Spinal Cord Injury Site "Scar Tissue"

[alan]

Dr. Young,

I e-mailed you a copy of Dr. Long's report. It's a pdf file. I wanted to copy the diagnosis part to this thread, but I couldn't figure out how to do that. He didn't get the history right, so I sent him corrections which he added to my file. I also sent him e-mails regarding what you've said re MRI scans not always showing everything about the cord, and that you didn't think the deterioration of my condition I describe is normal aging with SCI. His plan was to try Cymbalta again (I did - still couldn't handle side effects), and increase Lyrica again (I'm working on that, more for seizure prevention than pain relief. I hadn't used it for seizure prevention before, as my seizures started in 2009.) He mentioned deep brain stimulation, but didn't recommend it (I'm against it, anyway.) He thinks there is subarachnoid scarring which slowly occurred (is still occurring, he told me), and the possibility of tethering, but not enough evidence to warrant un-tethering (he told me that even if tethering was there, and surgery was done, it was very risky, it was unlikely to provide any pain relief, might not stop the upward progression of my sensation loss and pains, and that the scarring problem would likely repeat.) He doesn't see evidence of slowly progressive cord deficits (even though he said there has been change in the damaged area over the years. My guess is there was so little change from year to year that annual MRIs didn't show it, thus the "no significant change" reports every year, but scans from years apart did show much change .)

He is sending his report to Dr. George Jallo at Hopkins, the doctor who referred me to Dr. Long after he didn't see anything he deemed fixable in my MRIs.

[alan]

Dr. Jallo also recommends against surgery.

[kevrthom]

Question for Dr. Wise

Not sure if I'm posting right since it's my first. I had decompression laminectomy with anterior discectomy/fusion at C 5-6 and C 6-7 about 10 months ago. I have a small area of signal change/myelomalacia in the center of my posterior cord at C5. Could this cause numbness in my toes and/or neuropathic pain in my arms/hands (it particularly affects my index fingers)? My neurologist cannot explain these things. Many blood tests were normal. Repeat MRI shows moderate stenosis at the two levels above the surgery now.

[alan]

Not sure if I'm posting right since it's my first. I had decompression laminectomy with anterior discectomy/fusion at C 5-6 and C 6-7 about 10 months ago. I have a small area of signal change/myelomalacia in the center of my posterior cord at C5. Could this cause numbness in my toes and/or neuropathic pain in my arms/hands (it particularly affects my index fingers)? My neurologist cannot explain these things. Many blood tests were normal. Repeat MRI shows moderate stenosis at the two levels above the surgery now.

The Care forum is probably better.

[Disneytodd]

I have only read the bottom posts on this so please forgive me for not understanding it all. My understanding about removing scar tissue is that if you remove it that it just grows back worse then if it is left alone. I know their is deferent areas of scar tissue but read some things that help me or confuse me about this issue. The only things I have found to define it is ADHISIVE ARACHNOIDITIS or RSD it gets confusing for me but it makes sense that if you have scar tissue and try to remove it that it will only become worse.

[Wise Young]

Not sure if I'm posting right since it's my first. I had decompression laminectomy with anterior discectomy/fusion at C 5-6 and C 6-7 about 10 months ago. I have a small area of signal change/myelomalacia in the center of my posterior cord at C5. Could this cause numbness in my toes and/or neuropathic pain in my arms/hands (it particularly affects my index fingers)? My neurologist cannot explain these things. Many blood tests were normal. Repeat MRI shows moderate stenosis at the two levels above the surgery now.

kevrthrom,

The gray matter in the C5 spinal cord is responsible innervating for the biceps and sensation in the upper arms (lateral surface). The C6 spinal cord innervates the medial (thumb) side of your hand. It is likely that compression of your C6 root by a disc is responsible for the numbness and neuropathic pain in your index fingers. I attach the dermatomal map for the arms. The numberness in your toes may be due to either injury to your spinal cord long tracts or another disc affecting S1.

Wise.

[Wise Young]

I have only read the bottom posts on this so please forgive me for not understanding it all. My understanding about removing scar tissue is that if you remove it that it just grows back worse then if it is left alone. I know their is deferent areas of scar tissue but read some things that help me or confuse me about this issue. The only things I have found to define it is ADHISIVE ARACHNOIDITIS or RSD it gets confusing for me but it makes sense that if you have scar tissue and try to remove it that it will only become worse.

