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My Tarlov cyst recovery IV

The spine

The spine

After my September 2009 back surgery on my two Tarlov cysts, I had mandatory bed rest, ordered by my doctor, for a solid four weeks. After another two months, my incision had completely healed, on December 11, 2009 – exactly three months after my operation.

I was walking, pain free. Jim, Matthew and I made frequent trips across the border to Calexico to do our shopping, collect our mail, and drive on to El Centro to eat at Denny’s in the El Centro mall. The mall is where we buy our dog and cat food at Petco.

Life was wonderful.

However, on Monday, January 4, 2010, I suffered a temporary setback.

I found it difficult to get out of bed as my left leg felt a bit numb! Well, I totally freaked out.

That very Monday evening, Jim and I were at Dr. Carlos Maya’s office, anxiously waiting for him. When it was our turn, I rushed into Dr. Maya’s office, hopping on my right leg.

“Dr. Maya hola! You have to help me! This morning my left leg went a bit numb! What has happened? Everything was fine?’ I wailed.

“What have you been doing MaryAnn? Have you been exercising?” asked Dr. Maya.

“Well yes, I was doing some Jane Fonda exercises, you know, lifting up my legs, while lying on my bed; lifting up my butt, while lying on my bed, you know,” I said.

“Then Jim had a muscle spasm on Christmas Day. He was in so much pain that I had to drive him to the Emergency Room at the Hospital Almater on Avenue Madero. I dropped him off; parked the truck, and walked to the Emergency Room where I helped Jim find the patients’ waiting room.”

Dr. Maya nodded.

I continued, “Jim got to see the doctor immediately, who gave us a prescription. We walked across the road to the Almater Pharmacy to get the prescription which included an injection. Back at the hospital Jim got his shot, and then we went home.”

“I helped Jim, who could barely walk, to bed; did the dishes; walked our dog; cleaned the cat litter, and Matthew helped clean the house and cooked the food…other than that…nothing much,” I moaned.

Dr. Maya smiled and turned to Jim, “Jim, now you need help yes? and on Christmas Day as well?”

“Twaren’t nothin,” said Jim.

Dr. Maya nodded and said, “Let’s go, MaryAnn, stand against the wall, and put your hands against it. Now I am going to press on your spine, you tell me if there is pain, OK?” said Dr. Maya.

I complied. Dr. Maya pressed against each disc on my spine. “Pain?” he asked. “No,” I said.

“Now lie on the couch, face up, face up – OK? I am going to lift each leg up and you tell me if there is pain.” said Dr Maya.

Dr. Maya lifted up my right leg, and yanked it around. “Pain?” “No,” I said.

He then did the same with my left leg. “Pain?’ “No.” I said.

While Dr. Maya was moving each leg around, I felt like a grasshopper with its legs being pulled around.

“OK, come sit down,” said Dr. Maya.

“I cannot walk, you see; my left leg is numb – something is wrong with my left leg! See Dr. Maya?” I continued to wail.

“MaryAnn, sit.”

“Jim, is Maryann like this? No relaxation?” asked Dr Maya.

“You got it right Dr Maya,” said Jim, also shaking his head.

I could have almost smacked these men. I have a numb leg, and all they can do is smile and shake their heads!

“Dr. Maya? OK – I’m ready to listen.” I said.

“You have inflammation!” said Dr. Maya.

“Inflammation? what inflammation? my wound is healed, you see, my scar is so beautiful – the healing is done!” I said.

‘”No, no! The nerve from the S1 controls the movement of your left leg. It has been irritated.” said Dr. Maya

“I said to you, just walk. When we did your operation, the neurosurgeon and I worked together, with the spine, the bones, and we are very very careful with the nerves. The spine is full of nerves.

“Any nerve that is cut, the patient cannot walk. You can walk. The nerves inside your S1 and S2 must stay calm. No carrying heavy things – no driving – when you drive, you have to twist and bend your spine, right? Anytime when we cut open the back, the nerves get irritated, and your numbness in your left leg comes from the S1 nerve which is now irritated, and angry. Do you understand?” asked Dr. Maya.

“So I have a nerve problem.” I said.

“You have an irritated nerve, slightly inflamed, MaryAnn,” said Dr. Maya.

“I am going to give you a prescription,” Dr. Maya answered.

