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Thread: Ten frequently asked questions concerning cure of spinal cord injury

  1. #91
    dbassman,

    26 years is a long time. Syrinx is just medical slang for syringomyelia. They mean the same thing. In both cases, they refer to an enlargement of the central canal. The current theory that is most commonly accepted today (and one that I think is the best expalnation of the data) is that syringomyelia results from obstruction of cerebrospinal fluid flow at the injury site. Normally, a litter or more of cerebrospinal fluid passes down the spinal cord every day, mostly in the subarchnoid space that surrounds the spinal cord. The arachnoid is the membrane that covers the spinal cord and is responsible not only for holding but also absorbing the cerebrospinal fluid that passes down the spinal cord. Injury often causes adhesions between the spinal cord and arachnoid. Adhesions may obstruct cerebrospinal fluid and divert some of the flow into the central canal that runs in the middle of the spinal cord. The increased flow enlarges the central canal. In some people, the enlarged syringomyelic cavity may compress the spinal cord above and below the injury site.

    Diagnosis of syringomyelia requires an MRI, or a CT-myelogram. An MRI can detect a syringomyelic cyst as a high-signal longitudinal cyst in the spinal cord. A plain CT scan typically will not show a syringomyelic cyst because x-rays cannot distinguish between fluid and tissue. However, a CT-myelogram should show a syringomyelic cyst if the dye gets into the cyst. I would trust your SCI doctor's opinion concerning the diagnosis of the syringomyelic rather than a technician's opinion. Your SCI specialist is a surgeon and he is the one who wants to do the surgery? Is she a neurosurgeon? If not, who will the surgeon be? I am puzzled by the surgeon's opinion from Northwestern. Did he look at both the MRI's and CT-myelogram? Are you sure that he said that there was no syringomyelic cyst? Is that doctor an orthopedic surgeon? It seems that your SCI Doctor's was quite firm in her diagnosis.

    Now, there is disagreement amongst neurosurgeons whether surgery is necessary or advisable for asymptomatic syringomyelia. Most will not operate if there is no evidence of progressive neurological loss. You describe symptoms that may be consistent with the presence of a cyst but I cannot put together the complex AD and sweating picture that you describe. AD and sweating changes alone are not themselves necessarily due to syringomyelia. However, the fact that you are having intermittent worsening of urinary function is worrisome and would be sufficient reason to operate. Also, it is possible that decompression fo the cyst may restore other functions. Finally, I don't know of many cases where the syringomyelic cyst and neurological loss resolves without surgery.

    Wise.

  2. #92
    Dr. Young when do you think second generation therapies will be available in China?

  3. #93
    Senior Member dbassman's Avatar
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    Dr. Young,

    Thanks for your advice. Yes, 26 years is a long time, fortunately, I've been in good health most of the time and have had a great family to keep me that way. I'm new to the forums, so if these aren't the appropriate types of questions for here, or if they should be asked elsewhere, please let me know.

    In answer to your questions: My SCI specialist is Dr. Lisa-Ann Wuermser Board Certification: Physical Rehabilitation Medicine, Spinal Cord Injury Medicine. She advised me to see a Neurosurgeon, Dr. Aruna Ganju, Specialty: Neurological Surgery; Area of Interest: Cervical Spine Disorders, Complex Spine Surgery, Spinal Deformity and Spinal Fusion.

    When I saw Dr. Ganju (I'm 99% sure) she mentioned she didn't see a Syrinx and she had all the films Dr. Wuermser had. She did however think I should have the surgery to correct the tethering & remove the wire & if necessary replace it with titanium rods. She explained the surgery, how she would grind away the back of the vertebra open the spinal cord, correct the problem and then seal it with lining from a cow's stomach. I asked where she would take bone to replace the vertebra she ground away and she replied she would just leave it open, that there is enough muscle to hold it in place. Is this common practice these days? When I had my surgery in '78 they took bone from my hip and fused it in my neck.

    Would you please try to explain the tethering to me and how it is harmful? Also please look at the following email question and answer between myself and Dr. Wuermser and give your opinion as your last response seemed to differ. It's not that I don't have faith in her, rather just trying to get a second opinion from a knowledgeable SCI specialist.

    Q: "Dr. Ganju mentioned she didn't think my "sweating/not urinating" problems were related to a Syrinx & also that she doubted if I would regain any lost strength in my right arm. In your last email you said the "foreign object" is wire stabilization, and the wires are in exactly the correct place. Given these statements, why would I have the surgery? What WOULD it correct or help?"

    A: "To be quite blunt, Dr. Ganju is wrong (with all due respect Aruna). The not urinating is part of the increase in your spasticity and is directly related. The sweating is a common (albeit not discussed much in the textbooks) sign of dysautonomia, which is like low level dysreflexia. This is a big early symptom of syrinx. It is possible that you might regain strength in your arm. It is also possible that you won't. It is quite likely that over time you will continue to lose strength, so we want to be sure to prevent that. She has not seen much strength recovery in all the cases she has been doing, but most of these folks have had symptoms for years, and just not properly diagnosed or treated. In your case, I have no idea about recovery. I am convinced that the sweating will resolve and the spasticity will improve, which includes your bladder."

