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

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  • Hello Kap
    I had surgery on june 29, 2015. I was experiencing sudden onset of leg weakness, calf fasiculations prior to my surgery. The doctor ordered an MRI and there was a large disk bulge at T12/L1 which the doctor said was "flattening" the cord, however, other docs said it was just touch the thecal sac. Also on the MRI was moderate to severe spinal stenosis at L2/3. So the doctor stated I needed decompression surgery quickly. I had a T12/L1 laminectomy, disectomy, interbody fusion from the posterior with instrumentation (pedicle screws and rods) and an L2/3 hemi (left) laminectomy. After the surgery, I awoke with burning pain in the sole of my left foot. I did not have this pain prior to surgery. The doctor did not say much other than it would get better in time. Six months later, I still have burning pain in the heel of my left foot, and I also have burning, tight pain in my left calf and outer left thigh. I asked the doctor if he touched or retracted the cord during the surgery, and he stated he had not; this was also reflected in his surgical report.

    So I believe based upon my symptoms after this surgery my S1,2,3 nerve roots were irritated as they are in between T12 and L1. The fact that I had a severe burning pain in the sole of my left foot matches with the left sided disectomy and insertion of the 10 mm peek cage (with bone graft). The foot pain is less (it started at a 10 and is now can between a 4 to a 6 pain level depending on the day). The calf and thigh pain I did not have right after surgery, but now have these pains. Other doctors told me that spinal cord irritation can take 12 - 18 months to get better. I also wonder about the necessity of my surgery, and that I probably should have left things alone but I was afraid of being paralyzed or losing bowel/bladder control. My dad had a laminectomy when he as 53 (I am 48 male), and he did not fare so well. A cat scan post surgery showed some large bone spurs at T12 L1 that were also encroaching the spinal canal with the bulging disk. The surgeon did not remove these spurs; I suppose he felt the posterior decompression would be sufficient and he did not want work around the cord. Since I have this new pain I did not have before surgery, I worry that maybe the surgery was not necessary, or not done right. Or it could be that I needed it, and I must be patient.

    The burning pain is really frustrating and I wanted your thoughts on my situation, and if anyone else has comments. I did not have an accident leading to this. It was that my spine was pretty degenerated on its own (combination of bad genetics and abuse of time, weight lifting, etc). I had schmorl nodes as well through out the thoracic spine. What was in good shape as S1 and L5, as well as L4/L3.

    Does this burning pain go away? Will nerves settle down? I am almost at 6 months post op. I have a lot of worries about my current condition because everything happened so suddenly. I had no issues with strength, weakness, fasiculations, and pain for the most part until the weeks leading up to surgery. I did have some left outer thigh pain for awhile prior to surgery which was misdiagnosed as meraglia parasthetica but was probably due to the stenosis at L2/3. I have my leg strength but I noticed a good amount of muscle loss in my left calf. Also, prior to the surgery, I was given a strong steriod, which took away the leg weakness I was having. My thoughts were to still have surgery because the surgeon recommended it and that maybe I would get worse, but I think a lot that maybe I should have waited and tried more conservative treatments first.

    So I hope the folks on the forum as well as Doctor Young, can provide some comments/advice. I

    Comment


    • What are you currently doing for the pain? Pain that lasts more than 6 months is considered chronic pain. It may not improve. Generally pain like this is treated with things like TENS as well as medications such as Neurontin and Lyrica. Have you seen another orthopedic spine surgeon or neurosurgeon for a second opinion regarding possible root compression? Had an MRI?

      (KLD)
      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

      Comment


      • Comprehensive neurological facility in South Florida

        This facility has a very strong understanding of Cauda equina. Syndrome.


        http://www.centerforneurorecovery.co...-syndrome-ces/

        Comment


        • ehat is not the cauda equina that i have, nor most others here, Core strength rehab will not help when there is already nerve damage
          cauda equina

          Comment


          • Core strength rehab will make the working muscles stronger and help with balance. CWO
            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

            Comment


            • They have written AIS D on my SO's papers from the rehab, but he says he never got a thorough examination. He only got his reflexes checked and anal insertion at the beginning of his time there (once), it only took a couple of mins. Is this something he should get done? Who would he have to see to perform this, a neurologist?

              Comment


              • Originally posted by sweettangerine View Post
                They have written AIS D on my SO's papers from the rehab, but he says he never got a thorough examination. He only got his reflexes checked and anal insertion at the beginning of his time there (once), it only took a couple of mins. Is this something he should get done? Who would he have to see to perform this, a neurologist?
                A neurologist or physiatrist who specializes in SCI/D would be best. Be sure they have been trained in the proper administration of the ISNCSCI (the new name for the ASIA exam) and ideally, a member of the International Spinal Cord Society (ISCoS)

                (KLD)
                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                Comment

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