Hello doctor, It is about nine months since I have had L4 hemilaminectomy, L5 foraminotomy and drilling of bone fracture at L4-L5 level. I had an MRI two months later due to severe pain. The MRI report presented inflammation and edema of the back muscles, inflammation of nerve roots, compression of nerve roots at L4-L5, suspicion for radiculitis/arachnoiditis and low-lying conus at L3-L4 with tethered cord and thickened filum. Following the report, I was treated with Dexamethasone for a tapering 10-day course. During the last eight months, I have had many symptoms including severe back pain with a constant heart rate of 130 and up varying blood pressure. The results change constantly from 100/40 to 200/140 inflammation and wounds on my back with a weakness of the bladder and bowel issues. I had an EMG that showed acute neurogenic lesion annular distribution at L4-5 and L5-S1. I also had an echocardiogram that stated: Rest HR to be 130, in effort - 3:36 HR 90% effort level - 5.3. I am scheduled for a cardio examination next week. My question is whether these symptoms can be related to the low-lying conus with a tethered cord? Before the surgery, I only had a CT so I do not know if the tethered cord was there or not? Can it be that the inflation and edema caused the tethered cord issues and symptoms? Can it just go away on its own? I would appreciate any ideas and recommendations that you might have on this issue or any other finding that you come up with. Please help. I have attached the reports for your reference.
Hello. I have gone through your reports (attachment removed to protect patient identity). The tethered cord is a result of fibrosis and inflammation. Your symptoms of back pain and weakened bowel and bladder movements could be explained with the tethered cord.  The changes in heart rate could be related to a cardiac disorder or inflammation, but they are not related to the spinal cord damage in this region. Painkillers and steroids can lead to high blood pressure and changes in the heart rate. The pain can also activate the sympathetic nervous system leading to such changes in the heart rhythm. Coming to this point, I would recommend continuing physiotherapy. An antidepressant or Pregabalin would help as a long-term therapy for the pain. Consult your specialist doctor, discuss with him or her and with their consent take the medicines. Regards. For more information consult a neurologist online -->