Returning to his desk, Dr. Maya began writing on his pad.

“I am writing out a prescription, for you MaryAnn. Jim, this is for three injections, one each day. Jim, you can give shots?” asked Dr. Maya

“Shucks, no – only gave a shot to a horse once,” said Jim.

“You don’t know how to give shots?” asked a baffled Dr Maya.

“Jim, here, this is the prescription – it’s for anti-inflammtories, for all this you go down to the pharmacy, and they can give the injection materials – then just go to any hospital for the shot. OK?” said Dr. Maya, handing the prescription to Jim.

“Maryann, are you taking any medications that I should know about?” asked Dr. Maya

“No just aspirin, nothing else,” I replied.

“After you finish my medication, come back and see me in 21 days. All of this is anti-inflammatory, to calm down all the nerves, and continue with the recovery.”

“Just because your scar has healed, the inside of the sacroiliac and the nerves all need time to recover,” said Dr. Maya, smiling.

“So it’s my S1 nerve that is irritated? that’s it?” I asked.

“Yes, this is common with back surgeries, and you had the Tarlov cysts! These all sit on nerves!” Dr. Maya explained.

“Why did you ask me what other medicines I am taking Dr. Maya?” I asked.

“We don’t like our patients to take any strong painkillers, like opiates, too strong”

“Why?” Jim asked.

“Opiates make it difficult for doctors to see the real healing of the patient. Opiates will hide all the pain, and when the opiates wear off, the pain is worse!” said Dr Maya.

“If you were on opiates, MaryAnn, I would not be able to identify your pain, and any nerve damage.

“Back surgery is very complicated for the patient. The post-operation, avoiding scar tissue inside the sacroiliac, very important. Scar tissue will grow wrongly can irritate the spinal nerves, and the back pain will come back again.

“The nerves especially get irritated and that is very normal. Taking opiates like Vicodin. I am not for my patients to do it. Also it is addictive.

“Let the recovery of the spine, and the nerves be simple and basic. Good for patient, and for us surgeons. You understand?” asked Dr. Maya.

“Why are you moving around so much, MaryAnn? This is not what I want you to do. You have to walk slowly, rest, rest. Do everything slowly,” said Dr. Maya, visibly upset.

We thanked Dr. Maya and will see him in 21 days.

After we got back into our truck, Jim laughed, “No more Jane Fonda leg exercises and what-not you’ve been doing Maryann!”

“Well…don’t you go pull a muscle spasm on me just three months after my back surgery Mister!” I said.

“Why, sure, MaryAnn. Next time I’ll choose the right time for my back spasms,” said Jim, flooring it and cutting out into the traffic.

I am now five months into my Tarlov cyst operation recovery.

My S1 nerve is doing great. I got the three shots, at the Hospital Santa Monica, right near our home (we just walked in – no doctor appointments in Mexicali). I am not bending and taking Dr. Maya’s prescription, and Advil (great stuff at a friend’s suggestion), and back to being my old self.”

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7 comments to My Tarlov cyst recovery IV

  • I am sure Dr. F. is good, but, in general, the use of narcotics in the US, causes patients to move around too much during post-op. This can cause scar tissue. My Dr. Carlos Maya had me remain in bed for one month after my Tarlov cyst operation. I do not need any second surgery, and my recovery is as good as it gets, and much better than some, if not most, other patients.
    God Bless,

  • Here is a group I created on facebook if you are interested

  • George L

    I am an engineer working in Mexicali.
    I had some disc problems. Read Maryann’s surgery, and went to see Dr Maya. Had my surgery within the week, came out with no pain!
    I will tell you, Maya is a super surgeon.

  • Claudine:

    So good to hear from you!

    Thanks for the invite to the conference in France. We passed it on to Dr. Maya. We would love to attend, ourselves, but maybe next year.

    Another patient, who had something similar to a Tarlov cyst, posted the information below on the doctor’s procedure on the web – along with the fact that the patient was not doing too well, and heavily into Vicodin.

    After my post, Tarlov Cyst Recovery, the patient took down the doctor’s procedure, and replaced it with information on the great progress the patient had made. (I am using “the patient” instead of he or she to keep out of trouble).

    Below are the patient’s doctor’s notes (and you get one guess at the doctor’s name). His notes will mean more to you than to me.

