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Thoracic Spinal Cord Injury: Diagnosis & Treatment

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    #31
    Originally posted by Bonnie Turano
    While in Colorado his Neurosurgeron gave us the choice. Showed us the findings and referred us back to San Diego for a second opinion or the option of getting Nick into the Proneuron treatment at the Craig Hospital. We decided to come home. Immediately he was looked at by 3 surgeons who all agreed that surgery was a good choice not to have.
    I believe Nick's accident caused his spine to compress causing his injury but it all fell into place and was in alignment. He had bones that needed to heal, but there was not a compression.
    The diff is this. Most people with SCI have had surgery. You really don't know about this until it happens to you and then you have to learn really quick the best route.
    It is most difficult to understand, relate and get communicated to by Neurosurgeons.
    Again, if you are willing, I would love for you to look at the pics. Thank you for your quick response. Sincerely, Bonnie
    Bonnie, the question is whether or not Nick has compression now. If his spinal column became realigned and was no longer being compressed, he did not and does not need surgery. It is not a good idea for somebody like me to look at an MRI. It should be done by a practicing spinal surgeon who looks at films every day and operates on patients, or a neuroradiologist who knows the machine that produced the images and can even adjust the images. Many people send me their MRI's and the quality of the pictures are too low to see the spinal cord clearly. The question that you want to ask is whether or not he has compression and tethering of the spinal cord now. If he doesn't, there is nothing to operate on.

    Wise.

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      #32
      Thank you for this helpful information. I plan to call his neurosurgeon and ask that question. Alot of things have happened to us in the last 9 months and I am not sure we knew the right questions to ask. For some odd reason I keep going back and verifing these facts. It makes me feel stronger and more confident in my decision making.
      The good news is today at Project Walk they excitedly discovered that Nicks feet are able to sweat. According to them that is a signal that goes from the top of your body to the very bottom. They also taught him to use his spasms to his hip flexors and concentrate to make it past his hips and into his legs. With this new found concentration he was able to hold 1 leg at a time up 15" up and hold it unassisted for 10 seconds 4 or 5 times per leg.
      Super fantastic stuff.
      Our Thanks again, Bonnie & Nick

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        #33
        Dr. Young in my operative report it says that I had a T6 fracture, but I'm at a T4 level (nothing under nipples). Doesn't it seem like I should be a T7 level? Also it says that "limited laminectomy was done to T5, T6, T7,".Does this mean that I could still have some compression since it was a limited laminectomy? I had a MRI taken 4 months after my surgery, but I have gotten different opinions from the 2 doctors that looked at it.
        "There's too many things to get done, and I'm running out of days" 3 Doors Down

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          #34
          Originally posted by JerryF504
          Dr. Young in my operative report it says that I had a T6 fracture, but I'm at a T4 level (nothing under nipples). Doesn't it seem like I should be a T7 level? Also it says that "limited laminectomy was done to T5, T6, T7,".Does this mean that I could still have some compression since it was a limited laminectomy? I had a MRI taken 4 months after my surgery, but I have gotten different opinions from the 2 doctors that looked at it.
          Jerry, I am not sure. In general, your sensory level should be at or below your vertebral injury level. It is possible that even though your fracture was at T6, you had severe compression of your spinal cord at T5. In that case, your neurological level would be T4 since the neurological level is the lowest intact level. Do you remember whether you got methylprednisolone within 8 hours after injury? When were you decompressed? Does your latest MRI show any compression of your spinal cord?

          Wise.

          Comment


            #35
            I was given methylprednisolone less than 30 minutes after my injury and had surgery about 15 hours after. I had one doctor say that everything looked ok on the MRI, but the next doctor said that there was still some compression. So I don't know who to believe. Is there anyone I could email them to for another opinion?
            "There's too many things to get done, and I'm running out of days" 3 Doors Down

            Comment


              #36
              Originally posted by JerryF504
              I was given methylprednisolone less than 30 minutes after my injury and had surgery about 15 hours after. I had one doctor say that everything looked ok on the MRI, but the next doctor said that there was still some compression. So I don't know who to believe. Is there anyone I could email them to for another opinion?
              What does the radiologist report say? That is usually the most accurate and professional report. Wise.

