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Lower Thoracic, Conus, and Cauda Equina Injuries: Diagnosis & Treatment

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    #31
    Dr Young, thanks again for your help. It helps to know exactly what my injury is. Another question, you say in your article that "Lower thoracic, conus, or cauda equina injuries often result in flaccid paralysis and muscle atrophy. Can it be reversed or prevented? Most of the atrophy that occurs is very likely to be due to non-use." Is there a way to tell whether the atrophy in my calves is due to non-use? I wear my AFO's when I'm out of bed and wonder if I should do that or if I could strengthen my calves by not using AFOs all the time (I'm starting to go to the pool again and I don't wear AFOs and can walk in the pool).

    Kap - thanks for posting your scores. It was interesting to compare them with another T12/L1. Sure do hope you can resolve the problem with C7.

    Mike

    T12 Incomplete - Walking with Crutches, Injured in Oct 2003
    T12 Incomplete - Walking with Crutches, Injured in Oct 2003

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      #32
      MikeC,

      The calf muscles are called gastrocnemius. If you have any reflexes or spasticity in your gastrocs, you are likely to have S1 gray matter and also intact S1 spinal roots. The gastroc reflex is the ankle jerk, resulting from tapping of the Achilles tendon. Flaccid paralysis and absence of reflexes suggest damage to gray matter or the spinal roots.

      Based on your questions, I am getting a little worried that you are not understanding the main point that I am trying to make. Let me try again to make sure:

      If you look at the figure, a T12 burst fracture will damage the S2/3 cord (yellow colored part of the spinal cord). However, note that there are one green (thoracic T12), some blue (lumbar L1-L5), and some yellow (Sacral, S1-2) spinal roots that are passing alongside the spinal cord at T12. They might have been damaged, too. I drew a semi-opaque box where I think the injury is. Can you see how the roots are involved in a T12 injury?

      Wise.
      Last edited by Wise Young; 28 Sep 2006, 4:18 AM.

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        #33
        accept no substitutes

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          #34
          Dr Young

          Thank you for the intelligence insight of the paper that you have posted. I to have a T12 burst SCI and what you have put forth has given me grater insight it to the level and area were I am damage at. It also appears that my injury is some what similar to the others that have posted there questions here as well.

          My observation is that you put forth "sensory points" were to test as the level of injury, but what about the actual movement of the muscle themselves? For instance on my left side all muscle groups work but with little or patchy sensation below the knee. While on my right side most muscle groups work (but weaker) with "more sensation". I can not bring my right foot large toe toward my knee on my right side but I can contract my calf's (stand on my toes) with having no or very little reflexes by tapping the Achilles tendons.


          So, if I am missing sensation and have muscle movement or visa versa, how would this determine what exact level that I am at or my chance for more recuperation? I.e. I'm 9 month post injury.

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            #35
            Thanks Dr Young - that did clear it up. I was misunderstanding. I'm still not sure if the S2 (for example) is damaged that it matters whether it was damaged at the T12 level or lower. In other words, does it make any difference that my injury is a T12 versus Conus? Or does this question show that I still don't understand?

            Kap - glad to see your new figures. Look a lot more like mine. I'm going to compare later - it's surprising to me that you can walk unaided but I'm still using crutches. I guess the motor scores are more important than the touch scores when it comes to walking. Mike

            T12 Incomplete - Walking with Crutches, Injured in Oct 2003

            [This message was edited by MikeC on 05-20-05 at 03:38 PM.]
            T12 Incomplete - Walking with Crutches, Injured in Oct 2003

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              #36
              Dear Dr. Young;

              Thank you for this information, very interesting. I have an incomplete T11 T12, would like to know how can I contact Dr. Shaocheng Zhang. I am schedule to have Surgery with Dr. Huang on September 14th. and will also like to contact Zang to send my MRI and hear his opinion on the possibility of nerve rerouting.

              I am form Argentina and will travel to the United States in July, I will like to have an appointment with you, could you please direct me on how to schedule this?

              Thank you

              Regards

              Lauratipsusa@msn.com

              Laura
              Laura

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                #37
                Mike...yeah...the second time I did the test is much more accurate. I was tired and med'd up pretty good and my wife was half-asleep the first time...LOL. What a scare when I was getting nothing in the C dermatomes! She just wasn't touching me right....hahahah (sounds kinda kinky). I'm anxious to hear what Wise says about my injury when he finds the time to reply.

                Ever since they made me get up and walk at 6 days post surgery, I've been getting better. It's just the damn neuro burning pain that keeps me from walking more.

