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Spinal Cord Injury Site "Scar Tissue"

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  • #31
    Wise,

    in the patients of the ChinaSCINet do you take note if the patient has just glial scar or also fibrotic scar?

    It would be usefull if at the end of the study you could say how many patients had just gliosis and how many had also fibrosis, so next time I see Carlos Lima I would like to clear this endless discussion.

    Paolo
    In God we trust; all others bring data. - Edwards Deming

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    • #32
      Dr. Young, I have read a lot of your posts in an attempt to explain what is happening with me. I am 38 yr old female. About 4wks ago I had a fall from my home exercise bar. I landed on the hardwood about 5-6 ft down as my back was folded and ended up breaking my T6. The CT(taken in ER) and later the MRIs do not show damage to the cord (according to my Orthopedic surgeon). The CT and MRI are taken three and 1/2 weeks apart. The other day I saw a neurologist and he seems to think that there is a big difference b/n the two, the latter showing the vertebrae more compressed and touching (just barely) the cord, with lots of room still behind it.
      The problems I've started having is an on and off numbness/weakness in both my legs, usually below my knees. This started happening a week after the accident. As of recently, (about a week now) I also have numbness, weakness in my arms, mostly below the elbow. This is now an everyday thing. The orthopedic surgeon said he cannot explain where this is coming from because the T6 cannot be responsible for numbness in my arms. He did not seem to be concerned with the fact that the T6 is now touching the cord because, he says there is plenty of room behind it.
      Having read your posts, I am concerned about scar tissue. I am also worried about cord damage, this is how I explain the numbness. Although it is true, that I did not have it during the first week when I was mostly lying down. I am wondering if I would gradually become paralized. I am awful stressed out and cannot sleep because of that and because of the numbness, which is driving me crazy. I can still walk just fine and my reflexes are good but my limbs feel like they've gone to sleep. I do have sensation everywhere, though.

      Please, let me know what you think and if there is something that needs to be done right away. Anybody else, who knows something about that, your responses are really appreciated.

      Rossita

      Comment


      • #33
        Originally posted by Rossita View Post
        Dr. Young, I have read a lot of your posts in an attempt to explain what is happening with me. I am 38 yr old female. About 4wks ago I had a fall from my home exercise bar. I landed on the hardwood about 5-6 ft down as my back was folded and ended up breaking my T6. The CT(taken in ER) and later the MRIs do not show damage to the cord (according to my Orthopedic surgeon). The CT and MRI are taken three and 1/2 weeks apart. The other day I saw a neurologist and he seems to think that there is a big difference b/n the two, the latter showing the vertebrae more compressed and touching (just barely) the cord, with lots of room still behind it.
        The problems I've started having is an on and off numbness/weakness in both my legs, usually below my knees. This started happening a week after the accident. As of recently, (about a week now) I also have numbness, weakness in my arms, mostly below the elbow. This is now an everyday thing. The orthopedic surgeon said he cannot explain where this is coming from because the T6 cannot be responsible for numbness in my arms. He did not seem to be concerned with the fact that the T6 is now touching the cord because, he says there is plenty of room behind it.
        Having read your posts, I am concerned about scar tissue. I am also worried about cord damage, this is how I explain the numbness. Although it is true, that I did not have it during the first week when I was mostly lying down. I am wondering if I would gradually become paralized. I am awful stressed out and cannot sleep because of that and because of the numbness, which is driving me crazy. I can still walk just fine and my reflexes are good but my limbs feel like they've gone to sleep. I do have sensation everywhere, though.

        Please, let me know what you think and if there is something that needs to be done right away. Anybody else, who knows something about that, your responses are really appreciated.

        Rossita
        Rossita,

        I am not sure but what you describe does not seem to be due to "scar" tissue formation. Let me first discuss that and get it out of the way because I don't believe that you have an "scar" in your spinal cord from the injury that you describe.

