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Thread: Dr. Young... Can you explain?

  1. #1

    Dr. Young... Can you explain?

    I just received my son's surgical records and read the following, would you please translate? And in your opinion, would this hinder his recovery?
    Thank you in advance.

    "A fragment from the posterior superior aspect of the T12 vertebral body remains retropulsed, approximately 7mm into the spinal canal. There is a small fragment from the posterior inferior aspect of T11, and a fragment adjacent to the anterior aspect of T12, presumably from the anterior/superior aspect"
    FAITH: Is not believing God can, but knowing he will.

  2. #2
    Quote Originally Posted by Faithful1990 View Post
    I just received my son's surgical records and read the following, would you please translate? And in your opinion, would this hinder his recovery?
    Thank you in advance.

    "A fragment from the posterior superior aspect of the T12 vertebral body remains retropulsed, approximately 7mm into the spinal canal. There is a small fragment from the posterior inferior aspect of T11, and a fragment adjacent to the anterior aspect of T12, presumably from the anterior/superior aspect"
    Faithful,

    According to this report, there is a bone fragment in the spinal canal at T12. It protrudes 7 mm into the spinal canal, unquestionably pressing on the spinal cord. There is a small fragment at T11 and another fragment in front of T12 but both of these are probably not significant because one is small and the other is outside of the spinal canal. In my opinion, the T12 fragment that is protruding into the spinal cord should be removed. I know that some neurosurgeons would disagree with me and say that removing it will do nothing. I agree that removing it would do little but not removing means that nothing would happen. The question is whether or not the benefits of removing this bone fragment warrant the risk of surgery.

    Wise.

  3. #3

    Wink Dr. Young....

    Thank you so much for your rapid response. We were told immediately after surgery that they weren't able to get all the bone fragment and that a second surgery "might" be needed. He explained that he "might" need to go throught the front to install a bird cage and at that time he could remove the fragments. We were also told that his spinal cord had not been compromised....And, after 3 follow ups and CT's he always stated the fragments were not an issue. And this surgeon is the "chief" at UT Houston.

    This is so frustrating...I feel as though the spinal cord surgeons that do these surgeries are TOTALLY disconnected to the "real" SCI community and current science. They also told us he was "incomplete" b/c he could move his legs, only to find out through my research here that he's complete. Ugh...

    He was able to move his legs in the ER and feel his knees... they waited 2 days to do his surgery and even post op, he could still feel his and move his knees slightly.

    He's 19 years old and 16 months post, T12 Complete, but has regained light sensation yet strong movement in his hip flexors. He has ab deducotors. Can swing his feet from the side of the bed and pick his foot up from the floor to his chair foot plate. And, he can walk with HKAFO's/walker.

    Do you have any recommendations as to where we could go? Craig? Kennedy Kreiger? Are there any studies that I could use to pursuade someone to remove these? Any suggestions would be greatly appreciated.
    Thank you again for all you do!
    FAITH: Is not believing God can, but knowing he will.

  4. #4
    he is actually incomplete. any movement in the legs means that. plz read more thoroughly.

  5. #5
    Thanks Lakboy, but from my readings, incomplete would mean he would have voluntary contration of the anus and/or feel the pin prick to the anus. Which he has neither.
    FAITH: Is not believing God can, but knowing he will.

  6. #6
    Faithful, let me explain.

    In 1991, I co-chaired a committee with the American Spinal Injury Association (ASIA) that set some of the current definition of "complete" and "incomplete". Complete means that there is some level of the spinal cord below which there is no conscious sensation and no voluntary movement. Since S4/5 is the lowest segment of the spinal cord, we defined complete spinal cord injury (ASIA A) as complete loss of sensation in the S4/5 dermatome to pin prick and touch. This is the skin surrounding the anus. The anal sphincter is innervated by S4/5 and therefore we included voluntary sphincter contraction. Note that the normal reflex state of the anal sphincter is closed but one can vountarily contract the sphincter. Once the definition of complete is set, the definition of incomplete followed as somebody who had either sacral sensation or sacral sphincter function, otherwise called sacral sparing.

