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Thread: Would a delay of surgery affect my outcome?

  1. #1
    Junior Member Firefly_Aviator's Avatar
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    Would a delay of surgery affect my outcome?

    I wasn't sure which topic to post this in, but since my injury is still sort of new, decided to post here. I'm a L-1 burst fracture and my neuro said it was a conus injury. I'm walking with some extra effort, heels and back of upper legs are numb, , and I have the bowel and bladder issue. I've read on another site, that surgery for traumatic injuries to cauda equina should occur within 24 hours. My surgery didn't happen for 11 days (sick surgeon and the other was out of town). I'm a paramedic and if I had known I was in bad shape, I would have gone the extra 5 minutes to a level 1 trauma center. At the time I just wanted to quit moving around so much because of the pain. So did waiting so long to have the surgery worsen my condition? I also asked the neuro recently if I had been given the steroid, and he said he didn't know. Thanks for any feedback I get!
    L-1 Burst fx 8.11.2010
    Can walk with effort short distances
    bowel and bladder blues

  2. #2
    Early decompression is important for any injury to the cord where compression is a factor. There can be benefits for later decompression if early was not done, but preferrable is to get the pressure off right away.

    Regardless, at this point worrying and ruminating about this, though, is not very productive. What is important at this point is to maximize your recovery and get back to a life. I will ask Dr. Young to comment on this as well.

    (KLD)

  3. #3
    Senior Member WarrenJ's Avatar
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    In my experience ASAP..I had pressure on cord as well but still functioning..get er done
    Appreciate the small gains and the large ones will be ignored!!

  4. #4
    What surgery did you have on the 11th day. Did they put rods in your back?
    L1 Complete - Injury 3/12/06 - Grateful to be alive!!!!

  5. #5
    Did you have an accident in an airplane? Just wondering since you list flying as and interest and your profile name leads me to believe you were flying a Kolb Firefly or Firestar. Just guessing and wondering. I an an L1 complete injury due to accident in a Talon XP Experimental. Wheelchair dependent. No walking at all. You are a very lucky man to be walking. Get in rehab somewhere that KNOWS SCI!!!! Most local Spine PT rehab places are woefully inadequate when it comes to rehabbing SCI. Be grateful for what you have an don't worry about the "if only's" and "what ifs" of what happened after your accident. Move forward from here. Good luck. Ask any questions you might have.
    L1 Complete - Injury 3/12/06 - Grateful to be alive!!!!

  6. #6
    i agree with the nurse, i didnt have surgery until 4 or 5 days in the hospital.
    lucky for me the neuro stopped in sat nite at midnight to talk to me and tell me it would be monday morning surgery , with a fusion , but he knew nothing about my history, but i met him when he removed a cauda equina tumor in a 8 hr microsurgery on my best friend, and i knew he was very good.
    once i told him i already had a full laminectomy 5 years ago in the same area, and had permanent damage and weakness in my same leg from it, he decided to He decided to do the surgery that night in a hour , no hardware, since he said he felt it was better to get me closed and off the table. Hopefully i would come out better than hardware and wc + more problems
    i did speak to 3 lawyers that specialized in it though . have to do that in a short time frame or its lost.i had closure and as the nurse said , time to move on.
    sometimes you just drive yourself crazy, i think it is called the "what if", "if i had"
    mind game that just makes you worse. Many here have been there.
    good luck and check with legal counsel that specializes in this, to get closure.
    cauda equina

  7. #7
    My son in an L1 burst fracture with much less mobility than you. He had surgery the day after the accident. No steroids were administered. That really ticked me off at first. I needed something to be ticked off at. Five years post, however, we've learned to look forward not backwards and not fret about the past. Seriously, unless you are considering legal action because of the delay - let it go.

    It sounds like you have had a good recovery so far and it's still early ... work hard, do your stretches and exercises, pt, etc and get the best possible recovery you can.

    Best wishes.
    Ugh, I've been kissed by a dog!
    Get some hot water, get some iodine ...
    -- Lucy VanPelt

  8. #8
    Quote Originally Posted by Firefly_Aviator View Post
    I wasn't sure which topic to post this in, but since my injury is still sort of new, decided to post here. I'm a L-1 burst fracture and my neuro said it was a conus injury. I'm walking with some extra effort, heels and back of upper legs are numb, , and I have the bowel and bladder issue. I've read on another site, that surgery for traumatic injuries to cauda equina should occur within 24 hours. My surgery didn't happen for 11 days (sick surgeon and the other was out of town). I'm a paramedic and if I had known I was in bad shape, I would have gone the extra 5 minutes to a level 1 trauma center. At the time I just wanted to quit moving around so much because of the pain. So did waiting so long to have the surgery worsen my condition? I also asked the neuro recently if I had been given the steroid, and he said he didn't know. Thanks for any feedback I get!
    It is unusual for surgery to be delayed 11 days. There use to be two camps of opinions concerning the speed of decompression. About 50% of neurosurgeons and orthopedic surgeons believe that the spinal cord should be decompressed as soon as possible, within 24 hours for example. There are some who think that it is okay to wait 2-3 days. Today, more surgeons decompress early.

    Hank Bohlman at Cleveland Clinic showed that decompression surgery may help even when carried as late as several weeks to 3 months after injury but that doesn't answer the question whether really early decompression is better than delayed decompression. In the 1980's, I tried to get NIH to fund a clinical trial to look at this problem and was turned down repeatedly.

    The problem today is that surgeons who believe in early decompression are not willing to randomize people to late decompression. Those who don't believe in early decompression usually don't do it. Therefore, it is very hard to do a clinical trial to test the hypothesis that early decompression is better than late decompression.

    Common sense would suggest that leaving something pressing on the spinal cord is not a good idea. On the other hand, the spinal cord is fairly malleable and can adjust to 50% compression, for example, without much damage. Compression causes ischemia (by increasing tissue pressure to reduce blood flow). So, it is not clear.

    You sound like you have an incomplete conus injury. Do you have anal sensation and tone?

    Wise.

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