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

[misbahuddinka]

Hi,

First of all, thanks a lot for your quick reply.

My symptoms are kind of constant wrt sitting, standing or lying down ( I think, I dont understand how can I distinguish ? ). Is there no other definitive way of knowing for certain if I have CES or not ?
What I am worried about is of not acting too early. I just got engaged before the surgery and was thinking of nice things to come in life when this happened. This is seriously affecting my self confidence :-(

Going back, can any exercise cause a dislocation of something to cause such problems ? I mean, is there any other problem other than disk herniation which can cause this issue ? I have no stenosis or any other trauma.

Also, a new development is that I have started feeling numb all over my body now including both my legs. And even my head is kind of numb & it hurts ( probably because of thinking ? ) But I have control over my legs.

May God Bless You for your service.

Regards,
Misbah

[ejkern]

Help I have a s1 L5 bullet wound

Hello sir,

my name is jeff I am a gulf war vet

i have a 30 cal bullet that went through l-5 s-1 area it is still there

On july 12th the va is doing pre op. to remove it.

I am afraid due to the mechanics of the injury. oh with a AFO I can walk with a cane.... without the AFO my baack spasms and pulsates after about 1 hr.

ok so the bullet is like a vacume so I am afraid it may of sucked some of the lower spinal cord or roots out with it , thus now an incapsulated bullet of scarr tissue and the unknown because no mri or ct exam due to hot spot problems,
so if there are roots or fingers then......
cutting the roots could cause more and worse damage then what I have now.

Is this a good ?

[metronycguy]

i would find a neurosurgean outside the VA if your going to try this,
you want the best of the best, becuase even with the best , possibility of coming out worse are still high.
you may want to post over in care, it gets a lot more eyes than here. hopefully dr young sees your question

[medic1]

The Tri-fecta

So finally after all these years I feel like I found what exactly happened. L1 burst fracture that involved the spinal roots, conus, and cauda equina. That pretty much leaves me screwed as to putting things back together. Oh well, I will keep marching on!

[JSTMEMP]

jstmemp

Dr Wise,
I read your recent post and was very impressed.
I'm writing on behalf of my 16 yr old son.
HX: He suffered what is being classified a Cauda Equina injury. burst FX of L2 with compression below the cone. surgical repair of L2 and debrisment revealed only compression to the nerves, no severence of the nerve roots visible.
SX: Loss of motor function below level of T-12. He has sensation ( burning/tingling) in bilateral lower extremities, motor function stops below hip flexors. most recent sensation changes in saddle region. Motor function and sensation greater on one side than the other. Bladder sensation, but incontinent, able to empty bladder by flexing abdominal muscles. Bowel sensation, but no rectal tone.
While I have full confidence in our Neuro MD, we can not get a prognosis. We have heard everything from "what you see is what you get" to " full recovery possible since his injury.
So many questions loom. after reading your recent post, I'm trying to see where my son would benefit the most in the treatment of his condition.
Of course, if there is anyone out there with similar circumstances, we would love to hear about your experiences

[callora]

please help just come home from emergency op for cauda equina never heard of it and still not sure had sciatica for 4wks pain unbareable, went to docs prescribed dycodamol and diclufenic couldnt move so I rang them they changed meds to codine instead of dycodamol then after no effect over the phone again prescribed tremadol they booked a MRI scan for last tuesday At no point did they warn of immediate action if I experienced numbness in the saddle and bowel problems and trouble passing urine Then on saturday I became numb and had to make effort passing urine had no bowel movement but thats not unusual for me so I very stupidly left it till the tuesday they scanned me and said the clinic at the hospital would be intouch in 7 days after advice from my mother I crawled to the doctors all hell broke lose and got whisked away to hospital for a emergency op Did I leave it too long what are my chances of recovery does anyone have any advice wot should I be doing to help myself

[MargritFeliz]

Hi there, I'm Margrit from Germany and had a bad accident last April, in which L1 was fractured and the spinal cord compressed. After the accident I couldn't move anything below my bellybutton but they operated on me immediately and when I woke up afterwards I could move my legs but not my toes and my butt felt kind of numb but I always thought it was temporarily. Well the doctors didn't explain much, only that it can take some time until it gets better (which implies that its gets better) and that I might keep some damage, the latter I took as a very farfetched possibility (you might be hit by a lightning as well), they strictely refused to tell me anything about probabilities, plus they didn't sound to pessimistic so I always thought everythings gonna be fine after a few months, a year or so. I've been to many doctors since then, and whereas some tell me that I have a good chance for complete recovery, others tell me that I should at last accept that this will not happen. Let me tell you about my symtoms and their development:

