discouraging news for low spinal injuries

[sbdspray]

I was encouraged by the New Yorker article and the bullsh*t hype about treadmill-harness therapy. I called around, talked with the experts, experts?! they all tell me that if your injury is below T12 it's useless. They mentioned that since my injury was more than 56 days old, it's again useless. It seems that low spinal-cord injuries have no spare tissue under the injured tissue, the cord dissolves into the cauda equina. She told me staraight up that my injury was worse than Chris Reeve's in terms of therapies. That's funny, I thought the lower your SCI the better. Don't buy the hype! You call around at these facilities offering new innovative therapy in which you read about in the media and scientific journals, and they sound all the same as the so-called therapists of yesteryear- it's hopeless, useless, blah, blah, blah. It's buisness as usual for these a******s. They are hacks who couldn't cut it to be a real Dr. I got the same treatment with the ugly wench handling treadmill therapy at Miami Project. She wasn't even listening to me as I explained my situation, I could see her eyes darting around the room, making no eye contact with me. In regards to Miami Project, I went to their fundraiser in NYC last month and I couldn't believe the tired, uninspired presentation. In all reality, they couldn't answer a single question.
Does anyone with a T12 or below injury have any clues on where we are or aren't heading?

sherman brayton

[Wise Young]

sherman,

While I understand your frustration, you should try to understand the anatomy of the spinal cord. It is true that the lower the spinal cord, less of your body is affected. However, the spinal cord between T10 and L1 contain the lumbosacral enlargement. The neurons that control some of your leg muscles and bladder/bowel/sex function reside between T10 and L1. At T12 vertebral level, the spinal cord segments are S1 through S3, the segments that control your feet, your bladder, and sexual function. Below the L1 vertebral level, the spinal cord ends and the spinal canal contains mostly spinal roots called the cauda equina.

Please note that the exact location of the spinal cord at the different segmental levels differ somewhat from person to person. The damage to the spinal cord also differs from person to person. Therefore, a careful neurological examination is necessary to determine the level of your injury and what you have lost. Rather than talk about T12 vertebral injury, you should know what your neurological level is. You should then work from there to figure out what kind of therapy that you need.

If you go to the article that I posted about spinal cord injury levels, you can see the distribution of sensory and motor function associated with each of the segmental levels. http://carecure.rutgers.edu/spinewir...nalLevels.html The easiest way to determine your neurological level is to figure out what parts of your leg have sensation or not. From that information, you should be able to figure out your sensory level.

After that you can figure out your motor level. I assume that you have movement of your hips and knees. Can you move your foot up and down? Your ankle dorsiflexion (flexing your foot towards your head) is L4, long toe extensors (wigging your big toe upward) is L5, and ankle plantar flexion (bending your foot down) is S1. S2-S3 innervates your bladder and penis. S4-5 innervates your anal sphincter.

There are currently two approaches that some surgeons are taking towards dealing with lower thoracic and lumbar injuries.
1. Peripheral nerve bridging, using a peripheral nerve to bridge from a peripheral nerve to the bladder up to the spinal cord above the injury site. This is being done by Dr. Zhang in Shanghai. I heard of several other surgeons in China that are doing similar work. Both animal studies and the experience of surgeons suggest that neurons in the spinal cord will grow into peripheral nerves, spinal root axons will grow into peripheral nerve bridges to re-innervate the bladder.
2. Transplantation of fetal stem cells. This is of course more speculative and there is not much data from either animal or human studies that have yet shown that the implanted stem cells will replace neurons and that in turn will form motoneurons. Nonetheless, I think that this is something that can happen in theory and there are scientists who are doing such transplants.

There are a number of prosthetic approaches that have been used to restore bladder and anal sphincter There are also devices and drugs that can be used to produce erections (vacuum, viagra) or prostheses that can be implanted for penile erections. For orgasms, there are reports that people may have pathways for sensation to reach the brain outside of the spinal cord. For example, women with complete transections of the spinal cord can have orgasms and this is thought to be through their vagus nerve (the 10th cranial nerve) which completely bypasses the spinal cord.

In any case, details really matter and you need to understand what your neurological level is and then try to resolve the problems detail by detail. At this level, there are probably few neurosurgeons who will have solutions and you need to become the expert on your condition. Please ask questions and I will do my best to answer them.

Wise.

[Andy]

Sherman, I kind of have the same view as you do towards some of these therapys. Lets see, what factors would contribute to a therapy being proven as non-useful...older injury (no initial recovery that could be attributed to a therapy), and in the case of low injuries...no reflexive motor function that could be attributed to a therapy. I may have a dim view of some of these excercise therapies as I like to simplify things, but I still think that without a functioning spinal cord, any moving the parts around will not fix the problem. Of course there is lots of money to be made if you can somehow make it look like a therapy is responsible for something [img]/forum/images/smilies/wink.gif[/img]

[fuentejps]

actually the age of injury really doesnt impact anything, if its inc, thats what researchers look for.

[john smith]

Brayton;

Dr Young is right. You must become the expert with regard to your injury. The authorities on SCI are those who are coping with the condition and many of them can be found right here in these forums. Check out the web sites for SitTall,StandTall and Project Walk and SCI-Step. There are low thoracic clients there who are improving. If you go the conventional route through established insurance covered rehab facilities you will continue to be frustrated. They are more about maintenance than recovery. They offer very very important services. They can be an adjunct to creative alternative exercise based programs but it is unrealistic to expect them to be "the bomb". You must find others in this field who are thinking outside of the box.