Disneytodd,

You are correct. If one cuts into the spinal cord to remove "scar" tissue, this is likely to introduce scar tissue in the spinal cord.

After injury, there is usually adhesions between the spinal cord and surrounding tissues. These adhesions are associated with inflammation of the arachnoid membranes after injury and therefore are called adhesive arachnoiditis. These adhesions can be cleared by surgery and this sometimes helps reduce syringomyelic cysts (cysts that develop in the spinal cord because the adhersions shunt cerebrospinal fluid flow into the central canal) and may improve function.

Wise.

[alan]

As I posted in the Care forum, Dr. George Jallo at Hopkins has also said I have scar tissue in my spinal cord. Whatever's there, it isn't spinal cord.

[jsilver]

As I posted in the Care forum, Dr. George Jallo at Hopkins has also said I have scar tissue in my spinal cord. Whatever's there, it isn't spinal cord.

Scar tissue around the cord (adhesive arachnoiditis) is different from scar tissue inside the cord. Your doctor is describing astrogliosis that may or may not contain additional fibroblastic or other cells that have migrated from outside to inside the cord.

[khmorgan]

As I posted in the Care forum, Dr. George Jallo at Hopkins has also said I have scar tissue in my spinal cord. Whatever's there, it isn't spinal cord.

I think that is Dr. Young's point. Using the term "scar" tissue to mean the tissue which replaces damaged tissue is too broad of a generalization. I know it is more intuitive to a medical layman than astrogliosis, and suffices for people who don't want to know more. I believe that Dr. Young just wants to never use the term scar for anything except the Webster's Dictionary definition:

scar : a mark left (as in the skin) by the healing of injured tissue.

and Dr. Silver wants to use it for a more intuitive although possibly easier to misunderstand explanation.

So, I think they are both right. Of course, I am a layman, so what do I know? Many years ago, I was told the reason I couldn't walk was that scar tissue in my spinal cord was blocking nerve signals. Until I read Dr. Young explanation, I pictured it as hard tough skin like scar tissue. Hence, I greatly appreciate both his and Dr. Silver's clarifications.

[Reba52]

What do you call what is in the spinal cord when you have Arachnoiditis? My Dura was punctured during an Epidural Injection..That is how I ended up with this horrific disease!
Becky

[khmorgan]

What do you call what is in the spinal cord when you have Arachnoiditis? My Dura was punctured during an Epidural Injection..That is how I ended up with this horrific disease!
Becky

Wikipedia calls it: inflammation of the arachnoid, one of the membranes that surround and protect the nerves of the central nervous system. See http://en.wikipedia.org/wiki/Arachnoiditis . The author also comes close to calling it malpractice.

[blairc7]

kevrthrom,

The gray matter in the C5 spinal cord is responsible innervating for the biceps and sensation in the upper arms (lateral surface). The C6 spinal cord innervates the medial (thumb) side of your hand. It is likely that compression of your C6 root by a disc is responsible for the numbness and neuropathic pain in your index fingers. I attach the dermatomal map for the arms. The numberness in your toes may be due to either injury to your spinal cord long tracts or another disc affecting S1.

Wise.

dr wise young in the diagram you posted with all the levels shown are those also for the back area to the reason i ask is my back muscles work down to about 2inch ubove the waist line and about half way around my sides but filling stops about nipple line i just went in for a follow up andthe noticed i had gotten some normal reflex respones in my right leg . but they didnt coment further on that , i was just wondering why the back goes that low but the front stops around the nipple line.i am also getting more movement in my fingers not alot compared to normal but alot compared to wene i was first hurt

[Wise Young]

dr wise young in the diagram you posted with all the levels shown are those also for the back area to the reason i ask is my back muscles work down to about 2inch ubove the waist line and about half way around my sides but filling stops about nipple line i just went in for a follow up andthe noticed i had gotten some normal reflex respones in my right leg . but they didnt coment further on that , i was just wondering why the back goes that low but the front stops around the nipple line.i am also getting more movement in my fingers not alot compared to normal but alot compared to wene i was first hurt

The muscles of the back are quite complex and their innervation originate from the insertion points of the muscles. So, for example, both front and back muscles are attached to ribs and the other end attach to the pelvis. The deep muscles of the back, e.g. the erector spinae and the transverso-spinalis muscle, receive innervation from T1-T4 and go all the way to the base of the spine. Sensation at the nipple indicates T4. This suggests that you have recovered some of T1-T4.

Wise.

[blairc7]

thank yOu DR WISE YOUNG