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

  1. #11
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    But the real conundrum lies in the fact that even with irreversible SCI, if therapies existed ( which we all know they don't ), the SACRAL spinal cord damage would still be irreversible. No researcher is going to take the time to work on such a difficult part of the spinal cord, when the paralysis of the patient is soo low anyways. In the land of spinal cord research, our needs haven't even been addressed yet, and we are a near bottom priority, treated as whiners to SCI doctors, when compared to someone with a higher injury. Let it be known on this day that Sacral regeneration of spinal cord tissue is not going to happen within our lifetimes, and/or 20 to 25 years. Like me, if your sexual function, bowel, and bladder have been gone for some time, then they are gone for good and nothing's gonna bring 'em back! Even Dr. Young knows deep down that this need is in the basement on the priority list, and we deserve it for having the gaul to have an injury soo low.

    sherman brayton

  2. #12
    Senior Member MikeC's Avatar
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    Dr Young, thank you very much for your offer. I gladly accept it. I'll do the Asia scale tonight and post here - I really appreciate your helping me interpret the results. I do not have an MRI or CT scan from my injury but do have x-rays from my follow up visits where you can see the rods and vertbrae that the doctor rebuilt. Hopefully that will be good enough.

    Brayton, as usual, what you say makes sense. We may be the last ones to be 'cured.' That's one reason I asked in another post if electrical implants - which several groups seem to be working on - are our best (soonest) hope of getting bladder control back. I wouldn't do a surgery where they had to cut any nerves but if they can develop something that will strengthen the signals from the nerves I would try it.

    Mike

    T12 Incomplete - Walking with Crutches, Injured in Oct 2003

  3. #13
    Sherman, give me a chance to convince you. Wise.

    MikeC, great. Wise.

  4. #14
    Doc

    I had a T12 burst and I can feel my penis, the left side of it actually will hurt when touched, sort like a nerve ending. I can also tell when I am going to have to void, I just can't hold it.

    Any thought's
    Doug

  5. #15
    Senior Member MikeC's Avatar
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    Okay, Dr Young, here goes. Again, thanks for your help. Now I know why you need to train people to do this - it isn't as easy as it looks. I'm glad you told me to check where the dot is on the figure - otherwise I probably would have gotten a lot wrong (it's odd that the L5 test is on the top of the foot).

    On the sensory - I am a 'yes' to all of L4 and above.

    L5 I couldn't feel the light touch or pin prick on my right side but could feel both on the left. The pin prick on the left didn't feel like a pin (I couldn't distinguish the pin from the Q-tip but could feel both).

    S1 - no feeling.
    S2 - like L5 - no feeling on right but could feel both on the left - I could distinguish the pin from the Q-tip here.
    S3 - S5 - no feeling. However, when checking S3 on the left side I can feel right touch sensation on the crack of my butt right next to my anus but it doesn't look like that's where the dot is on the picture. It is relatively new (within the last few months) that I could feel here. On S4-5 I couldn't feel the pin or the Q-tip but I can feel when something larger (like a finger) is inserted. However, my anus doesn't contract even when something is inserted. In your previous post you said I shouldn't be able to feel my penis and I can't - however I can feel when I need to void. I'm not sure if that's a bladder sensation or if my stomach feels tight. If I'm awake I get very uncomfortable once my volume gets around 400 cc's and at night I wake up when I get around 600 cc's. I get erections (not like I used to) without any drugs, etc and can ejaculate.

    On the motor test - I have a hard time distinguishing exactly what muscle groups works what. As far as I can tell all of the muscles on the front and inside of my legs work. My hamstrings work and my knees are strong. However, my calves are flaccid. Also, when I lay on my back I can move my legs sideways but I'm probably a 3 - very little resistance can stop that movement. When I lay on my back I can't raise my legs at all. I can't contract my butt muscles. I can move both ankles up to the neutral position but I'm probably a 3 here also - very little resistance stops any movement. My left ankle is stronger then the right but it's not very strong either - I wear 2 AFOs. I can't push down with either ankle. I can move my right big toe but can't move any toes on my left foot. Like I said, this is really sketchy - hope you can make sense of it.

