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Thread: Thoracic Injury- Need Help!

  1. #1

    Question Thoracic Injury- Need Help!

    Hello All, I am new here. I had a Thoracic injury several years back. Due to the severity of the injury they referred me to the local University as no Ortho doctor would touch it. This was after 80+ rounds of PT, seeing multiple Ortho Docs, etc.
    My question is this: I have developed severe pain in both of my legs, more in my right than left. I take 50mg Kadian twice daily, Tramadol 4-6 times a day for BT, Naproxan, etc. I have had weakness in both legs but that weakness has now turned into pain, very severe at times. Of course, I also have the severe Mid to lower back pain that radiates into my ribs. I have grown to deal with that. Surgeon has wanted me in the OR for the last 2 years but due to the complications, I am holding off as long as possible. The Pain Mgmt. doctor says he has a problem correlating the pain in my legs to my Thoracic Spine. He said if it was a Lumbar injury he could see it. Does anyone have any thoughts on this?
    Here are my last MRI Results: (The worse of it is at the end)
    T1-T2: Small right paracentral disc protrusion is noted with mild sac narrowing.
    T3-T4: Small right paracentral disc protrusion is noted with mild sac compression.
    T4-T5: Left paracentral disc protrusion is noted with mild sac compression.
    T5-T6: Small right paracentral disc protrusion is noted with mild flattening of the ventral cord.
    T6-T7: Right paracentral disc protrusion is noted with superior migration causing mild flattening of the ventral cord.
    T7-T8: Broad disc osteophyte complex is noted with mild flattening of the cord.
    T9-T10: Left paracentral disc buldge is noted with mild sac compression.
    T10-T-11: Moderate Canal Stenosis is noted secondary to disc oteophtye complex and hypertrophled facet joint. Mild cord compression is noted. Bilateral foramina are unremarkable.
    T11-T12: Left Paracentral and left foraminal disc oteophyte complex is noted with severe canal stenosis and cord compression. Bilateral facet arthropathy is noted. Severe foraminal narrowing is noted on the left and moderate on the right.
    Questionable increased T2 signal is noted within the cord at the level of T11-T12.
    Pre- and paravertebral soft tissues are unremarkable.
    Impression: Degenerative changes of the Thoracic Spine, the most significant level is at T11-T12 where there is severe canal stenosis/cord compression and severe foraminal narrowing. Suggestion of subtle increased T2 signal within the cord at this level.

  2. #2
    What is the surgeon recommending? Does he think you have myelopathy from central cord compression? Have you had an EMG/Nerve conduction studies?

  3. #3
    That actually reads like a very good MRI interpretation. Certainly enough to get the attention of your neurosurgeon, who will look it over carefully after all that it contains. I cannot comment on whether surgery is in the picture, but given the multiple areas, I would certainly get the very best doctor you can. There is an artery (artery of Adamowicz) which supplies cord from one side that can be damaged in thoracic spinal surgery, so it can be tricky. I don't know what institution you are seeing, but I would get the very best I could, even if it means travel. I had SSEP tests to see how my cord was doing, and I think it is one of the more sensitive tests. With these kinds of films, you should not rely on random posting here, especially from me. It will take an expert. Sorry you had this injury.

  4. #4

    Smile Answers- Sorry for the delay!

    Thank you for your responses. Sometimes you kind of feel like you are out here alone and that nobody really gets it.
    I reviewed my doctors report and he states: "His Myelopathy again stems from T10-T11, T11-T12 disk herniations and ligmentum hypertrophy". The Pain Mgmt. doc is recommending a EMG (Electromyogram) and a NCS (Nerve Conduction Study). Any thoughts on this? I'm sure how these test are going to help.
    Regarding where I am going, the only place that would take on my case was the University of Miami. The doctor seems very confident, almost to confident. I told him I am concerned about his confidence after being turned down by numerous others but he said this is his area of Expertise and they have a complete Spinal Center that specializes in the Spine. My concern of course is either waking up a Paraplegic or not waking up at all. Right now I am walking and getting around so I am holding off. The surgeon is not real happy on me waiting as he says "it" could happen at any given moment and then there may not be as many options as there are now. Sorry to get off track.
    Leg Pain- Has anyone else with thoracic expierenced severe leg pain in both legs from their injuries?
    Thank you again for your replies.