    Thanks again in advance!

    Yard by Yard, Life is Hard---
    Inch by Inch, It's a Cinch!

  4. #94
    I feel better after re-reading this post
    all the time!

    Dr. Young,

    You will keep updating the time
    frames for better or for worse yes?

    Joe

  5. #95
    dbassman,

    I want to first say that internet medical advice is not a good idea even though you are very clear and remarkably detailed in your account. The reason is of course that I or anybody in my place do not have direct eyeball experience and ability to examine. I cannot comment on whether there is a syrinx, tethering, or other problems. However, I can try to answer your questions from the viewpoint of my experience.

    In general, I agree with Dr. Wuermser in her belief that increased sweating, spasticity, and bladder spasticity may be due to tethering and syringomyelia. I don't think that Dr. Ganju was necessarily contradicting Dr. Wuermser but was just expressing a more cautious view that the surgery may not resolve the sweating, improve the lost strength in your arm, or improve your spasticity. On the other hand, she is willing to do the surgery, suggesting that she does think that you have tethering that is sufficiently severe to warrant surgery. This is because the surgery may prevent further damage to your spinal cord.

    A laminectomy means to remove the bone from the back. This generally does not destabilize the spinal column and most neurosurgeons do not replace the bone that they remove from a laminectomy. Some surgeons (like Dr. Huang in Beijing) uses a micro-saw and removes the bone and then replaces it but this is usually only desirable if the laminectomy involves multiple segments. This is a matter of surgical judgment and I don't think that it is harmful to not put bone in the place of the laminectomy.

    The surgery that you had in 1978 probably involve the front of your spine. They probably removed a disc, part of the vertebral segments above and below the disc, and replaced the removed bone with a bony plug from your hip. This is called a Cloward procedure and is standard practice for fusing the two vertebral bodies from the front. This is only carried out in the front of the spine and not the back.

    Tethering occurs when scar tissue forms between the spinal cord (the its roots) with the arachnoid (the membrane that covers the spinal cord) and the dura (the membrane that is just outside the arachnoid). Normally, your spinal cord can slide in the canal in response to movement of your spine. When there is scarring, the spinal cord or its roots may be tethered, i.e. held so that they cannot slip and slide. This results on pulling on your spinal roots and cord when you move. These movements causes wear and tear on your spinal cord and may cause damage. Untethering of the spinal cord sometimes restores function, reduces pain, and prevents the formation of syrinxes.

    Wise.

  6. #96
    Dr. Young,

    Would an MRI show need for untethering?

    Joe

  7. #97
    That is an interesting, and cautiously optimisitic thread. I can really hope we (or rather you, the scientific community) are well on the way to those goals. One question I have is this: What is the difference between "chronic" and non-chronic SCI? Also, how much of an influence is federal law going to hinder/help the progression of these "cures" that are being developed?

    Sorry if these are a repeat of anything recent. This is my first post here. I'm a T-8, post 1.8 years, complete.

  8. #98
    Senior Member Leo's Avatar
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    Hi donut, Welcome to CC and the Cure Forum, first i know very little but i'm studying, as i understand it after a couple weeks of being injured your considered cronic.

    i won't go into federal law, however increased federal funding is the ticket to sooner rather than later.

    "All you have to decide is what to do with the time that is given you."
    Gandolf the Gray

  9. #99
    Senior Member Zemuron's Avatar
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    "People should avoid procedures that cause irreversible loss of peripheral nerve and other functions"

    Soon I'm going in surgery. It's called sacral nerve stimulator.

    Should I go for a different surgery?

  10. #100
    Originally posted by donut:

    That is an interesting, and cautiously optimisitic thread. I can really hope we (or rather you, the scientific community) are well on the way to those goals. One question I have is this: What is the difference between "chronic" and non-chronic SCI? Also, how much of an influence is federal law going to hinder/help the progression of these "cures" that are being developed?

    Sorry if these are a repeat of anything recent. This is my first post here. I'm a T-8, post 1.8 years, complete.
    donut, "chronic spinal cord injury" is usually used to refer to the phase after injury when recovery has reached a plateau. Unfortunately, this is not a good definition because many people with spinal cord injury continues to get some function back years after injury. It is often used in contrast to "acute spinal cord injury" which refers to the early phase after injury during which there may be continuing injury and before the recovery phase. Some people used the term "subacute spinal cord injury" to refer to the phase between acute and chronic but "subacute" usually refers an earlier period during the first days and weeks after injury.

    So, these definitions are quite vague in terms of timing because the timing of each phase depends on injury severity and level. In practice, most clinicians consider the period that is more than one year after injury as "chronic". Acute spinal cord injury generally refers to the first 24 hours after injury. Subacute usually refers to the week or two after injury.

    Personally, I use "acute spinal cord injury" to refer to the first 8 hours after injury and "subacute spinal cord injury" to refer to the first few days after injury. After that, I prefer to use the term "recovery phase" until recovery is no longer occurring. The chronic phase differs from person to person. If the injury is severe, the chronic phase may start earlier at 6-12 months. In a person with a less severe injury, the recovery phase may last years.

    Wise.

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