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

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  • #46
    What would my level of injury be described as?
    I have no sensation or movement from the waist line down

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    • #47
      Kap

      Do you not have a feeling like walking on broken glass? That is what mine feel like. then sometimes but not that often the burning will set in. I have been wearing nothing but New Balance tennes shoes. I tried a pair of the Nike shock's and the verdict is still out on those.

      I can't straighten my toes or walk on the ball of my feet, Just the heel's.

      We kinda sound the same except for the penis. I can feel mine but No erectile activity.

      Bowel's are so tight. but bladder has shrunk and thatnk God I don't have to cath anymore!!! I can feel it but just can't hold it.

      Just like you though, afraid the cure will get here and I will be to old
      Doug

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      • #48
        kap i wear the water sandals when i canoe, i cant walk very far in them without foot pain maybe 10 20 feet, i wear the MBT sandals they have the most cushioning of any footwear and the most rocker bottom i have seen, also stops the foot slap , which causes pain in me,they arent good for water stuff , only for walking, but i can walk for long distance with the AFO, its a night and day difference for me.
        cauda equina

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        • #49
          With pain symptoms similar to Cauda Equina type
          could there be compression of the root without
          disk herniation or stenosis showing on Mri?There is a cyst just right of S1-2 exiting neural foramen,15mm,perineural.

          Rob C6/7

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          • #50
            Originally posted by Kaprikorn1:

            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
            Kap, thanks for the info. It clarifies and confirms my previous assessment.

            1. I agree with the assessment of your plantar flexor (gastrocnemius) which should allow you to raise yourself onto the balls of your feet. This suggests that your S1 is 4/4, meaning that your spinal cord injury must is below S1 and therefore probably S2 and some of S3.

            2. The fact that have a tight spastic anal sphinceter means that your S4/5 segment is intact, arguing strongly against a conus injury.

            3. The fact that you have lost superficial sensation of your penis is consistent with damage to S2. The fact that you have some bladder sensation suggests that part of S3 may be intact. So, I may narrow down your injury to S2 with some preservation of S3.

            Regarding 4-AP, there are people who have reported that it reduces neuropathic pain for them. It should also reduce spasticity, fatigue, and improve coordination.

            The goal of OEG is to encourage sensory axonal growth into the spinal cord (to restore sensation). This may help improve sensation (particularly pinprick mediated by the spinothalamic) if the sensory axons grow into the spinal cord and make synapses with segmental gray matter.

            Wise.

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            • #51
              Duge...I don't feel like walking on glass...just the constant burning like feet are in boiling oil up to about my ankles.

              Metro...my Merrell sandals are the "High Tide" model. They have a pretty good "air cushion" sole. What are MBT's? I'm not familiar with them. Are they Merrells?

              Kap

              accept no substitutes
              accept no substitutes

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              • #52
                mbt pic

                kap this site has good closeup pictures, do a goggle search for MBT or Masai barefoot technology.

                the brown sandals i recently purchased and they do not have a adjustable heel strap,(fine tuning AFO heel pocket) the black ones i bought last year and they had a adjustable heel strap and a neoprene stretch at the toe box(which i cut)
                your best bet is to find a store that sells them to try them on , since they fit a bit different.
                i have no s1 basically, so i have no calf muscle , and these work great with the AFO to give a roll forward , since they have a huge rocker bottom.
                my ankle weakness require me to wear a AFO or at least a brace as the height of the shoe will cause my ankle to roll out evert badly,
                they are expensive , but i really cant walk far without them, the pain reduction for me is night and day
                insurance may pay for them , i have had workers comp pay for mine and the VA ordered me a pair from a local shoe store and mailed them to me. i have the docs make out the prescription for MBT custom rocker bottom shoe, they have stiff non flexing sole bed also that helps.
                cauda equina

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                • #53
                  Here is a redrawn/relabeled picture of the dermatomes
                  Last edited by Wise Young; 09-28-2006, 04:18 AM.

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                  • #54
                    Dear Wise, Thank you for your info. What dermatomes innervate the bottom of the foot?