John

[Ray F.]

dr. young, you were talking about restoration of
bladder and sexual function in women using
CN X and this was being studied in china. do you know any study for restoring sexual function in men. and if so, where and whats your thoughts about it.

[Curt Leatherbee]

I think it is kind of irrelevent at least for now as there is no Cure for either High or Low Injuries. Perhaps in the future it will become more of a relevent point as it could be more easy to regenerate white matter (Upper Injuries) than grey matter (lower injuries). But this could be 20 or 30 years away Anyhow. If it were me and I had a choice, I would take the lower level injury so that I had that extra function for most of my remaining life even though there are a few other negitives that go along with low level injuries such as a flaccid bowel, extreme leg atrophy and not much you can do about it due to no reflex arc and less hope of regeneration (when or if it ever becomes available) due to more grey matter damage.

"Life is about how you
respond to not only the
challenges you're dealt but
the challenges you seek...If
you have no goals, no
mountains to climb, your
soul dies".~Liz Fordred

[Chris Chappell]

john smith, well said. Agreed.

[glomae]

brayton i hear ya dude i'm a T12 and i've been hearing that same shit for 4yrs. i've made up my mind that after my surgery with dr hanug i'm doing my pt at TIRR and i'm insisting on harness treadmill training even if i gotta come out of my own pocket. i truly believe in treadmill since so little is known about the cns and every injury is unique why not just give it a shot.

[Wise Young]

Rayfak posted:
dr. young, you were talking about restoration of
bladder and sexual function in women using
CN X and this was being studied in china. do you know any study for restoring sexual function in men. and if so, where and whats your thoughts about it.

Rayfak, the work on cranial nerve X mediating sexual sensations in women was carried out by Barry Komisaruk and Beverly Whipple at Rutgers
http://www.mcmaster.ca/inabis98/komi...e0437/two.html
http://www.langston.com/Fun_People/1997/1997AMO.html
http://content.health.msn.com/conten...?printing=true

While this work does not indicate a specific therapeutic method of restoring sexual function in men, it does indicate that there are multiple pathways for orgasmic sensations to reach the brain. In one of the articles, Whipple talked about "outercourse", an interesting idea.

There is work going on in China where they are doing peripheral nerve bridging from the spinal cord above the injury site with the peripheral nerves innervating the bladder and sexual organs. The only thing that I know is that they are doing a lot of such surgeries in Shanghai and other places but there have been few reports (at least in the English literature) documenting the effects of the surgery, particularly on sexual function. Most of the work has focussed on bladder function.

Wise.

[Steve Oakes]

Dr Young,

I was interested in your reply to sherman about understanding your neurological level, I have a low level injury due to a prolapsed disc, which I was told was at L5-S1. I can flex my foot towards my head and wiggle my big toes upwards and I believe from your reply and other research I have done that my L5 nerve has not been greatly damaged (if at all) by the injury. I have no 'lift' in my walk and by toes make a clawing action, I would interested to know which nerve roots are related to these problems.

Another curious thing is that although I use self intermittent catheters I find that occasionally (maybe a day each month) I find I can urinate for a few seconds before using my catheter, I ususally know that this is going to happen as I experience some pain in my genital area just prior to the event. I have spent some time investigating a product from Interstim which places a wire close to the nerve roots to the bladder, and with electrical stimulation opens the sphincter. I have discussed this system with my urologist but I would appreciate your opinion on its suitability for an injury such a mine, I know it does not involve cutting any of the nerve roots.

I have found during the 30 months after my injury that some slight sensation has returned to areas around my anus and a really weird thing is that I can feel the outer ring around by foreskin but nothing else on my penis, is it likely after such a long time that this return of sensation could continue.

Finally, does peripheral nerve bridging has any relevence on an injury like mine or could you suggest what may be of potential benifit in the years ahead.

[Scribe]

Dr. Young:

You said: "However, the spinal cord between T10 and L1 contain the lumbosacral enlargement. The neurons that control some of your leg muscles and bladder/bowel/sex function reside between T10 and L1."

I have a T-9 burst (complete). I was diagnosed as a T-10 in the San Jose hospital in which I recovered. Another doctor says my neurological level is T-9. Am I in the lumbosacral enlargement loop? The possibility of regaining bowel-bladder-sex function would be great. But is my level too high?

This is a good forum.

[sbdspray]

no-
if your injury is T9 you're ok. It's T12 and below that is the difficulty. There is no doubt that any neuronal damage in the Lumbosacral spinal cord is fatal to functioning of the spinal cord. People with complete T12 and below SCI's, who have not recovered naturally will never, ever recover sexuality/walking, etc. Nothing in the next 100 years will fix this. It is not only safe, but 100% accurate to say that recovery in this case is 100% impossible, today, tomorrow, 10 years, etc. Do not believe what anyone may preach about physical therapy and axonal regeneration, neuronal replacement for the Lumbosacral spinal cord will never be done in ANY of our lifetimes. This will remain an enigma dacades and decades, and decades to come. If you are 10 years old now with this problem, maybe, just maybe will you benefit by the time you are 70.

sherman brayton

[mk99]

Brayton I would kindly ask you to lay off the "never ever" doomsday talk. I'm not asking you as a Moderator, just as someone who doesn't want urine in his cereal with every post you write.

thanks

[Curt Leatherbee]

I always say never say never. We all get negitive at times, but it is best to never give up hope. For now, just try and live your life the best you can.

"Life is about how you
respond to not only the
challenges you're dealt but
the challenges you seek...If
you have no goals, no
mountains to climb, your
soul dies".~Liz Fordred