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Kyphosis causing stretched cord

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    Kyphosis causing stretched cord

    I was injured in a car accident 5-11-2015. For two years I was doing great. I walked in my house unaided, I could stand for 45 min without having to sit, I walked all over with forearm crutches for the same amount of time. I even painted my bathroom by myself (ceiling and all). Fast forward to today and I can’t stand up straight to walk, I lose my balance, I can’t stand up for more than a few minutes and can only walk short distances with a walker. My back is very spastic while my legs feel heavy and weak. There is a horrible pain between my ribs that feels like tearing. It comes and goes thankfully but it seems to be there after I stand or walk. My blood pressure has been crazy! I have woken up to check my bp and it’s been 90/60 and have a hr in the 50’s. It makes me worried that it’s lower while sleeping. Sitting it’s 106/80. My cholesterol and everything looks great.

    I finally got an MRI this February (it was the first one since leaving rehab) and was told degenerative changes then during a routine appt last month I asked my physiatrist about my mri and he told me I had a cyst on my spine and needed to see the neurologist since I was having issues with walking. Today I had a telehealth appointment with the neurologist and he didn’t mention anything except my kyphosis. He said he is concerned that it is stretching my cord?!?!? He wants me on methyl prednisone until he can see me there.
    I’ve attached a photo of my mri, side view, you can not see the hardware well but I’m fused from c7 to t5 and the area of concern is under t5 where it bends.

    Looking at the MRI image how does the kyphosis not effect breathing, the heart, swallowing, the pain I’m having is right at the T5 area in my stomach where my curve is bent.
    I am always told my problems are due to having a spinal cord injury and it’s normal but I see so many people who are more active and have more complete injuries.

    Has anyone had an experience like this?
    Last edited by Bren31115; 8 Aug 2020, 8:21 AM.

    #2
    How long ago did you notice the kyphosis? Did he mention any syrinx (cyst) in the cord at all? Was your physiatrist talking about a cyst in the spine (bone) or in the cord itself (a syrinx)? Did the NS mention the term "Charcot joint" for your kyphotic area? This is not a common condition, but can occur below the level of injury in the spine, hips, and other joints.

    I can't make a diagnosis, but I would recommend that if possible you get a second opinion about surgical management, either from another neurosurgeon or an orthopedic spine specialist. Correcting the kyphosis is a tricky surgery, and can also cause further damage to your cord if not done by a very skilled and experienced surgeon. Unfortunately there is no guarantee that the surgery will return the function you have recently lost, but may be needed to prevent further functional loss.

    (KLD)
    Last edited by SCI-Nurse; 8 Aug 2020, 12:40 PM.
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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    • Bren31115
      Bren31115 commented
      Editing a comment
      I have noticed my kyphosis for at least two years. I have Idiopathic scoliosis plus more as a result of the trauma. And lordosis with herniated disks at l4/5 and a bulging disk At S1. The term syrinx was used. He said it seemed to be small and in the scar tissue but we don’t have any prior mri’s to go from.
      Talking with the neuro surgeon he didn’t mention a Charcot joint but seemed very concerned of the cord stretching at the area of T5/6 where my rods end. They called this morning to make my appt for Sept 4 to see him in person and have additional xrays. He is the NS who did my first surgery after trauma. I’m in so much pain in my upper abdomen it literally feels like I’m being ripped open. It is hard to touch with a heartbeat. My regular dr did a ct when this pain was starting (January) to get worse. She checked for an aneurysm but nothing was found. The pain is parallel to the t5/6 area. I did have a pretty good fall or 2 last summer but was not seen after. I called my regular dr but they didn’t seem concerned.
      I started my methyl prednisone today and my legs feel asleep.

    #3
    You need to call the neurosurgeon immediately if you have loss of sensation as a result of taking the methylprednisolone. It is common to have a small syrinx at the site of your spinal cord trauma, and generally unless it gets bigger and bigger or causes loss of sensation or motor function, the normal thing is to just watch it if discovered on MRI.

    I agree with the NS that it is very likely your cord is being stretched and/or pinched by your kyphosis. You probably need decompression and restabilization surgery ASAP.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

    Comment


    • Bren31115
      Bren31115 commented
      Editing a comment
      My syrinx is at t1/2 area... my understanding is that he’s seeing something on my MRI that has him concerned about cord stretching at the t5 t6 area due to the kyphosis and he did say something about a vertebral deformity at t5 or t6.
      My physiatrist said he wouldn’t have had me see the neuro for the syrinx except for the fact I’m losing function. So I am not sure it’s off the table but it sounds like it wouldn’t be the cause of my decline over the last two years.
      I went to my general practitioners office for the pain in my upper stomach last week and she immediately called to get me in with my neuro earlier than I was scheduled because I showed up in my wheelchair not walking like normal bc I can’t... so that is why I had a telehealth appt Friday with NS rather than a scheduled appointment in mid September.
      Today was my first day on prednisone and I noticed my legs heavier... I’m not sure if it’s the medicine or just decline at the rate I’m declining. I do not take any meds on a normal basis. Anytime i have such a huge change around the time I take a new med I’m always first to point my finger at the medication.