        As you probably know, I don't believe in the concept of scar tissue forming inside the spinal cord. After spinal cord injury where the spinal cord has been transiently bruised or compressed enough to cause damage to blood vessels, the number of glial cells increase (called gliosis) to repair the blood vessels. This is not only necessary and good but, in my opinion, is not the primary obstacle to regeneration. However, when one makes a cut in the spinal cord and allow skin cells (called fibroblasts) to invade into the spinal cord, true collagenous "scar" can develop in the spinal cord. Glial cells will grow around such a scar and wall it off. Axons will not grow through this. Finally, some scar may form between the arachnoid (the membrane that holds in the cerebrospinal fluid) and the pial surface (the surface of the spinal cord). Such scars cause "tethering" of the spinal cord and may prevent cerebrospinal fluid (CSF) flow. If the adhesive scars obstruct CSF flow significantly, some of the CSF will flow in the central canal, a normally tiny canal of <1 mm in the center of the spinal cord. Because of that flow, the central canal expands, forming what is called a syringomyelic cyst.

        In my opinion, you do not have a scar in your spinal cord and you are unlikely to have developed adhesive scarring and tethering of your spinal cord. The latter may happen but it may take much longer and usually happens if there has been blood vessel breakage and blood has pooled in the subarachnoid space. If such had happen, it should have been detected in the MRI scans and you don't describe this.

        From your description, you probably had a mild contusive injury of your spinal cord. It was not enough to cause any immediate loss of function. The spinal cord does swell after injury and this may cause transient loss of function but it should go away. If your orthopedic surgeon believes that there is no instability and the spinal cord is not compressed, you do not need surgery to correct the fracture site. That is good because fusion or placement of screws and rods into the thoracic is a major operation and you don't want it to be done unless it is necessary.

        A T6 injury should have no effect at all on your arms. The fact that you have distal numbness in your legs also is not consistent with something happening in your thoracic spinal cord. Incidentally, such sensory changes can happen when you are anxious and breathing too rapidly, i.e. blowing off too much carbon dioxide. I don't mean to suggest that you have hyperchondria but many patients are anxious about what happened and hyperventilation may be causing some of your sensory symptoms. The treatment is to breath in a paperbag for a while. Yoga also helps.

        I also want to reassure you that you will not become paraplegic from this. It will get better with time.

        Wise.

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        • #34
          Using a paper bag hasn't been recommended for quite a few years: http://www.emedicinehealth.com/hyper...n/page6_em.htm
          Disability Humor

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          • #35
            Originally posted by Khaleeka View Post
            Using a paper bag hasn't been recommended for quite a few years: http://www.emedicinehealth.com/hyper...n/page6_em.htm
            I agree that breathing in a paper bag is not a good therapy. It is more useful as a diagnostic tool. The therapeutic goal for anxiety-induced hyperventilation is to be calmer and to do exercise to control respiration.

            Wise.

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            • #36
              Removal of &quot;scar tissue&quot;

              Dr. Young; If I recall correctly, you stated that there is no proof that removing "scar tissue" from a the spinal cord is beneficial. However, in the article posted on the gentleman in Brazil, they stated that scar tissue is removed before the bone marrow stem cells were instilled at the injury site. Do you think that they saw improvements in the animal studies so that's why they chose to do this? If doing this is beneficial, would it pay to wait to have cord untethering done at the same time any stem cell treatments would be performed? It's not like I can get a surgeon to operate on me anyway because I'm a complete injury.

              P.S. I would love to be at the Open House tomorrow, but I live a distance away. I'm looking forward to hearing the news.

              Comment


              • #37
                Originally posted by lepups3 View Post
                Dr. Young; If I recall correctly, you stated that there is no proof that removing "scar tissue" from a the spinal cord is beneficial. However, in the article posted on the gentleman in Brazil, they stated that scar tissue is removed before the bone marrow stem cells were instilled at the injury site. Do you think that they saw improvements in the animal studies so that's why they chose to do this? If doing this is beneficial, would it pay to wait to have cord untethering done at the same time any stem cell treatments would be performed? It's not like I can get a surgeon to operate on me anyway because I'm a complete injury.

                P.S. I would love to be at the Open House tomorrow, but I live a distance away. I'm looking forward to hearing the news.
                Lepup3,

                I was not convinced that the Braziian study removed scar tissue from the injury site nor that the improvements resulted from the removal of "scar".

                In Hong Kong, we are currently untethering the spinal cord, if any is encountered, at the time of transplantation. The results of our current trial should be very interesting in this regard. We have five groups of patients, all of whom will have received untethering but there will be increasing doses of umbilical cord blood mononuclear cells and the last group will be combined with lithium.

