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Thread: What Am I?!

  1. #1

    What Am I?!

    Hello!

    After long 4 month journey i Am back at home doing rehab, going to work soon and doing all the things i used to (almost). It started may 14 2012 with L1 burst fracture which left me with a paralysis b&b issues and sensory loss. Ive been reading a lot but still cant figure out what kind of injury i sustained. First i had feeling on top of my right thigh (tingling) and possibly some hip flexor movement. Which would leave me as ASIA C? My bladder and bowels were flaccid (everything falling out without me even knowing), no reflexes in my ankles and knees, no other movement. When i got discharged from hospital and started doing therapy things started to fall in place and still are (slowly) my hip flexion is really strong now, my hamstrings starting to work and my quadriceps on left leg started to flicker recently (yay!). Left leg is much stronger than left one. All muscles respond to tens unit really well except quads and dorsiflexors. When it comes to feeling i have feeling around my penis (normal) and on top of my right thigh that includes sensation, pain and temperature, also more feeling on sides of my right thigh, left one has feeling on top but not as good as right one. some sensory feeling by my ankle on left leg. Also i feel my right genital normal. Can get erection with touch but cant mantain. My sphincter has a tone and wont release anything until i use my finger. Constaipated quite a bit in the beggining now getting better. Bladder (penis?) has weird spasms sometimes like it wiggles. I thing ive covered all the fields. My question is does this put me into spinal cord injury, conus injury, cauda equina or all 3? Its hard to move on and accept what i have without even knowing what ive injured. I hope any of you guys, maybe Dr. Wise or some nurses can help me with figuring out this problem. On the mris ive been told its cauda equina. My doc told me its conus and cauda. And in the beggining i had sci. Please help me with understanding my injury!

  2. #2
    Super Moderator Sue Pendleton's Avatar
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    I would think you'd fit under incomplete flaccid paraplegia. Only you wrote that you had flaccid bowel and bladder in line 3 but that your sphincter was spastic in line 8. If you went from flaccid to spastic then I'd say just incomplete paraplegia. I'll be interested to hear what the professionals say too. Good luck on continueing return!
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  3. #3
    The AIS exam which is a complete hands on evaluations takes 40 minutes and each muscle group is tested. Can't give you motor and sensory levels without it- especially being L1.
    and you may have areas of partial preservation .ASk your rehab doctor and it should be repeated in 3-6 months anyway.
    Sorry
    CWO

  4. #4
    Well Im not asking for AIS was just wondering type of injury from what ive written.

  5. #5
    I may be wrong, but they are all spinal cord injuries. I dislocated my spine between T12 and L1 and have similiar symptoms. You may have some your terms confused which is making it hard for me to know what you are describing. But our symptoms sound similiar. If you are seeing return this early on it is a good sign. I am going on 10 months post and walk full time with crutches.

  6. #6

    • “Conus Medullaire” refers to injury of the conus or lower tip of the spinal
    cord. This damages the lower lumbar and sacral spinal cord segments.
    • “Cauda Equina Injury” refers to the condition when the damage is limited to the spinal roots below L1.

    CWO


  7. #7
    wesmaister,

    I think that your doctor's opinion, i.e. that you have had conus and cauda equina injury is likely to be the best explanation of your symptoms. You are still early after injury and should be recovering more function in the coming months. Let me describe the implications of each of your symptoms from a diagnostic point of view.

    • Sensory. While you describe your sensations on the top and sides of your thighs (R>L), as well as a patch of sensation on the left ankle, you don't say whether you have feeling in and around your anus or ability to contract your anal sphincter voluntarily. I assume that you have neither. If you don't have anal sensation (S4/5) or movement of your sphincter, you are an ASIA A. Since you have normal penile sensation (which is innervated by S2), right testicular sensation (S3), and sparing of function on your left ankle (S1), you have some sensory information coming from as low as S3. On the other hand, the fact that you don't have feeling in your lower thighs or legs (except for the spared patch in the ankles) suggest that you have had damage to L3-L5 spinal roots.

    • Motor. According to your description, you have strong hip flexors, weak quadriceps and hamstrings, and suggests that L2 is intact, L3 are partially intact, and muscles innervated from L4 down are absent. The observation that the quadriceps and dorsiflexors do not respond to surface stimulators is consistent with damage to the L3-L5 spinal roots.

    • Flaccid bladder/bowel. The bladder and anal sphincters are controlled by S4/5. This could be a result of either damage to the conus or the S4 and S5 spinal roots.

    In summary, it sounds as if you have a sensory level at L1 (that is the lowest dermatome that has intact sensations) and a motor level also at L1 (intact hip flexors). You are likely to be an ASIA A, if you don't have any anal sensation or voluntary contraction of the anal sphincter. In terms of the injury location, you probably had injury to the tip of your conus (S4/S5), the L2-S3 roots on your right and L2-L5 roots on your left. This is consistent with a burst fracture of your L1 vertebra. The conus is located in the spinal canal at the L1 vertebra. You seem to have spared your S1 and S2 roots on the left, accounting for intact penile sensation and patch of sensation in the left leg. You may have spared S3 on the right, accounting for the right testicular sensation.

    Wise.





    Quote Originally Posted by wesmaister View Post
    Hello!

    After long 4 month journey i Am back at home doing rehab, going to work soon and doing all the things i used to (almost). It started may 14 2012 with L1 burst fracture which left me with a paralysis b&b issues and sensory loss. Ive been reading a lot but still cant figure out what kind of injury i sustained. First i had feeling on top of my right thigh (tingling) and possibly some hip flexor movement. Which would leave me as ASIA C? My bladder and bowels were flaccid (everything falling out without me even knowing), no reflexes in my ankles and knees, no other movement. When i got discharged from hospital and started doing therapy things started to fall in place and still are (slowly) my hip flexion is really strong now, my hamstrings starting to work and my quadriceps on left leg started to flicker recently (yay!). Left leg is much stronger than left one. All muscles respond to tens unit really well except quads and dorsiflexors. When it comes to feeling i have feeling around my penis (normal) and on top of my right thigh that includes sensation, pain and temperature, also more feeling on sides of my right thigh, left one has feeling on top but not as good as right one. some sensory feeling by my ankle on left leg. Also i feel my right genital normal. Can get erection with touch but cant mantain. My sphincter has a tone and wont release anything until i use my finger. Constaipated quite a bit in the beggining now getting better. Bladder (penis?) has weird spasms sometimes like it wiggles. I thing ive covered all the fields. My question is does this put me into spinal cord injury, conus injury, cauda equina or all 3? Its hard to move on and accept what i have without even knowing what ive injured. I hope any of you guys, maybe Dr. Wise or some nurses can help me with figuring out this problem. On the mris ive been told its cauda equina. My doc told me its conus and cauda. And in the beggining i had sci. Please help me with understanding my injury!
    Last edited by Wise Young; 01-02-2013 at 05:10 AM.

  8. #8
    http://spinalcordresearchandadvocacy...g-2-walk-2012/ Would this type of procedure be successful ?

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