do you ever get any return on a t-10 injury?

[quarterhorse]

My husband was injured at a t-10 level and while in rehab i seen a lot of c injurys that were getting a lot of return, but the t level injurys seemed to get nothing even if they were incomplete.SO i was wondering if there has been anyone who got a lot of return at T injury?Also do the bowel and bladder ever return at this level and how many months could it take?

[Wise Young]

I have seen some people get back substantial function after a T10 injury, particularly if there is any residual sensation or movement below T10 during the first 24 hours after injury. Even in people with so-called "complete" spinal cord injury at T10, most people get back 3-4 levels of sensation, abdomenal recti, and even some hip movement. It is interesting that some get back toe movement, sometimes on one leg before they get back hip, knee, or foot movements.

In contrast, people who have "complete" injuries to T11-L1 or T4-8 don't get as much function back. The former may be because the injury is low and damaged the gray matter in the lumbosacral spinal cord. The latter may be because the distance to the lumbosacral cord is greater.

Melissa Holley was a "complete" T6, I believe. She is the young woman who was the first to receive activated macrophage transplants. On the last report of her function, I think that she was able to move her hip, knees, foot, and toes on both legs although they are still weak. She has some bladder control.

Recovery takes many months. In most cases, it may take a year or more.

Wise.

[Sorry, I mistyped former rather than latter in the above sentence]

[This message was edited by Wise Young on August 18, 2001 at 08:00 AM.]

[KDK513]

My husband had a hemorrhage that resulted in a bloodclot at the T4 level. The cause of this remains unknown. He collapsed while coaching a boys basketball game on December 23, 1999. The original prognosis was grim. The Neurosurgeon on call that night stated that my husband would never feel or move anything again from the nipples down. Their greatest concern at that time was to preserve his arm and hand function and hope the damage did not go higher.

On Christmas morning he could feel a pin prick on the big toe of his left foot. I was in the process of reading a students textbook kindly provided by the Resident and was overjoyed to declare that according to what I just read this was a good sign. (assuming I really understood it)

Like so many others confronted with the numerous complications of a spinal cord injury, I was forced to become as expert as possible. Considering my backround was in marketing and sales you can imagine suddenly existing in a world where noone spoke in fewer than 5 syllables. I asked a friend to get me a paperback medical dictionary. That has indeed been most helpful; moreover, I learned it was best to trust my instincts and ask questions until I felt I understood. If I could repeat back what was said to me and receive an approving nod I knew I was getting somewhere.

I have drifted off, sorry... to answer your question...I also learned that SCI recovery is totally unpredictable. Ask your doctors to give you best case, worst case senarios. They do not have to make promises and you get some hope.

I spent the night when I could while my husband was in rehab This was infrequent because we have 2 children who were 14 and 16 at the time. I wanted to be there when the Doctors were there to examine my husband. I will never be an expert; however anyone can become an astute observer and push when you think you need to. I noticed his Physiatrist never actually examined my husband. Typically he arrived at his bedside, asked how he was doing... did he have any questions and left.

He supported the original diagnosis even after my husband indicated he had returning sensation. We switched docs, rehab centers and therapists within the same center when we felt it necessary, though this was not always easy. The result has been finding a Doc who detected motor return that was not a spasm and down the road a therapist who believed my husband could do functional walking. Six months post injury my husband took his first steps. He wears a brace on his right ankle and uses a walker whenever possible, though this is very tiring. He is trying crutches, hopes to progress to a cane by this Christmas. Who knows maybe he'll even play golf again. It is of course a long story and to answer your question... my husband is living proof that you can get some return in function. Everyone's recovery is different.

[This message was edited by KDK513 on August 18, 2001 at 12:52 AM.]

[Wise Young]

I strongly echo and support KDK's posting.

Between 1980-1990, I was still very much immersed in the neurosurgical dogma that no recovery occurs in people with "complete" spinal cord injury. I remember the huge fight in 1984 when we were planning the NASCIS trial to convince the 14 neurosurgical centers in the U.S. to include so-called "complete" spinal cord injury cases in the trial. Fueled by the experience in Vietnam, the only major source of spinal cord injury recovery data, a vast majority of neurosurgeons were absolutely convinced that no treatment would make any difference in a patient who was admitted to hospital with no motor or sensory function below the lesion site.