    I'm happy to answer any questions to clarify these comments. Thanks again.

    Mike

    T12 Incomplete - Walking with Crutches, Injured in Oct 2003

  6. #16
    Senior Member Kaprikorn1's Avatar
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    Wise...This is exactly the information that I was seeking when I started the thread "Is there any hope...". Ever since I started coming to CareCure I have had to glean whatever data I could from the posts about Quadraplegia and Paraplegia and attempt to apply whatever I could to my own injury. It's kind of like fitting a square peg into the round hole.

    Due to the sheer numbers of quads and upper paras, we low thoracic, lumbar, conus and cauda equina injuries don't get a lot of posts that specifically address our own set of unique deficiencies. With this one article you have given me, and probably many more CC members, more knowledge about our injuries than has probably been posted on CC ever before! THANK YOU!

    I had an L1 burst fracture from a fall where I landed on my buttocks in a sitting position. The posterior 1/3 of the L1 vertebra broke off and jammed itself into the spinal cord, compressing it and causing hemorraging in the interspinous ligament. This data I got from the orthopedic surgeon's post-op report and the x-rays. Since the x-ray films have faded so much they can't be copied, here is a picture of what my spine looked like upon admittance: (see pic below)
    <pre class="ip-ubbcode-code-pre"> </pre>

    The neurologist's reports from my last exam (1 year ago) state "burst fracture injury of L1, with biomechanical lumbar abnormalities, injury to conus medallaris of spinal cord and cauda equina problems." He also states "neurological impairment of S2/S4..." and goes on to describe my bowel, bladder and sexual disfunction. Another part of his report states "reflexic-atonic bladder/bowel difficulties w/ erectile difficulty. Rectal sphincter tone was lax and bulbo-cavernosus and cremasteric reflex are absent". In his summary he mentions "cauda equina lesion (incomplete)".

    I am going to take the ASIA worksheet and get it to you for your observations and comments. However, from what the neurologists have stated in these reports, it looks like I've got a triple whammy of SCI, Conus and CE injury. It seems like a miracle that I can still walk or is walking something completely unrelated to the neurological injuries that I have?

    Can you offer any direction as to what type of treatments it would take to restore BBS and what is being studied by whom that will address these issues?

    Thanks again, Wise.

    Kap

    accept no substitutes
    Last edited by Wise Young; 09-28-2006 at 04:18 AM.

  7. #17
    Senior Member Kaprikorn1's Avatar
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    Wise...For those of us taking the ASIA test ourselves can you give some guidance on specifically what is meant by "light touch" and "pinprick"?...ie: how much pressure to apply? is it a light touch w/ a pencil eraser, fingertip or flat hand? is the pin held perpendicular to the skin or angled? should the pinpoint depress the skin or just touch it?

    This would lead to more accurate results for us doing it at home.

    Thanks

    Kap

    accept no substitutes

  8. #18
    MikeC, let me summarize based on your description. Please correct me if I am wrong.

    Vertebral injury: T12 burst fracture

    L/R Motor
    L2 ?/? (Hip flexors)
    L3 5/5 (Knee extensors)
    L4 4/3 (Ankle dorsiflexors)
    L5 0/2 (Long toe extensors)
    S1 0/0 (Ankle plantar flexors)

    L/R Pin Touch
    L4 2/2 2/2 (front of leg above knee)
    L5 1/0 1/0 (medial top of foot)
    S1 0/0 0/0 (heels)
    S2 2/0 0/0 (kneepit)
    S3 0/0 1/0 (butt crease)
    S4 0/0 0/0 (perineal)
    S5 0/0 0/0 (anus)

    From your description, the T12 burst fracture damaged your S3 spinal cord on your left. I surmised this from the loss of pin and touch sensation from S3 to S5. The question is whether you have damage to your L5 through S2 roots. Damage to your L5 through S2 roots on your right, as well as your L5, and S1 spinal roots on your left, and sparing of your left S2 root would explain the distribution of your sensory findings. The fact that you can feel a full bladder may come from sparing of your left S2 root. Bilateral S1 root damage is consistent with flaccid paralysis of your calf muscles (plantar flexors).