    The reason why we used this definition of complete and incomplete was because many people had an injury level, a zone of partial preservation, and a segment below which they had no motor or sensory function. For example, a person may have a C4 injury level with intact C3 and partially preserved C4, C5, and C6 but nothing at C7 or below. Such a person would have an neurological level of C3. The presence of C4, C5, and C6 does not mean that the person is "incomplete". This definition has been extensively tested over the past 20 years. When properly examined, a person who is an ASIA A during the first week after injury has significantly less probability of walking than a person who is ASIA B, C, or D. Please note that this classification system was designed to be applied to a person during the first days after injury, to classify the severity of injury. In the case of your son, he is ASIA A if he has no sphincter control and no peri-anal sensation.

    I prefer the ASIA classification approach because it reflects the neurological examination and not some abstract image of whether the spinal cord injury is "complete" or "incomplete". I believe that the words "complete" and "incomplete" are misleading and inappropriate. Most people who are "complete" do not have transections of their spinal cords and still have axons passing through the injury site. Many people with incomplete spinal cord injuries do not recover and still severe deficits. Despite it all, clinicians and patients continue to use the words "complete" and "incomplete". Between 5-15% of patients with ASIA A classification will recover walking. Between 30-35% of patients with ASIA B classification will recover walking. Over 90% of patients with ASIA C classification should regain walking and all those with ASIA D should be able to walk. These statistics alone give lie to the words "complete" and "incomplete".

    Let me describe the anatomy of the spinal cord around T12. The lumbar cord is located at T11-12. The sacral spinal cord is located at L1 (just below T12). The spinal cord ends just below L1. The tip of the spinal cord is called the conus and contains S4/5. Only spinal roots are below L1, called the cauda equina. An injury to T12 is very likely to have damaged the lumbar cord directly. The lumbar cord contains most of the circuitry for the legs. The sacral cord contains most of the circuitry from the pelvic organs, bladder, and bowel, as well as the ankles. I attach a copy of the standard ASIA classification sheet for your perusal.

    Whether or not your son is able to walk depends on the damage to his lumbar cord. Sometimes it is difficult to tell how much damage there is because of muscle atrophy from non-use. If he has his hip flexors (L2) and knee extensors (L3), your son should be able to walk, even if he is ASIA A. But, I am concerned that there is continued bony pressure on his spinal cord at T12. Relieving that pressure may restore some function and his walking would be so much better if he regained some sensation. Even more important, it may restore some bladder and bowel function. That is why I am saying that it should be decompressed.

    Regarding where to go, where are you in Texas? We are working closely to Brackendridge Hospital in Austin. I recommend that you see Charlotte Smith and she can refer you to the best neurosurgeons in Austin.

    Wise.
    Last edited by Wise Young; 03-31-2010 at 07:46 AM. Reason: added words in red.

  7. #7
    sorry then I stand corrected .

  8. #8
    Quote Originally Posted by lakboy View Post
    sorry then I stand corrected .
    Lakboy, many doctors make that mistake also. Wise.

  9. #9
    Thanx a lot Dr. Young, though it makes me think that I would rather be ASIA -A than be ASIA - B if I could walk , even with support. Defeats the very purpose of the classification, don't you think.

  10. #10

    Dr. Young.... We are near Houston

    However, I am very familiar with Brackenridge. I drove down last March to hear your SCI presentation. As a result, I chose to take our son to the Spine Rehab Center there for his round 2 of Acute therapy instead of returning toTIRR, Houston. We drove 3 hours 3 days/week during the summer. They were great, they actually got him to crawl foward and backward. We didn't see any doctors there though, I will give your recommendation a call as it would be great to find someone in-state. Thank you again for all you do and your quick responses.
    FAITH: Is not believing God can, but knowing he will.

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