                Kap

                accept no substitutes
                accept no substitutes

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                  #38
                  kap .....is the burning pain that keeps you from walking more only there when you are standing or walking? walking pain sucks whe you have the muscles function to walk, but it hurts to much..
                  fortuanely i got a good handle on mine..
                  cauda equina

                  Comment


                    #39
                    Metro...the burning pain mostly kicks in if I walk or stand for too long. Also, wearing any kind of shoes that are slightly tight causes it too. What's a drag is that I don't really realize that I've been on my feet for too long until it's too late. By the time they start to burn, even when I get off them they just keep on burning. The neurontin and oxycontin handles it most of the time except when I just plain overdo it. Lately, I've been getting bad cramps in my calves for some reason too. Not spasms but muscle cramps like mad.

                    How did you get your burning under control?

                    Kap

                    accept no substitutes
                    accept no substitutes

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                      #40

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                        #41
                        kap, i find that when i get redness in my toes that coincides with the start of the burning. same with you , shoes cause this,even shoes that do not seem to be too tight they still compress the foot. i went to wearing open toed sandals full time now , only thing that doesnt cause pain with my afo.
                        my weight bearing foot pain is night and day better, the foot and toes have less compression due to the straps of the sandals, i even feel the difference when i wear heavy socks in the sandals in winter , that causes more compression since they tighten the fit of the sandals. i have only a cauda equina injury, a lot of my S1 root is injured , calf muscle is denerved and big toe doesnt move, so some siliarites
                        cauda equina

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                          #42
                          Metro, thank you for your description. I think that what you have described is very important and food for thought. Wise.

                          Comment


                            #43
                            i am very surprise when I read about the rest of you. I do not have normal sensation belowe 2cm down from my navel, I do not have any problems with my toes and ankles, i can move them like normal. I even drive with my feets and have full controll.

                            My problems are my hips and my butt and the biggest problem are the knees, I can't straight them out and they don't keep me very long when I stand up.
                            TH 12 incomplete 12-12-69.
                            TH 12, 43 years post

                            Comment


                              #44
                              Wise...thank you for your evaluation. Let me first answer your questions:

                              1) I was a bit confused by the "...against some resistance" vs. "...against full resistance". I'm confused about the muscle names and what they each do. After spending 1/2 hr googling anatomy, now I'm more confused!

                              I can stand from a sitting position, raise up onto the balls of my feet and walk a little that way, I can point my toes(but this causes calf cramps), I can squat till thigh is lower than 90 degree angle then rise again, I can stand on my heels and walk a little that way. There is some weakness compared to before my injury but I can move against some resistance, either body weight or opposite force. SO...I guess the lumbar muscle groups would be a 4/4 rather than 5/5.

                              2) My anus is not flaccid. Quite the contrary it is very tight and it takes digital stimulation in order to relax it enough for BP. It does not contract when I am doing BP but if I stop dig stim for a minute it tightens back up. I don't feel any reflexive contraction when a finger is inserted nor do I have bulbocavernosus reflex. I can feel inside my bowel and know when I need to do BM, can feel stool, etc. When I do extensive BP I get sore inside bowel so I have sensation inside and of the muscles but not outside on the skin.

                              3) I do have deep sensation of penis but not on the skin and have not had any erectile activity since injury, even with viagra. I had a few spontaneous retrograde ejaculations at night when first out of rehab but nothing in over 2 years. I can feel it inside when I cath and can feel squeezing of penis but very little rubbing type sensation. I only have bladder spasms when I am very full or also need to do BP. However, bladder sphincter is very spastic. It is so tight sometimes that it takes several minutes to get cath into bladder by constant cath pressure.

                              I hope that answers the questions you asked. How does this change your eval?

                              Regarding tethering...this would need MRI to determine, right? How could this be done as I have titanium rods on each side of spine held by titanium bands screwed to each vertibra from S3 to T8? I have long suspected that I may be tethered, as I still have "cord pain" when I am jolted or flex spine as in twisting or bending too quickly.

                              Re: 4AP...if it increases sensation and spasticity, wouldn't it cause my burning feet to get worse and my bladder and bowel sphincters to lock up even tighter?

                              If OEG is all I could try now...I'll wait for something more reliable. I'll only have one shot at some kind of cure surgery due to money and age. I just hope one gets here before I'm too old to do it.

                              Kap

                              accept no substitutes
                              accept no substitutes

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                                #45
                                Metro...LOL...I've gone to nothing but sandals too! I do have a pair of hiking boots that were way to wide when I bought them and I can wear them if I only tighten the laces at ankle, not on the foot part.

                                I got a pair of Merrell "all terrain" sandals that are great. They're all synthetic materials, velcro on toe straps as well as ankle straps. You can wear them swimming even...LOL. Check them out, they have several different styles.

                                I never noticed the redness of my toes. I'll remember to check that next time.

                                Kap

                                accept no substitutes
                                accept no substitutes

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