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Thread: Spinal Cord Injury Site "Scar Tissue"

  1. #41
    Senior Member alan's Avatar
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    I can't convince neurosurgeons that I've got tethering going on. They look at my MRIs, and say that they see no tethering and no change in the scans (I took along several scans from various years, but from the same radiology provider.) I got the same response in the 1980s and 1990s when I was able to ride to Hopkins, University of Maryland Hospital, and some DC hospital - they saw no syrinx, and had no explanation for deterioration and worsening pain intensity.

    The most recent is Dr. George Jallo at Hopkins. I had a friend drop off MRIs from four different years at his office, and have been conversing with him via email. He sees nothing that can be helped by surgery.
    Alan

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  2. #42
    Looks bleak, are there any projections for when funding and resources will begin to increase?

    I know with what's happening in Government recently, that it looks as though it"s going to get worse before it gets better.

    Simon.

  3. #43
    Senior Member alan's Avatar
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    What happened to the knife-happy surgeons of yore?
    Alan

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  4. #44
    Senior Member alan's Avatar
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    According to Dr. Donlin Long, former head of neurosurgery at Hopkins, I have ongoing scar formation between C-4 and C-6, between two small, stable syrinxes.
    Alan

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  5. #45
    Quote Originally Posted by alan View Post
    According to Dr. Donlin Long, former head of neurosurgery at Hopkins, I have ongoing scar formation between C-4 and C-6, between two small, stable syrinxes.
    By the way, in the context of this topic, I emphasize that I do not claim that fibrous scars cannot form in the spinal cord. In fact, they do form when investigators cut into the spinal cord to produce spinal cord injury. Especially when they do not repair the dura and this allows fibroblasts from surrounding tissues to invade into the spinal cord, a glial-fibroblast scar does from. Such scars do prevent axonal growth.

    I am saying that such scars do not usually occur when there has been no penetrating wound that allows fibroblasts to invade into the injury site. In a majority of contusion injuries, the dura remains intact and the spinal cord injury has just been briefly indented. In such situations, while glia will proliferate at the injury (as they should, in order to repair the blood brain barrier), no fibrous "scar" develops.

    I am not sure that I understand what Dr. Donglin Long is referring to when he says that you have "ongoing scar formation between C4 and C6, between two small and stable syrinxes." Usually, MRI's reflect the concentration of water in tissues. Greater MRI signal intensity usually suggests cell loss and associated increase in tissue water. This may or may not imply "scar". MRI of collagenous scar usually show reduced water content and hence less MRI signal intensity. Do you see enhanced or reduced MRI signal in the space between the two syrinxes?

    Finally, what does Dr. Long proposed to do? The past year of experience with seeing chronically injured spinal cords in the operating room and being able to compare them with MRI images have convinced me that MRI's, even the best 3T images, don't tell you much about the spinal cord. For example, we encountered a case where the dorsal surface of the spinal cord was virtually covered with veins, the spinal cord was tethered, the cord itself was twisted nearly 45˚, and none of this was apparent on the MRI before surgery.

    Wise.
    Last edited by Wise Young; 12-13-2011 at 12:34 PM.

  6. #46
    Senior Member alan's Avatar
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    Dr. Young,

    I e-mailed you a copy of Dr. Long's report. It's a pdf file. I wanted to copy the diagnosis part to this thread, but I couldn't figure out how to do that. He didn't get the history right, so I sent him corrections which he added to my file. I also sent him e-mails regarding what you've said re MRI scans not always showing everything about the cord, and that you didn't think the deterioration of my condition I describe is normal aging with SCI. His plan was to try Cymbalta again (I did - still couldn't handle side effects), and increase Lyrica again (I'm working on that, more for seizure prevention than pain relief. I hadn't used it for seizure prevention before, as my seizures started in 2009.) He mentioned deep brain stimulation, but didn't recommend it (I'm against it, anyway.) He thinks there is subarachnoid scarring which slowly occurred (is still occurring, he told me), and the possibility of tethering, but not enough evidence to warrant un-tethering (he told me that even if tethering was there, and surgery was done, it was very risky, it was unlikely to provide any pain relief, might not stop the upward progression of my sensation loss and pains, and that the scarring problem would likely repeat.) He doesn't see evidence of slowly progressive cord deficits (even though he said there has been change in the damaged area over the years. My guess is there was so little change from year to year that annual MRIs didn't show it, thus the "no significant change" reports every year, but scans from years apart did show much change .)

    He is sending his report to Dr. George Jallo at Hopkins, the doctor who referred me to Dr. Long after he didn't see anything he deemed fixable in my MRIs.
    Last edited by alan; 12-16-2011 at 02:59 PM.
    Alan

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  7. #47
    Senior Member alan's Avatar
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    Dr. Jallo also recommends against surgery.
    Alan

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  8. #48
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    Question for Dr. Wise

    Not sure if I'm posting right since it's my first. I had decompression laminectomy with anterior discectomy/fusion at C 5-6 and C 6-7 about 10 months ago. I have a small area of signal change/myelomalacia in the center of my posterior cord at C5. Could this cause numbness in my toes and/or neuropathic pain in my arms/hands (it particularly affects my index fingers)? My neurologist cannot explain these things. Many blood tests were normal. Repeat MRI shows moderate stenosis at the two levels above the surgery now.

  9. #49
    Senior Member alan's Avatar
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    Quote Originally Posted by kevrthom View Post
    Not sure if I'm posting right since it's my first. I had decompression laminectomy with anterior discectomy/fusion at C 5-6 and C 6-7 about 10 months ago. I have a small area of signal change/myelomalacia in the center of my posterior cord at C5. Could this cause numbness in my toes and/or neuropathic pain in my arms/hands (it particularly affects my index fingers)? My neurologist cannot explain these things. Many blood tests were normal. Repeat MRI shows moderate stenosis at the two levels above the surgery now.
    The Care forum is probably better.
    Alan

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  10. #50
    I have only read the bottom posts on this so please forgive me for not understanding it all. My understanding about removing scar tissue is that if you remove it that it just grows back worse then if it is left alone. I know their is deferent areas of scar tissue but read some things that help me or confuse me about this issue. The only things I have found to define it is ADHISIVE ARACHNOIDITIS or RSD it gets confusing for me but it makes sense that if you have scar tissue and try to remove it that it will only become worse.

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