                In Kunming, we are doing the same trial as in Hong Kong but the patients will also be doing intensive walking exercise. These phase 2 trials are in preparation for our phase 3 trial next year, where we hope to compare umbilical cord blood transplants alone or in combination with lithium, stratified by intensity of locomotor exercise.

                Wise.

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                • #38
                  Thank you for getting back to me Dr. Young. Your time is greatly appreciated.

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                  • #39
                    Back in 1986, when a doctor tried to move my spinal cord stimulator (since removed) past my C-5 injury level, he said he couldn't push it past C-6 due to scar tissue. The surgeon who did my C-5 laminectomy in 1987 said there was a lot of scarring in the area.
                    Alan

                    Proofread carefully to see if you any words out.

                    Comment


                    • #40
                      Originally posted by alan View Post
                      Back in 1986, when a doctor tried to move my spinal cord stimulator (since removed) past my C-5 injury level, he said he couldn't push it past C-6 due to scar tissue. The surgeon who did my C-5 laminectomy in 1987 said there was a lot of scarring in the area.
                      Alan, the kind of scarring that he is talking about suggests that you have tethering of the spinal cord and adhesions between the cervical spine and the arachnoid. Wise.

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                      • #41
                        I can't convince neurosurgeons that I've got tethering going on. They look at my MRIs, and say that they see no tethering and no change in the scans (I took along several scans from various years, but from the same radiology provider.) I got the same response in the 1980s and 1990s when I was able to ride to Hopkins, University of Maryland Hospital, and some DC hospital - they saw no syrinx, and had no explanation for deterioration and worsening pain intensity.

                        The most recent is Dr. George Jallo at Hopkins. I had a friend drop off MRIs from four different years at his office, and have been conversing with him via email. He sees nothing that can be helped by surgery.
                        Alan

                        Proofread carefully to see if you any words out.

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                        • #42
                          Looks bleak, are there any projections for when funding and resources will begin to increase?

                          I know with what's happening in Government recently, that it looks as though it"s going to get worse before it gets better.

                          Simon.

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                          • #43
                            What happened to the knife-happy surgeons of yore?
                            Alan

                            Proofread carefully to see if you any words out.

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                            • #44
                              According to Dr. Donlin Long, former head of neurosurgery at Hopkins, I have ongoing scar formation between C-4 and C-6, between two small, stable syrinxes.
                              Alan

                              Proofread carefully to see if you any words out.

                              Comment


                              • #45
                                Originally posted by alan View Post
                                According to Dr. Donlin Long, former head of neurosurgery at Hopkins, I have ongoing scar formation between C-4 and C-6, between two small, stable syrinxes.
                                By the way, in the context of this topic, I emphasize that I do not claim that fibrous scars cannot form in the spinal cord. In fact, they do form when investigators cut into the spinal cord to produce spinal cord injury. Especially when they do not repair the dura and this allows fibroblasts from surrounding tissues to invade into the spinal cord, a glial-fibroblast scar does from. Such scars do prevent axonal growth.

                                I am saying that such scars do not usually occur when there has been no penetrating wound that allows fibroblasts to invade into the injury site. In a majority of contusion injuries, the dura remains intact and the spinal cord injury has just been briefly indented. In such situations, while glia will proliferate at the injury (as they should, in order to repair the blood brain barrier), no fibrous "scar" develops.

                                I am not sure that I understand what Dr. Donglin Long is referring to when he says that you have "ongoing scar formation between C4 and C6, between two small and stable syrinxes." Usually, MRI's reflect the concentration of water in tissues. Greater MRI signal intensity usually suggests cell loss and associated increase in tissue water. This may or may not imply "scar". MRI of collagenous scar usually show reduced water content and hence less MRI signal intensity. Do you see enhanced or reduced MRI signal in the space between the two syrinxes?

                                Finally, what does Dr. Long proposed to do? The past year of experience with seeing chronically injured spinal cords in the operating room and being able to compare them with MRI images have convinced me that MRI's, even the best 3T images, don't tell you much about the spinal cord. For example, we encountered a case where the dorsal surface of the spinal cord was virtually covered with veins, the spinal cord was tethered, the cord itself was twisted nearly 45˚, and none of this was apparent on the MRI before surgery.

                                Wise.
                                Last edited by Wise Young; 12-13-2011, 12:34 PM.

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