April 3th 2011 Accident, operation dorsal stabilisation between Th12 and L2, L1 fractured, little bleedings on MRT in spinal Cord. For days later ventral stabilisation with titanium Cage between th12 and L1, the disc between L1 and L2 is kept intact.
being diagnosed with Conus-Kauda. Got BB problems as well, no tension at first in sphinkter but it got better after a few weeks. The inner part of ma butt and intimate parts felt numb, as well as the outer back part of my lower legs, whereas the toes on my left foot burned like they are awakening after falling asleep. On this leg I could move my foot a little but not against any resistence. My other leg felt less numb but foot movement was even weaker and I couln't move my toes at all. Abductors weren't working at all.
Now, ten month later I can walk again without crutches but slowly and I'm limping. I still have difficulty walking up stairs without using banisters. Sometimes I have to go to the toilet very suddenly very urgently, but most of the time I got it under control. I still can't stand on the tip of my toes, I'm almost only walking on my heels and can not give much pressure on the ground. My left foot still burns but my butt feels less numb. When I_m lifting my right foot, the smalltoes side doesn't come up with my foot neither does the big toe. I can't lift my right big toe and only slightly move it down. Standing on one foot is difficult on the left side and hardly possible on the right, Abductors got better. I'm not on any meds, make physio and sports. Do you think there stil is a chance for me to walk normally again, without other people noticing? I calculated if the nerves of the cauda equina recovered like any other peripheral nerves the new axons could reach my toes if they grow 1 mm a day in november 2014. My neurologist sais this calculation is nonsense and there are other mechanisms of nerve recovery but Waller regeneration (I read about it in Internet) but didn't explain it any further. Is there anybody here that can explain to me how exactly nerves recover if they weren't completely severed and what the speed of nerve reaction has got to do with it, how many Axons inervate each muscle and what the effects are, if only half of the nesessary Axons reach the muscle - how do nerves function. My doctors alwas seem to busy to explain these things to me. I hope there is anybody here who's not.
One last thing: I know that I'm lucky compared to most of the other folks here on this site. In spite I want to be cured very badly, I always loved hiking and dancing, so I really have trouble accepting that I might be handicapped forever and that I can never do these things again. I know that you probably consider that complaining on high level and admire anybody who is coping well with having SCI. I still can't and I also don't want to until it's for sure that I have to, for the rest of my life. Knowing exactly what happens in my body would really help me. I think you can't really accept, what you don't understand. Wish you all good luck and all the best!
Yours Margrit

[Christopher Paddon]

I've been completely paralyzed from T7 down for 29 years now and I still want to walk normally again "without other people noticing" - it's a hard thing to explain, just to want to fit in to the majority of the human race and not draw attention to your physical shortcomings

I think your doctors should spend a bit more time explaining things, unless they don't want to admit to not understand spinal cord injuries

Sadly all most doctors can say is that it won't get any better or it may get better on its own

I am hopeful some new therapies will emerge soon and perhaps your incomplete injury will respond particularly well

[peterf]

I'm a year and a half into a T11 complete injury.
the only realistic possibility of being able to come near to a possibility of walking is to buy a rewalk device should it be affordable.

[jody]

so much information.
my diagnosis seems incorrect from the charts.
I should have hip flexor, but they are weak.

also my birth defect is not at t10 according to the chart. it hits the vertebra opposite the very botom of my sternum, at t-6.

I got a exam recently by a neuro. he used a broken tongue depressor. I could not get him to understand, that though I could feel area's affected, when he poked and scratched, it is not like touching my face, and feels like your feet would feel as they are waking up. that awful feeling you get when your feet wake up, only it is that way on most of my body, and especially from the top of my crack down.

with examing my hands and the way they react to the reflex test, well that just throws cauda equina out the window, however the pattern of burning and pain exactly fits cauda equina description.(saddle area) I guess at this point in time it isn't that important since nothing can really be done, However this thread has more info about my dx than I have ever seen.

Thank you.

[RJB]

Dr Wise Young,

On 10 Dec 2011, I suffered a spinal injury after falling about 10-15 feet. I was told that the injury resulted from excessive flexing as I was doubled over on impact with the ground. The initial write up from the Neurosurgeon stated that I had a closed fracture of lumbar vertebra with spinal cord injury. There was a fracture dislocation at T12-L1 with fracture of the L1 body also. There was a spinal cord compression at the level of deformity with abnormal signal in the cord extending superiorly, and there were signs of conus medullaris syndrome. Majority of muscle groups below the level of injury are greater than 3/5. Sensation decrease over LE with no rectal sparing. I had incomplete sensory loss rectum and decrease rectal tone. They conducted a posterior decompression at T12-L1with reduction of deformity with T10-L3 instrumented fusion. There was weakness and evidence to suggest I would have bowel/bladder and sexual dysfunction.