  5. #5
    Senior Member marycsm77's Avatar
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    Quote Originally Posted by Thoracic2011 View Post
    Thank you for your responses. Sometimes you kind of feel like you are out here alone and that nobody really gets it.
    I reviewed my doctors report and he states: "His Myelopathy again stems from T10-T11, T11-T12 disk herniations and ligmentum hypertrophy". The Pain Mgmt. doc is recommending a EMG (Electromyogram) and a NCS (Nerve Conduction Study). Any thoughts on this? I'm sure how these test are going to help.
    Regarding where I am going, the only place that would take on my case was the University of Miami. The doctor seems very confident, almost to confident. I told him I am concerned about his confidence after being turned down by numerous others but he said this is his area of Expertise and they have a complete Spinal Center that specializes in the Spine. My concern of course is either waking up a Paraplegic or not waking up at all. Right now I am walking and getting around so I am holding off. The surgeon is not real happy on me waiting as he says "it" could happen at any given moment and then there may not be as many options as there are now. Sorry to get off track.
    Leg Pain- Has anyone else with thoracic expierenced severe leg pain in both legs from their injuries?
    Thank you again for your replies.
    I had cervical myelopathy/severe compression of my cervical cord from spondylosis. One day i was walking fine and one day i couldn't hold myself up, so um yeah, at least take what the surgeon says seriously because it is true. It continued to wax and wane but my gait was never normal thereafter. I had my decompression surgery 19 months ago, have had significant return but i still have a little bit of a limp, legs still fatigue abnormally, cant run, some residual partial foot drop and some other problems. I consider myself quite fortunate obviously that i didn't end up in a much worse situation which i feel in retrospect was a matter of when, not if. My neurosurgeon felt it needed to be done asap and he is not a gratuitous cutter, he is conservative. Not trying to scare you, just my experience. I realize the thoracic area is scary. Good luck to you.

    I also have a T7/8 herniation that is pressing on my thecal sac,(causes me radiating pain in that area) that originally was reported to be compressing my cord but was a radiologist error and they were talking surgery for this as well. So that scared the crap out of me. I can understand you wanting to hold out but I hope you weigh your options carefully.

    Maybe this thread should be in new injury area so as Dr. Young or SCI nurse might comment.
    Last edited by marycsm77; 09-23-2011 at 08:53 PM.

  6. #6

    Smile Wow!

    Thank you for sharing. To have Cervical Myelopathy and have it effect your walking just confirms what I am trying to convey to my Pain Mgmt. Doctor. I also appreciate the warning you give. I know there are risk with waiting. It looks like by your picture you had youth on your side. That's a good thing but very scary for you none the less. I congratulate you on making that decision. When my injury occurred I was 340+ lbs. I have since lost a little over 100+ lbs "just in case". I am probably kidding myself with the just in case but it works for me! I have a feeling the leg pain is becuase the cord has become more compressed. I am probably going to move forward with the testing the doc wants to do and see what comes out that.
    Thank you again to all for sharing. It truly helps to hear everyones story. It helps me to put the pieces together in my story.

  7. #7
    Senior Member marycsm77's Avatar
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    Quote Originally Posted by Thoracic2011 View Post
    Thank you for sharing. To have Cervical Myelopathy and have it effect your walking just confirms what I am trying to convey to my Pain Mgmt. Doctor. I also appreciate the warning you give. I know there are risk with waiting. It looks like by your picture you had youth on your side. That's a good thing but very scary for you none the less. I congratulate you on making that decision. When my injury occurred I was 340+ lbs. I have since lost a little over 100+ lbs "just in case". I am probably kidding myself with the just in case but it works for me! I have a feeling the leg pain is becuase the cord has become more compressed. I am probably going to move forward with the testing the doc wants to do and see what comes out that.
    Thank you again to all for sharing. It truly helps to hear everyones story. It helps me to put the pieces together in my story.
    just to add thoracic, I did not have pain in my legs. I was losing motor function in my lower extremities. I mean i had spasms in my calves and right leg but not pain. The only pain i had walking with an altered gait stemmed from imbalance, therefore my hip would hurt and so forth, not pain in my legs, like you speak of. Of course i had excruciating nerve pain in my neck and arms along with numbness and some other things.

    Anyway, good luck again.

  8. #8
    thoracic - the EMG/NCS (nerve conduction study) is diagnostic - it won't help you as in make you better, it is a test to better characterize the current injury of the nerves that are coming out of your spine through these foramina or openings that are getting pinched. It will help the surgeon know where the problem areas are. Since the nerves of the legs run through the the the area that is getting pinched or squeezed, it is reasonable that your leg pain is attributable to your impairment in your T spine. I don't see how you couldn't be afraid of the surgery that is ahead of you but you have find someone you trust and make a decision about doing it. I wouldn't be put off from a confident spine surgery at U Miami. You want someone who is confident and can assure you that he does cases of equal or greater difficulty than yours. I was a giant train wreck and a complicated case and found a surgeon at UCSF who was supremely confident and I asked him if my case was particularly complicated. He assured me, that although it was a complicated case, that he does cases of this complexity and greater all the time. I decided to trust him and he did not let me down. He preserved my limited motor function and I am eternally grateful for his expertise. It sounds like this U Miami surgeon may be similar..

    I also would do everything in my power to continue to lose weight which will make recovery easier as you regain mobility.

    I wish you luck...

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