information

Postby tnglitter » Sat Jan 17, 2009 10:23 pm

Here's a picture of my back - spine and right shoulder blade (where they've put the drain between my lung and ribs).

Image
T Spine SM T8-T12 (9 mm) Syringopleural Shunt & Laminectomy T10/T11 5 Jan 09
C spine Disc bulges/canal narrowing/DDD
L spine Spondylosis/DDD

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Re: SM Shunt Information

Postby birdlover3 » Sun Jan 18, 2009 3:41 am

Thank you for doing this and keeping it updated. I’m an ‘oldbie’ here & I can tell you it helps to be reminded about do's and don't's. Thank you for keeping us updated about yourself. I’m praying for you and sending healing, happy thoughts.
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Re: SM Shunt Information

Postby marymac » Sun Jan 18, 2009 4:24 am

Hi Ho Rhonda:
You were the first person that was there for me via this Board, so don't know you much yet but you're currently my #1 American idol: you walked the walk, talk and share so much with the talk it means the world to us, and here you are helping us already. Thank you and I'm SO very glad your surgery went well. You'll recuperate faster because of your fine attitude. Sending thoughts and prayers your way,
Mary
Marymac
Central disc herniations C5-6 and C6-7, extensive syringohydromyelia cavity throughout the cervical & thoracic cord (large syrinx from C6 inferiorly.)

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Re: SM Shunt Information

Postby tnglitter » Sun Jan 18, 2009 11:37 am

Here's the Operative Report from the surgery. Hope it helps someone:

Operative Report

DATE OF SURGERY: 01/05/09

PREOPERATIVE DIAGNOSIS: Thoracic Syringomyelia

POSTOPERATIVE DIAGNOSIS: Thoracic Syringomyelia

SURGICAL INDICATION: This is apparently increasing size and increasing symptomatology from mid lower thoracic syrinx.

SURGEON: Anthony Capocelli, M.D.

ANESTHESIA: General endotracheal

POSTOPERATIVE CONDITION: Stable

ESTIMATED BLOOD LOSS: 100 cc

FLUID REPLACEMENT: Crystalloid

DESCRIPTION OF THE PROCEDURE: The patient was brought to the operating room and anesthesia was induced in a routine fashion. We then placed the patient in the prone position on the OSI table. We then prepped and draped the back in a routine fashion. We then marked out two skin incisions, one a few fingerbreadths below the scapula on the patient’s right and one centered over the T10-11 interspace.

We then infiltrated with one percent Xylocaine. We then made a T10-11 incision with a 10 blade about three inches in length. We infiltrated with lidocaine and dissected through the subcutaneous layers with Bovie electrocautery and found the thoracolumbar fascia which was then taken down with paraspinal muscles over the spinous process and lamina at T10 and 11 exposing the lamina bilaterally.

We then placed several retractors and cerebellars. We then did a decompressive laminectomy at 10 and 11 utilizing ___________ and Kerrison punches exposing the thecal sac. We then opened up the dura with an 11 blade and opened up the arachnoid with 11 blade nerve hook exposing the cord.

We put FloSeal on the edges of the epidural space for hemostasis and under the operating microscope we opened up the midline septum of the cord utilizing electrocautery and an 11 blade. We then placed a portion of a T-tube shunt.

We then passed it with a passer to the right wound at the scapula where we made an incision with a 10 blade, dissected down with Bovie electrocautery and identified a rib and dissected along the superior border of the rib to expose parietal Pleura. We then opened this up and placed two clamps on it then passed the distal shunt tubing to that wound and passed it into the pleural space about eight inches.

We then closed the fascia of the muscles there and closed the skin in multiple layers with Vicryl and staples for the skin. We then closed the dura primarily with a running Gore-Tex. All this was done incidentally under the operating microscope. We then placed Tisseel and Surgicel and Duragen over dura followed by closing the fascia with 0 Vicryl for the fascia and staples for the skin. We then placed a routine dressing and turned the patient over to Anesthesia for extubation.


I finally gave up and just re-typed the report into Word so I could cut and paste it. :roll: I separated the report into paragraphs to make it easier to read. Anyway, there it is for those who want to know exactly how the procedure is done - at least on me.

Rhonda
T Spine SM T8-T12 (9 mm) Syringopleural Shunt & Laminectomy T10/T11 5 Jan 09
C spine Disc bulges/canal narrowing/DDD
L spine Spondylosis/DDD

Mom of 3 daughters & MiMi to 2 grandsons & 1 granddaughter
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tnglitter
 
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Location: Central Tennessee

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