      I’m sorry if anything I said was confusing... I was thinking all of this was from a syrinx until yesterday and now it sounds like it’s possibly more serious and I don’t know much about a stretched cord. If I’m looking at a second sci do to all of this I’m a bit scared... and tired of hurting so much
      Thank you so much for your feedback. I will definitely be asking some needed questions next week when I talk to the NS nurse practitioner

    • Bren31115
      Bren31115 commented
      Editing a comment
      I wanted to update you... my neuro surgeon redid images and did not think there was any compression on the cord. My kyphosis remains at 47 degrees which he said it was after my initial surgery 5 years ago. He thinks that my decrease in sensation and function is probably due to weight gain. He said that he does not think there is any charcosis or syrinx but that he thinks that there may be a very slight increase in the size of the central cord from 2015 to 2020 but nothing to be concerned with.
      I’m still in so much pain when standing. I’ve been taking my bp and it’s been fine but I’ve noticed my heart rate goes up to around 130 when standing. It’s possible it would go up more but I don’t keep standing to find out! This combined with the increasing difficulty I’m limiting my activity.
      Again thank you for your help..

    #4
    Kyphosis can cause severe pain and discomfort, breathing and digestion difficulties, cardiovascular irregularities and signs of nerve injuries. Did you complete the Methylprednisolone and was there any decrease in symptoms. Do you have degenerative disc disease? was there compression or your foramen or nerves exciting the spinal cord? Are you diabetic? I would check and make sure you are not having cardiac problems or irregularities such as atrial fibrillation. Abdominal pain should be worked up to ensure it is not cardiac in nature, especially in diabetics, women and SCI. You mentioned gaining weight- this puts straining on muscles and nerves and I would start a program of slowly increasing strength and endurance by low impact/ low weights and exercises even if starting as sitting in a chair and planned weight loss. (after you have been cleared by internal medicine, PCP or cardiologist). Would your doctor order physical therapy for you or at least an evaluation? So they could plan an exercise/decrease pain program for you. When a person stops using a muscle for 3 days, the muscle starts to weaken. I think surgery is not indicated and no guarantees surgery is going to help- especially the second time around.
    Is your Vitamin D and B 12 , thyroid etc... all within normal limits.

    CWO
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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    • Bren31115
      Bren31115 commented
      Editing a comment
      Do they check Vitamin D and B12 on a normal CBC? I don’t remember ever knowing anything about them...

    #5
    I did complete the prednisone. I felt pretty good on it... in fact I didn’t even check my heart rate when I was on it bc I didn’t feel the palpitations or the stomach pain.

    Lumbar spine: Mild multilevel degenerative disc disease and mild to moderate multilevel facet arthropathy... this was straight from the X-ray. This also occurs in a smaller form in my cspine but nothing is noted of my thoracic spine in respect to degenerative disease.

    It’s my understanding that the nerves exiting the spinal cord have compression and that is peripheral? Dr seems to think weight loss could benefit this

    No diabetes. I have been around 150 lbs give or take 5lbs... Before sci I was 5’4 1/2 and now I’m around 5’1 1/2 who knows with posture, loss of vertebral height and the bulging disks. But I am 176 now and have gained it in the past year and half. My tsh is also 3.4 so it’s not functioning like it used to. All my cholesterol and everything is great. Dr says my heart has a strong good beat (but of course this is sitting and it’s good when I’m not straining)

    I do physical therapy two times a week. I have a great relationship with my pt and I think he’s a bit concerned abt my raising heart rate on standing. I feel like he’s waiting for the gp to do something. I feel like my gp is waiting on my neurologist to treat me and I feel like my neurologist wants my gp to treat me.

    Two weeks ago I went in to the dr again for it and she sent me to get fluids for dehydration but the hospital took urine first and I wasn’t dehydrated. My sodium was 134 when it should be 135. That was the only thing flagged on CBC.

    I’m tired of feeling awful like I can’t do anything physical without my heart jumping out of my chest and I just generally feel unwell when this happens and want to lay down... which really helps! I can’t hardly get down and play sidewalk chalk with my son which last summer I did for hours. We had races in my wheelchair vs bike... I can’t anymore. It’s to the point I generally do not feel like moving around. It seems like every so often I would take where I was 6 months ago from where I am at now.

    Thanks again!
    Last edited by Bren31115; 7 Sep 2020, 10:32 PM.

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