Another report stated the following: A CT scan of the spine revealed an anterolateral fracture of the L1 vertebral body with the T12 facet perched on top of L1 bilaterally with TP fractures noted. MRI of the spine was then performed which demonstrated abnormal signal in the conus to the lower spinal cord at T11. Patient subsequently underwent T10-L3 posterior segmental instrumented fusion with decompression and T12-L1 partial inferior and superior laminectomy with bilateral facetectomies.

Initially in the hospital I was unable to lift my right leg, while straight or bent, against gravity, but I could lift my left leg. I had decreased sensation down the posterior sides of my legs and minimal feeling in my pelvic area and feet. At first I couldn’t walk but after a couple days I could get myself up with a walker. Eventually after a week I could walk around with the walker and after 2 weeks I could walk with just a cane. Around that same time I was able to lift my right leg against gravity. Within two months I could walk without a cane or any other assistance and have been able to do so ever since. My gate has greatly improved, however, I still have a limp since I walk on my heels, but I can walk over a mile without assistance. My inability to fully use my calves prevents me from moving normally, and I cannot stand on my toes except when in water about waist deep.

I still have numbness on the posterior sides of my legs but I can feel some sensations. I have not had the pin/touch sensation test done recently but can get that assessed at my next doctor visit if that will help. The numbest area of my body is still the pelvic area. I can feel fullness in my bladder and some irritation to my urethra during cathing but I do not have much sensation. I should also have urodynamic testing done in the next couple of weeks. Also, initially I could not get an erection, but now I can and have some ability to ejaculate despite almost no sensation in my penis but I have no control of when it occurs. As for bowel control, I am still on a bowel program and I have to manually remove stool once a day since the anus has enough tone to hold stool in through most of the day. In addition, within the last couple months I have developed the ability to expel the majority of waste by pushing if I manually loosen the anus. I have been seeing a pelvic floor specialist and doing biofeedback tests and when clinching it shows a small increase.

I am currently coming up on 6 months from my accident and hopeful to keep improving. I have been having issues with bad sciatica in my lower back and right hip that shoots down my right leg, and will have nerve conduction testing done next week. I have been reading a lot of the posts on here and have become curious if my symptoms are more closely related to a conus injury or a lower thoracic injury and what that will mean for continued recovery? I know due to the location of my injury and the report, I would have guessed lower thoracic, however, it seems like I have more of the indications of what I have seen described for a conus injury. I would also guess since my injury is at L1 it is too high for cauda equine.

[MFlounlacker]

I really don't want to sound like a smart ass because I am curious. Maybe I have missed something. I was injured 12/11 and was fused at the T-11-L1. I suffered a complete dislocation and resultant SCI.

To my knowledge I have never had any tests to determine my nuerological level of injury. My rehab doctors acted as if they were tryint to figure out the nature and extent of my injuries but then I left Kernan and that was that.

I have had amozing amounts of return so far and am very thankful. I now walk with fore arm crutches and rarely use my wheelchair anymore.

I guess my question is what difference would it make to know whether my injury is lower thoracic, conus, or equina? Would they want to treat me differently? Am I missing something?

Again I am not trying to be a smart ass. Ever since I left Kernan and been doing outpatient therapy I have been the one doing all the research to aid in my recovery. I would like to know if I need to get some testing done that may help guide my treatment.

[SCI-Nurse]

Did you never have an ASIA exam? That would be the standard of care in a SCI rehab program (at both admission and discharge). It does not really alter your treatment to know accurately, but having a good ASIA exam allows later comparisons to be made that can document the return that you are getting.

We send all of our SCI rehab patients home with a written copy of their discharge ASIA exam (as part of their discharge personal portfolio) so that they can use it for comparison in the future regardless of where they get further care.

(KLD)

[MFlounlacker]

I was given the ASIA exam but it seems that many of the symptoms over lap when determining the exact nature of my injury. Pretty sure that I was released as ASIA C and a lower body score of like 5/50. But none of that followed me to outpatient. I was evaluated there as well but have not seen those scores.

I don't need another ASIA exam to know that I am far above the scores at Kernan now and really don't care what classification I am as it evidently makes no difference. I am what I am.

I was just wondering if I may be missing the boat on this and would not be surprised in the least that the doctors and Pt's I saw at outpatient didn't really know how to treat SCI.

I have since ceased therapy as it has seemed to digress into a waste of time and money. I do my own therapy at home and exercise regularly. I do my own research and adjust my work outs accordingly.

Thank you for your response KLD. You guys are great.

[TM from PA]

Hello , I was told i have TM leasons at t11L1 and nuro. said at the tip of the conus at S1 i have no ankle movement at all and no feeling at top of toes. does that mean i have a conus injury even though no blunt injury.