    God Bless,

    Post-Operative Diagnosis: Giant sacral meningeal diverticulum and tethered spinal cord with fatty phylum.

    Operation Performed:
    1. S1-S3 laminectomies.
    2. Treatment of giant sacral meningeal diverticulum. 64999
    3. Spinal cord dethering.
    4. Sacral laminar reconstruction with resorbable plating 64999
    5. Use of intraoperative electrophysiologic monitoring
    6. Use of intraoperative microscope.
    7. Use of intraoperative fluoroscopy.

    Description of Operation: The patient was brought to the operating room and an adequate anesthetic plane was obtained with the patient in the supine position. The patient was then intubated by the anesthesia team who were instructed to give her prophylactic antibiotics. She was turned to the prone position on the Wilson frame with all pressure points padded. Her lumbosacral region was prepped and draped in a sterile fashion. Intraoperative fluoroscopy was used to identify the operative level of the spinal needle to the spinous process tips. I then made an incision from S1 to S3 and carried out a subperiosteal dissection bilaterally. I inspected the sacral lamina and they were greatly thinned out to the point of being translucent due to the underlying cyst and the erosion that it had caused. I then carried out laminectomies from S1 to S3 using a combination of Leksell rongeur, and #2 and #3 Kerrison rongeurs. After this was completed, I brought the operating microscope into the field. I could see the patient’s giant sacral meningeal diverticulum dorsal to the distal cecal sac and nerve roots.

    The cyst was covering the distal thecal sac and under high magnification with micro-instruments, I began by dissecting the cyst off the lower part of the thecal sac down towards the area where the ostium would be located at the tip of the thecal sac. I then dissected laterally over the cyst, basically getting around it from the sides. While stated simply, this was quite laborious and involved dissecting the sacral nerve root off the cyst wall. At no time was there any undue or unacceptable traction on the nerve roots as best I could tell. I should note that intraoperative electrophysiologic stimulation proved that the nerves were still firing at low thresholds above the area of the ostium treatment after the procedure. In any case, I dissected the cyst from the caudal to cephalad to the point of the ostium at the distal thecal sac tip. I had, by this time, opened the giant meningeal diverticulum on its dome. I could see the point of the ostium where spinal fluid was entering the cyst. I could also see a fatty tethering phylum entering the cyst and anchoring just inside the cyst wall. I then cauterized 2 different segments of the fatty phylum, transected it and sent it for pathologic analysis. I then truncated the distal part of the cyst, leaving a cuff around the ostium and sent the meningeal diverticula all for pathologic analysis. I then placed a hemostat over the ostium region, being careful not to include any of the distal sacral nerve roots. A single 3-0 silk free tie was placed. I followed this with a similar placement of a LigaSure such that the area of the ostium was double sutured. I asked the anesthesia team to Valsalva the patient and there was no further evidence of spinal fluid leekage from the cyst. The wound was thoroughly irrigated. A search for bleeding was carried out and non could be found. I overlay the areas of exposed dura, treated ostium and distal sacral nerve roots with a layer of Duragen. I then harvested some fat from the sucutaneous tissues and overlaid the area of the Duragen. I then turned my attention to reconstructing the sacral laminar defect. I hand cut and molded a piece of resorbable plating in the hot water bath. It seemed to have a good fit and I secured it in place with resorbable screws. A medium Hemovac drain was brought out through a seperate stab incision. The facia was reapproximated using interrupted #0 Vicryl suture. The subcutaneous layers were reapproximated using interruped 2-0 Vicryl sutures. The subcuticular layers were reapproximted using interruped 3-0 Vicryl sutures. Steri-Strips and sterile dressings were applied.

  • Dan:
    No, Dr. Maya did not say how long not to drive. My guess is that it is at least six months, if not more. Anyway, Jim does all the driving – no way around that – that’s Jim.
    God Bless,

  • All that makes sense to me. Dr Maya is the right doctor..I appreciate mostly the fact that he is not afraid ot speak of possible epidural scare tissue and/or arachnoïditis and that he says what is correct to the patient.

    Did you got the invite to the 2010 meeting.

    all best wishes

  • Dan

    Hi Maryann,
    I have been following your progress post surgery and am glad to hear you are doing well. I find it interesting that Dr. Maya recommends no driving because of the twisting of the spine. Did he tell you how long post surgery you can drive ?

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