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Thread: Lower Thoracic, Conus, and Cauda Equina Injuries: Diagnosis & Treatment

  1. #101
    Junior Member
    Join Date
    Jun 2012
    Location
    North Carolina
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    Dr Wise Young,

    On 10 Dec 2011, I suffered a spinal injury after falling about 10-15 feet. I was told that the injury resulted from excessive flexing as I was doubled over on impact with the ground. The initial write up from the Neurosurgeon stated that I had a closed fracture of lumbar vertebra with spinal cord injury. There was a fracture dislocation at T12-L1 with fracture of the L1 body also. There was a spinal cord compression at the level of deformity with abnormal signal in the cord extending superiorly, and there were signs of conus medullaris syndrome. Majority of muscle groups below the level of injury are greater than 3/5. Sensation decrease over LE with no rectal sparing. I had incomplete sensory loss rectum and decrease rectal tone. They conducted a posterior decompression at T12-L1with reduction of deformity with T10-L3 instrumented fusion. There was weakness and evidence to suggest I would have bowel/bladder and sexual dysfunction.

    Another report stated the following: A CT scan of the spine revealed an anterolateral fracture of the L1 vertebral body with the T12 facet perched on top of L1 bilaterally with TP fractures noted. MRI of the spine was then performed which demonstrated abnormal signal in the conus to the lower spinal cord at T11. Patient subsequently underwent T10-L3 posterior segmental instrumented fusion with decompression and T12-L1 partial inferior and superior laminectomy with bilateral facetectomies.

    Initially in the hospital I was unable to lift my right leg, while straight or bent, against gravity, but I could lift my left leg. I had decreased sensation down the posterior sides of my legs and minimal feeling in my pelvic area and feet. At first I couldn’t walk but after a couple days I could get myself up with a walker. Eventually after a week I could walk around with the walker and after 2 weeks I could walk with just a cane. Around that same time I was able to lift my right leg against gravity. Within two months I could walk without a cane or any other assistance and have been able to do so ever since. My gate has greatly improved, however, I still have a limp since I walk on my heels, but I can walk over a mile without assistance. My inability to fully use my calves prevents me from moving normally, and I cannot stand on my toes except when in water about waist deep.

    I still have numbness on the posterior sides of my legs but I can feel some sensations. I have not had the pin/touch sensation test done recently but can get that assessed at my next doctor visit if that will help. The numbest area of my body is still the pelvic area. I can feel fullness in my bladder and some irritation to my urethra during cathing but I do not have much sensation. I should also have urodynamic testing done in the next couple of weeks. Also, initially I could not get an erection, but now I can and have some ability to ejaculate despite almost no sensation in my penis but I have no control of when it occurs. As for bowel control, I am still on a bowel program and I have to manually remove stool once a day since the anus has enough tone to hold stool in through most of the day. In addition, within the last couple months I have developed the ability to expel the majority of waste by pushing if I manually loosen the anus. I have been seeing a pelvic floor specialist and doing biofeedback tests and when clinching it shows a small increase.

    I am currently coming up on 6 months from my accident and hopeful to keep improving. I have been having issues with bad sciatica in my lower back and right hip that shoots down my right leg, and will have nerve conduction testing done next week. I have been reading a lot of the posts on here and have become curious if my symptoms are more closely related to a conus injury or a lower thoracic injury and what that will mean for continued recovery? I know due to the location of my injury and the report, I would have guessed lower thoracic, however, it seems like I have more of the indications of what I have seen described for a conus injury. I would also guess since my injury is at L1 it is too high for cauda equine.

  2. #102
    I really don't want to sound like a smart ass because I am curious. Maybe I have missed something. I was injured 12/11 and was fused at the T-11-L1. I suffered a complete dislocation and resultant SCI.

    To my knowledge I have never had any tests to determine my nuerological level of injury. My rehab doctors acted as if they were tryint to figure out the nature and extent of my injuries but then I left Kernan and that was that.

    I have had amozing amounts of return so far and am very thankful. I now walk with fore arm crutches and rarely use my wheelchair anymore.

    I guess my question is what difference would it make to know whether my injury is lower thoracic, conus, or equina? Would they want to treat me differently? Am I missing something?

    Again I am not trying to be a smart ass. Ever since I left Kernan and been doing outpatient therapy I have been the one doing all the research to aid in my recovery. I would like to know if I need to get some testing done that may help guide my treatment.

  3. #103
    Did you never have an ASIA exam? That would be the standard of care in a SCI rehab program (at both admission and discharge). It does not really alter your treatment to know accurately, but having a good ASIA exam allows later comparisons to be made that can document the return that you are getting.

    We send all of our SCI rehab patients home with a written copy of their discharge ASIA exam (as part of their discharge personal portfolio) so that they can use it for comparison in the future regardless of where they get further care.

