Hello all!

My boss is also my patient currently (52 y.o. male) who had a progressive onset 3 months ago of symptoms including ptosis L eyelid, bilateral LE cold sensations/ numbness/tingling, clonus, and weakness. Testing showed a T12 spinal dural fistula which he had surgically separated (arteriovenous fistula ligation). He continues to have increased swelling of his spinal cord (according to doc) and visible around the incision site.

Since surgery, his symptoms include: increased bilat reflex for patella, bilat (L>R) clonus with achilles reflex and with sudden dorsiflexion, continued numbness/tingling of bilat LE (dermatomes diminished through bilateral L3-S1), bilat LE strength grossly 3-/5, bowel/bladder habits are "hit or miss" according to him aka going between constipation/diarrhea, and bladder being unable to empty all the way. He's got an ataxic gait, using mostly a walker or crutches to walk, very abducted/wide BOS and + trendelenburg bilat hips.

Any advice for needling? My initial thought is to focus on lumbar spine nerve roots and through the relevant bilat LE nerve distributions. Could I needle around the incision site with small needles for swelling reduction, similar to what we were taught for like a sprained ankle injury...?

Would appreciate any and all advice! Thank you!!

-Laura O'Lannerghty, PT, DPT, CIDN