              Comment


                #37
                I didn't see a radiologist report. I thought that the doctor that ordered the MRI was the one who read it. I'll have to write to the hospital and get a copy of it.
                "There's too many things to get done, and I'm running out of days" 3 Doors Down

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                  #38
                  mr.wise brad is now saying at time of injury. they said he was classed as c3 incomplete but that was back 10 years ago...apparently there is alot going on with brad that has been neglected on his part to as well..drs fault for never telling him and brads for not caring to find out anything to get better...but the things he is telling me now i just wonder mr.wise if brd has been sitting in chair this long with things that could be fixed and etc..He is T4 T5 ..for sure he knows...do u think LSUMc would be a good hospital for him to go to..they have some of the best drs and teaching hospital which most are teaching facilities..but i just want your opi..for those ready if u dont know LSUSMC is in shreveport louisiana.suppose to be one of the best hospitals in our area..we are thinking about moving to get brad somewhere where there is specialist in sci..because lord knows there is none here in monroe la..thanks brad and tracy..oh btw what i was getting at on c3 is 10 years ago he had problem with his arm on right.but he has been able to use this arm and no problem for many years now..thanks

                  Comment


                    #39
                    bradsgirl,

                    You need to turn on your private message topic. I am in West Monroe.

                    Comment


                      #40
                      Dr. Young,
                      First off let me say I'm a T-7 ,T-8 paraplegic. I have tried to get help for my cord injury for the past four years. I have tried several spine surgeons ortho and neuro but it seems no one wants to help. The most recent said if I had came to see him two years ago he would have done the decompression, now he says I wouldn't gain much from it. All I can think is why wouldn't they do it even if there is minimal gain? Any gained function at all would mean a lot.
                      As a result of being turned away by everyone I now have a complete spinal block at the trauma level is there a hospital you could suggest going to anywhere in the U.S. that will perform a decompression so I don't end up worse off ?... here is my latest report:
                      EXAM: CERVICOTHORACIC MYELOGRAPHY

                      CLINICAL INFORMATION: 27-year-old paraplegic with mid to upper back pain.

                      TECHNICAL INFORMATION: Under fluoroscopic guidance, a 26-gauge spinal needle was carefully advanced into the lumbar spinal canal via a left posterior paramedian approach at L2-3. 10 cc of iohexol, 300 mg/cc was injected into the thecal sac, and the needle was removed. The patient was placed in Trendelenburg position and the contrast column was mobilized to the thoracic spine. The contrast column abruptly terminated at the T7-8 level. The patient was repositioned from the prone to the left lateral decubitus position and an additional attempt to mobilize the contrast above the T7-8 was unsuccessful. Multiple fluoroscopic images were then obtained. No complications were encountered.

                      INTERPRETATION: Images reveal dorsal rod instrumentation with pedicle screws and laminar hooks from T5 to the T11 level. The hardware appears intact. Pedicle screws are oriented at a neutral sagittal angle at T9, T10 and T11 levels. Laminar hooks are noted above this level.

                      Just below the T7-8 level, there is abrupt truncation of the contrast column. Below this, there is no demonstrable canal stenosis. Kyphotic deformity of the thoracic spine at the T7-8 level is also demonstrated, with anterior wedge compression fracture at T7.

                      The more cephalad levels reveal normal appearance of the vertebral elements. The bony spinal canal is normal in caliber, but there is no contrast within the spinal canal above the T7-8 level.



                      CONCLUSION:

                      1. Spinal canal block at T7-8 with a kyphotic deformity and wedge compression fracture at T8.
                      2. Dorsal fusion instrumentation at T5-T11. Pedicle screws are oriented at a neutral to slightly positive sagittal angle at T9-T11. Laminar hooks are present above this level.
                      3. Mild spondylosis at C6-7without bony canal stenosis. The thecal sac is unopacified above the T7-8 level.
                      Only a life lived for others is a life worthwhile.
                      -A.E.

                      Comment


                        #41
                        Originally posted by Schmeky
                        bradsgirl,

                        You need to turn on your private message topic. I am in West Monroe.
                        Schmecky..thanks for the info, but ummmm i dont know how to do that..lmao.still looking to find out exactly what u are suggesting..lolthanks schmeky..oops my bad..lol..nevermind just found it ..it is done SCORE!!.
                        Last edited by bradsgirl; 23 Mar 2006, 12:23 AM.