At that time, I was just a young researcher who was trying to convince all these experienced neurosurgeons that we should include "complete" spinal cord injury in the trial. The group was convinced that no treatment would be effective for such cases that this would lead to a failure of the trial. Fortunately, Bill Hunt (whom I have the greatest admiration for) from Ohio State, spoke up and argued that if we don't try, we will never know. This turned the argument and he is one of the main reasons why methylprednisolone is being given to people with "complete" spinal cord injury today.

In the 1980's, all recovery belwo the injury site in "complete" spinal cord injury was attributed to the vague and unscientific (in my opinion) phenomenon of "root recovery". That view persists today in the practice of many American neurosurgeons in not choosing to decompress so-called "complete" spinal cord injury cases until a week or more after injury.

At that time, I did an analysis of about 450 patients who had been taken care of at Bellevue Hospital. About 17% of the patients who were so-called "complete" recovered substantially more than any of us could have predicted. Some of this recovery may have been predicted by the presence of head injury (which occurs in nearly 25% of people with cervical spinal cord injury) which may have masked the presence of residual tracts in the spinal cord. But, many of the recoveries occurred in patients without any extenuating circumstances. Many of my colleagues at the time dismissed reports of recovery after "complete" spinal cord injury, saying that the neurological examination was inadequate, that we did not poke the pin into the right places and therefore did not detect some residual sensation. However, having been there and having examined many of the patients, I did not really believe this.

In the intervening years, especially since methylprednisolone started to be given in the U.S., I have seen many people recover far more than their doctors predicted. A very good example of this is Christopher Reeve. He is probably one of the most examined and documented cases of C1/2 "complete" spinal cord injury that I know. Yet, he now has light touch sensation all the way down his back and in his legs. He is able to go off the ventilator for hours. He has shoulder shrug. I continue to expect more recovery in him over the coming years. This kind of recovery does not fit with what we know and believe, that the spinal cord does not spontaneously recover. Yet, I have seen many people who have recovered remarkably to begin to think that there is some degree of spontaneous regeneration after spinal cord injury. There are people who have attended this forum who have had these experiences.

There are ample reports in the literature of people who have recovered function within days or weeks after a decompression of the spinal cord, a compression that had been left in place because doctors felt that it was not worthwhile to decompress. I was stunned when I first heard Hank Bohlman at Case Western describe over a decade ago that he was getting substantial recovery in patients that he decompressed a decade or more after injury. This runs counter to all the established doctrines.

So, the door to recovery is not closed and we must try to open that door wider, both in the bodies and minds of people with spinal cord injury.

Wise.

[This message was edited by Wise Young on August 18, 2001 at 08:04 PM.]

[SCI-Nurse]

Some SCI injuries have return even more than a year post injury. This can be sensory or motor (feel or move) and can effect bowel and bladder as well. As SCI is individual with each person, so too can the experience of return. Some return involves feeling the sensation of a full bowel or bladder or having a limited ability to control emptying the bowel or bladder..............SAH

[KDK513]

Dr. Young
Thank you for continuing to advocate for the community of those whose lives have been touched by SCI. Your persistent quest for knowledge and your logical approach to the treatment of SCI, coupled with your skills and the strength of your convictions have been a tremendous benefit to us all. We are most fortunate that you give that which is most valuable... your time... sharing your wealth of knowledge and educating all who participate in this forum.