    There are several inconsistencies in the distribution of neurological deficits with the above explanation.

    1. Preservation of your right big toe movement but absence of right L5 sensation. The big toe (extensor hallucis longis) is partly supplied by L4 and L5, but you also say that you have greater weakness of your right ankle dorsiflexors (L4). One possible explanation may be extension of damage to your right spinal cord up to L4, resulting in a Brown-Secquard like syndrome. Do you have any spasticity?

    2. Loss of L2 motor function with no change in sensory. When you say that you cannot lift your legs from a lying down position, are you referring to a straight leg raise? Can you do a sit-up with somebody holding your knees down? In other words, do you have hip flexors?

    3. Sensation to your penis is carried by S2 or S3 root, usually on one side (varies from individual to individual). Since you appear to have spared your left S2 root and your S2/3 spinal cord is at least partly intact (erection and ejaculation), do you have any penile or scrotal sensation at all?

    I would recommend the following diagnostic tests that Dr. Aleksandar Beric (tel: 212-598-6294, fax: 212-598-6009) who is an expert on clinical neurophysiology of people with suprasacral and sacral spinal cord injuries at NYU Medical Center.
    • lumbosacral somatosensory evoked potentials.
    • electromyography of affected roots, to determine whether there are reflexes carried by the lumbosacral roots.

    In terms of therapy, as I had pointed out below, there is the possibility (once you have identified what remains, which roots are intact and which roots have been injured) of doing bridging, possibly combination olfactory ensheathing glial cell injections and growth factor administration into the dorsal root entry zones to encourage sensory axonal regeneration into the spinal cord (by the way, there is some animal data suggesting that OEG will encourage axonal regeneration from root to spinal cord, etc.

    Wise.

    [This message was edited by Wise Young on 05-17-05 at 10:38 AM.]

  9. #19
    Kap, touch is light touch using a wisp of cotton with a Q-tip. Pinprick is with a sharp pin. Wise.

  10. #20
    Senior Member MikeC's Avatar
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    Dr Young, my wife says that you've already figured out how to clone yourself - that's the only way you can spend as much time with us as you do! Just a small joke to say thanks for your response.

    Your summary of my results is right except that for S2 I can feel both the pin and the q-tip on the left side (behind the knee). I'm not sure what the difference is between a "1" and a "2" for sensory - I thought either you could feel it or you couldn't.

    To answer your questions:

    1. Yes, I also find it odd that my left side is so much stronger and with more feeling but it's the big toe on my right side that moves. I keep trying to move the toes on my left side but no luck even though I can feel the big toe and the one beside it real well. I do have spasms at night. I can't tell if my butt and calves tighten but my legs do - the spasms usually wake me up.

    2. Sorry I was confusing on my motor function. Yes, I would say my hip flexors are a 5. I can do sit ups (I wasn't sure what hip flexors are) and when I lay on my back I can lift my legs straight up with 5 lb weights without any problem. What I can't do is move my legs sideways (are those abductors?) with any strength. In rehab they would have me try to keep my legs spread and they would push them together without too much effort. I have a lot of strength moving my legs together - its just spreading them sideways that I am weak.

    3. I've got touch sensation in my scrotum and can feel the base of my penis (maybe the first half inch or so). When I insert a catheter I can feel the scraping in my penis (it's kind of like novacaine from the dentist in that it doesn't hurt but I can feel the pressure and movement).

    With these facts can you figure out if I've got a Conus or a Cauda Equina injury or do I need to get the tests done that you recommend? I thought I'd ask the VA to do the tests in Nov when I have my annual check-up unless you think I should have them done sooner.

    Thanks again for your help.

    Mike

    T12 Incomplete - Walking with Crutches, Injured in Oct 2003

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