    (KLD)

  4. #104
    I was given the ASIA exam but it seems that many of the symptoms over lap when determining the exact nature of my injury. Pretty sure that I was released as ASIA C and a lower body score of like 5/50. But none of that followed me to outpatient. I was evaluated there as well but have not seen those scores.

    I don't need another ASIA exam to know that I am far above the scores at Kernan now and really don't care what classification I am as it evidently makes no difference. I am what I am.

    I was just wondering if I may be missing the boat on this and would not be surprised in the least that the doctors and Pt's I saw at outpatient didn't really know how to treat SCI.

    I have since ceased therapy as it has seemed to digress into a waste of time and money. I do my own therapy at home and exercise regularly. I do my own research and adjust my work outs accordingly.

    Thank you for your response KLD. You guys are great.

  5. #105
    Member
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    May 2012
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    around an hr from Philadelphia
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    Hello , I was told i have TM leasons at t11L1 and nuro. said at the tip of the conus at S1 i have no ankle movement at all and no feeling at top of toes. does that mean i have a conus injury even though no blunt injury.

  6. #106
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    Sep 2015
    Location
    miami beach Florida
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    7
    Hello Kap
    I had surgery on june 29, 2015. I was experiencing sudden onset of leg weakness, calf fasiculations prior to my surgery. The doctor ordered an MRI and there was a large disk bulge at T12/L1 which the doctor said was "flattening" the cord, however, other docs said it was just touch the thecal sac. Also on the MRI was moderate to severe spinal stenosis at L2/3. So the doctor stated I needed decompression surgery quickly. I had a T12/L1 laminectomy, disectomy, interbody fusion from the posterior with instrumentation (pedicle screws and rods) and an L2/3 hemi (left) laminectomy. After the surgery, I awoke with burning pain in the sole of my left foot. I did not have this pain prior to surgery. The doctor did not say much other than it would get better in time. Six months later, I still have burning pain in the heel of my left foot, and I also have burning, tight pain in my left calf and outer left thigh. I asked the doctor if he touched or retracted the cord during the surgery, and he stated he had not; this was also reflected in his surgical report.

    So I believe based upon my symptoms after this surgery my S1,2,3 nerve roots were irritated as they are in between T12 and L1. The fact that I had a severe burning pain in the sole of my left foot matches with the left sided disectomy and insertion of the 10 mm peek cage (with bone graft). The foot pain is less (it started at a 10 and is now can between a 4 to a 6 pain level depending on the day). The calf and thigh pain I did not have right after surgery, but now have these pains. Other doctors told me that spinal cord irritation can take 12 - 18 months to get better. I also wonder about the necessity of my surgery, and that I probably should have left things alone but I was afraid of being paralyzed or losing bowel/bladder control. My dad had a laminectomy when he as 53 (I am 48 male), and he did not fare so well. A cat scan post surgery showed some large bone spurs at T12 L1 that were also encroaching the spinal canal with the bulging disk. The surgeon did not remove these spurs; I suppose he felt the posterior decompression would be sufficient and he did not want work around the cord. Since I have this new pain I did not have before surgery, I worry that maybe the surgery was not necessary, or not done right. Or it could be that I needed it, and I must be patient.

    The burning pain is really frustrating and I wanted your thoughts on my situation, and if anyone else has comments. I did not have an accident leading to this. It was that my spine was pretty degenerated on its own (combination of bad genetics and abuse of time, weight lifting, etc). I had schmorl nodes as well through out the thoracic spine. What was in good shape as S1 and L5, as well as L4/L3.

    Does this burning pain go away? Will nerves settle down? I am almost at 6 months post op. I have a lot of worries about my current condition because everything happened so suddenly. I had no issues with strength, weakness, fasiculations, and pain for the most part until the weeks leading up to surgery. I did have some left outer thigh pain for awhile prior to surgery which was misdiagnosed as meraglia parasthetica but was probably due to the stenosis at L2/3. I have my leg strength but I noticed a good amount of muscle loss in my left calf. Also, prior to the surgery, I was given a strong steriod, which took away the leg weakness I was having. My thoughts were to still have surgery because the surgeon recommended it and that maybe I would get worse, but I think a lot that maybe I should have waited and tried more conservative treatments first.

    So I hope the folks on the forum as well as Doctor Young, can provide some comments/advice. I

  7. #107
    What are you currently doing for the pain? Pain that lasts more than 6 months is considered chronic pain. It may not improve. Generally pain like this is treated with things like TENS as well as medications such as Neurontin and Lyrica. Have you seen another orthopedic spine surgeon or neurosurgeon for a second opinion regarding possible root compression? Had an MRI?

    (KLD)

  8. #108

    Smile Comprehensive neurological facility in South Florida

    This facility has a very strong understanding of Cauda equina. Syndrome.


    http://www.centerforneurorecovery.co...-syndrome-ces/

  9. #109
    ehat is not the cauda equina that i have, nor most others here, Core strength rehab will not help when there is already nerve damage
    cauda equina

  10. #110
    Core strength rehab will make the working muscles stronger and help with balance. CWO

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