I wish to extend my gratitude to the moderators and SCI nurses for answereing our many questions and concerns. My only regret is that I did not find you sooner. We have been living in the time consuming world of trial and error, fortunately with some successes. I believe you are providing a tremendous service and are touching the lives of so many. My Heartfelt Thanks! Kathy

[quarterhorse]

my husband went to a new spinal cord doctor today, and he did not give him any hope. Although he was supposed to be a incomplete t-10 with a anal wink, the papers that the new doctor had from shepherd center said that he was a complete t-9.So what do you you believe? This new doctor just pricked him with a pin and he didn't feel it then he checked his knee and ankle reflexs and it looked to me that he didn't have any. Anyway he told us that sence his spinal cord injury had been so long that he didn't expect him to ever get any movement. His accident was may 19, 2001. and he broke his back, it was a pretty bad dislocation but no bone fragments or cutting of the spinal cord.And a few weeks ago i thought that he was moving his big toes on command, but now he doesn't seem to be able to do it.

[SCI-Nurse]

May of 2001 is just 4 months ago...way too early to say definately complete forever (and ignorant and pompous to say so). Someone can certainly appear complete for months after their injury and then start to get some return. It is true that the longer he goes with no return, the less likely that any return that does occur will be significant, but if you start out complete any return at all is a plus.

Anal wink and deep tendon reflexes are just as likely to be present in a complete as an incomplete injury, in fact absence of reflex activity this early may indicate that spinal shock is still persisting some. Does he have any spasticity?

Don't give up, no matter what the doctor says. At the same time, get on with life. If return occurs, won't you feel great being able to say "I told you so"!!! (and ask for more therapy then).
(KLD)

[walker66_2000]

Hi Debbie,

Well first off I dont agree with what the Dr told me.He told me i am a t-11 incom and I had a 95% chance of never getting movement.Lets just say I proved them wrong.Im a walking para now with a cane and a brace for drop foot.I all so know of friends who have gotten movement back after 3 years plus.It was a long hall and a tuff road but im walking and that is all that matters.My first movement was a toe that they said I had movement in.Yet I could not see it move but there was a mucsel flicker.Then the spasms started and I still have them today.I have learned(on my own)how to use them for walking and every day chores.

Rule number one is never give up hope! Never beleave all that is told to you just beleave what you want to.As my motto says "The day you except the wheelchair is the day you quit trying" I have lived by that rule I do use the wheel chair on a daily baseses but I will never except that it will be my legs forever..I hope you husband will get movement back soon.I also got my bowel and bladder back(5 months post for bladder and 8 months for bowel) but it is a chore and it takes me longer but I can get the job done.

Please never give up hope and never give up trying to help him.The family is the best support a man could have.



The nurse and the dr here are one of the few who know first hand about the SCI recovery process.Every sci is different and spinal swelling can take up to a year to go away.Untill that time the spinal cord is in shock.It has to have time to recover in the mean time learn and live with what he has at this point.Any further developments will assist him in his daily life.Always do the range of motion it is the most important thing he has to do on a daily baseses.Keep those muscel tones up it will be easyer in the long run.

Pat walk6

[This message was edited by walker66_2000 on August 21, 2001 at 05:22 PM.

[This message was edited by walker66_2000 on August 21, 2001 at 05:25 PM.]

[quarterhorse]

my husband is getting a burning sensation and feelings like electricty shooting down his legs and it seems to be getting worse. I have heard that sometimes this means that there may be some return conected with this burning sensation. Is this true? He said that it is very painful and didn't think he wanted to live if it stayed that way for life.Will it get better in time?

[AliceM]

Hi Walker66 (Pat),

Thank you for the message you sent to me and for this for message. I admire your optimism and must tell you that your message reminded me how important it is not to give up hope. My son's injury happened two years ago on Nov. and I can tell you it is hard to keep hope alive. Your attitude will help me.

Take Care, Alice

Alice M. Mahmood

[SCI-Nurse]

Deb, while some people think that this type of shooting pain may indicate some recovery, it is not necessary to just endure the pain while waiting for some return to occur. This type of neuropathic pain is common following SCI, and may be helped with the use of tricyclic antidepressants (such as Tofranil or Elavil), antiseizure drugs (such as Tegretol or Neurontin) and some cardiac drugs such as Clonidine or Mexilitine.

It is important to work with a physician who is expert in the treatment of neuropathic pain, as this is different than the treatment for malignant pain such as for people with cancer. Currently Neurontin is the most used drug as it has a wide dosing range and is a relatively safe drug. (KLD)