                        Comment


                          #42
                          Originally posted by Wise Young
                          Diagnosis and Treatment of Thoracic Spinal Cord Injury
                          By Wise Young, Ph.D., M.D.
                          ....
                          Anatomy

                          The thoracic spinal cord is situated in the T1-T9 thoracic spinal canal. The thoracic vertebral segments form the chest wall and have ribs.
                          .....
                          Treatment

                          ....
                          Because the injury does not involve the lumbar and sacral spinal cord, lumbosacral reflexes are usually preserved and spasticity is frequently present. Thus, people with thoracic spinal cord injuries are good candidates for regenerative therapies aimed regrowing descending motor axons from the injury site to the lumbosacral segments or ascending sensory axons from the injury site to the brain.
                          ......
                          Dear Dr Young,
                          I just discover this interesting article of yours.
                          You mention that an injury in considered as thoracic between T1 and T9 level and that patients with that level of injury have preserved reflexes and spaticity and are good candidates for regenerative therapies.
                          My questions :
                          - Do you then mean T1 to T9 neurological level or bone fracture level ?
                          - I once saw that the selection criteria for a locomotor training trials was 'people with level up to T10' [I do also not know if they meant neurological or fracture level]. Is the assumption that locomotor training doesn't work under T9 or T10 level ?

                          Remark : my understanding is that I am myself T12 bone fracture level and T10 neurological level.

                          Thanks in advance for your reply
                          www.endparalysis.org!

                          Comment


                            #43
                            Corinne, you need to look at the other topic on lower thoracic spinal cord injury.... http://carecure.org/forum/showthread.php?t=21893

                            Wise.


                            Originally posted by Corinne Jeanmaire
                            Dear Dr Young,
                            I just discover this interesting article of yours.
                            You mention that an injury in considered as thoracic between T1 and T9 level and that patients with that level of injury have preserved reflexes and spaticity and are good candidates for regenerative therapies.
                            My questions :
                            - Do you then mean T1 to T9 neurological level or bone fracture level ?
                            - I once saw that the selection criteria for a locomotor training trials was 'people with level up to T10' [I do also not know if they meant neurological or fracture level]. Is the assumption that locomotor training doesn't work under T9 or T10 level ?

                            Remark : my understanding is that I am myself T12 bone fracture level and T10 neurological level.

                            Thanks in advance for your reply

                            Comment


                              #44
                              harrington rods

                              dr. young

                              A little of your insight might help my problem. I’ve had Harrington rods in since 1985 after an auto accident where I had a compression fx of t-10 and broke the transverse processes off of t-8 thru t-11. My rod ends at t-12 there is a notable lump in that area. is it possabile that the hook is coming in contact with the spinal cord causing a reaction. In the past few years I’ve been experiencing what I can only explain as drop falls. During one of these episodes my back will lock up and I will fall to the ground. I know exactly what is happening during the event but I can't move to brace myself. Have you ever come a crossed something like this? I’ve been to my local dr. - I’ve been to Jefferson and U of P. i've had CT scans and an MRI but because of the rods it was unreadable in that area. In your opinion would you recommend to a patient of yours to have the rods removed.
                              Last edited by FIREGUY; 11 Apr 2006, 4:00 PM.
                              ddd t1-6, f/x t8 thru t-11, fusion at t-9/t-10, 1 1/2" bruse on cord, fusion at t-12/1-1, lamy at L-1/L-2, foraminotomy at L-3/L-4 , protrusion at L5/S-1. ain't much left to fail
                              Well I guess I was wrong.

                              Comment


                                #45
                                I've only now happened upon this thread - I learned a lot. Thank you, Dr. Wise.
                                It's just recently that I'm beginning to understand what happened to my wife: attempted correction of a 90 degree deformity to about 45 degrees was probably too much, causing ischemia at T5. It is very hopeful to know that there's still a chance of some return, though we haven't seen much of anything in the 10 months since. Still don't know why they didn't give her methylprednisolone.
                                - Richard

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