                    [This message was edited by diane2 on 05-31-05 at 02:36 AM.]

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                    • #55
                      Diane2,

                      The L4 dermatome covers the medial bottom of the foot, the L5 dermatome covers the mid-bottom of the feet, and the S1 dermatome covers the lateral bottom edge of the foot. By the way, in another topic, I show pictures of dermatome maps that i think are wrong from textbooks of neurology and anatomy. Both the Netter and the Duke U dermatome maps (that is where the middle set of charts comes from) appear to have depicted the bottom of the foot relatively accurately. However, the dermatomes of the leg and particularly the coverage of the knee (patella) are inaccurate in both the Netter and Wash U. maps.

                      Wise.

                      [This message was edited by Wise Young on 05-31-05 at 05:03 PM.]

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                      • #56
                        Thanks a lot. Do you think there are individual differences in dermatome distribution that adds to the confusion?

                        On another topic, do you discuss "post polio syndrome",esp for those that are exercising quite a bit and seem to be getting gradual peripheral nerve re-growth? Seems esp relevant for conus and cauda equina injuries.

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                        • #57
                          Wise, Perhaps there are individual differences in dermatomes that contributes to maps being slightly different?

                          Have you commented on "post polio syndrome" for those who are cauda equina/conus and seem to be getting peripheral nerve regrowth?

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                          • #58
                            Diane2,

                            There are of course individual differences at the edges of the dermatomes. That is one of the reasons why the ASIA classification guidelines ask clinicians to test the dermatomes at the specified points. These are the points that everybody should share.

                            The Netter picture (linked to http://www.backpain-guide.com/Chapte...culopathy.html from Atlas of Human Anatomy by Frank Netter, MD) is very pretty and is widely used by many people for teaching dermatomes. As I pointed out in my earlier post, Netter made at least 15 errors that are consequential for the neurological examination.

                            The concern of the ASIA committee was to provide specific points for the neurological examination so that if there is sensation at that specific point, you can say with a reasonable degree of certainty that that particular spinal cord segment and root is intact. You can imagine the discussion that went on when we found all the conflicting charts from all the textbooks.

                            As it turns out, due to the high prevalence of lumbosacral disc herniations and an abundance of clinical experience mapping the sensory loss in the foot, maps of the foot are reasonably accurate. But, you can see that there are discrepancies between the Netter chart and the Duke chart (linked to http://www.regionalabc.org/lower/ana...ermatomes.php:)



                            Netter shows L4 covering only the medial side of the great toe whereas the Duke image shows the L4 dermatome covering the entire medial side of the foot. Netter also wrongly shows S2 extending to the bottom of the foot; the S2 dermatome stops midcalf and does not extend into the foot.

                            The Duke University dermatome maps are wrong concerning the L2, L3, and L4 dermatomes. As shown above, the Duke map shows the L2 dermatome covering the front of the upper thigh from the inguinal ligament to the upper midthight, the L3 dermatome covering the front midthigh and the the medial thigh and part of the back of the leg, the L4 dermatome covering the entire lateral aspect of the thigh and spiraling in the front to cover the patella (the bump of the knee). According to the ASIA map, L2 covers the front and medial aspect of the upper thigh, L3 covers the front lower thigh and knee, L4 the the medial lower leg, L5 the lateral lower leg, and S1 the back of the lower leg and heel and lateral aspect of the foot.

                            By the way, the above images are simply links to images on internet... If you want to find the URL of the images, just right-click or control-click (on Apple) the image in your browser to open the image in a new window and look for the URL address. The Netter image is displayed at www.backpain-guide.com. What I call the Duke images is a link from www.regionalabc.org which is hosted by Duke University Medical Center.

                            Wise.

                            [This message was edited by Wise Young on 05-31-05 at 06:36 PM.]

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                            • #59
                              Back to the subject of cure-Dr. Young, deep down in my black heart i honestly feel that if anything were to arise ( likely not ) that nothing would work.

                              sherman brayton
                              sherman brayton

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                              • #60
                                Sherman, I still don't have a good idea of your injury level. Wise.

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