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

  1. #21
    Originally posted by Wise Young:


    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.
    dr young..i keep writing fr wise,, sorry it fits! you may not always be young , however you always will be wise!
    you may have answered what i have been thinking about for the last couple of weeks.
    where can i go in NYC to find an expert on cauda equina injuries and everything it encompasses.
    the physical therapy up here is not worth my time.

    my left leg and foot atrophy is severe , however i know there are a couple muscles that are not denerved in there, i know i have the half arterial blood flow from the knee down compared to my good leg from the bone scan. that was last year and the atrophy and muscle wasting is much more severe now.. not sure if this AFO is making the problem worse, however it help so much with my walking i cant go without it. it also reduces the ankle trauma i get from constantly reverting the ankle, NYU is easy for me to get to , ortho AAFOS doc is there.
    my bowels are a mess since i stopped the ultram, going every hour or 2 for a couple weeks now.
    do you other lower level injuries have this atrophy ? atrophy pic

    [This message was edited by metronycguy on 05-17-05 at 11:18 PM.]

    [This message was edited by metronycguy on 05-18-05 at 12:15 AM.]

  2. #22
    MikeC,

    First, you don't have either cauda or conus injuries. What you have is a T12 burst fracture with a L4 neurological level. The ASIA classification system defines the neurological level as the lowest "normal" neurological segment.

    Second, in terms of the actual location of spinal cord and root damage, you have damaged your S3 spinal cord. I think you also damaged your left L5 and S1 spinal root and your right L5 to S2 spinal root. Another possibility is that you have damage or extension of the damage to your L5 spinal cord on the right side. But, it is not possible to distinguish these two possibiliites without a more detailed reflex examination and/or neurophysiological test of the L5 to S2 roots.

    Based on your new information, the following are your revised ASIA information. Sensory scores of 0, 1, or 2 where 0 indicates no sensation, 1 is abnormal sensation, and 2 is "normal".

    L/R Motor
    L2 5/5 (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 2/0 (kneepit)
    S3 0/0 1/0 (butt crease)
    S4 0/0 0/0 (perineal)
    S5 0/0 0/0 (anus)

    Wise.

  3. #23
    Senior Member MikeC's Avatar
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    Metro - your left calf looks just like both of mine! Sure wish one of mine still looked like your right calf.

    Dr Young - Thanks again - you're really educating me (and hopefully others). Afraid I'm really feeling stupid, er, uneducated now. I know I had a T12 but thought that I also had a conus or cauda equina. How can you tell the difference?

    A far simpler question - when you say 'butt crease' to test S3 do you mean the crack of my butt or where the butt meets the thigh?

    Thanks,
    Mike

    T12 Incomplete - Walking with Crutches, Injured in Oct 2003

  4. #24
    mike c , yes i know i am very fortunate to have the right leg still working ok so far..
    my upper quad muscles are visible smaller, hamstring is much weaker and smaller too.
    i just wonder how much longer the leg will hold up. i do walk a lot with the AFO, so its not due to non use, the muscle had died and turned to fibroid per my doc today, says nothing can be done.

  5. #25
    I guess that the S3 can be both the crease between the leg and the buttock, as well as the upper midline of the cleavage between the buttock.

    A conus injury is defined as an injury to S4/5 of the spinal cord, the tip of the spinal cord. It is possible that you also have damage to S4/5 but to distinguish that you would need to see if the S4/5 gray matter is intact. That is not easy to test clinically since your sphincter is paralyzed. On the other hand, as you point out, you have some sensation there.

    A cauda equina injury is defined as injury to the cauda equina which begins below L1. If you had a burst fracture of the L3 vertebra, it would be more likely to be a cauda equina injury.

    Wise.

  6. #26
    Senior Member Kaprikorn1's Avatar
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    OK Wise...time to do me now...LOL!

    Here's my scores on the ASIA test. I'm only listing those that were impaired or absent as much was normal:

    Level/Touch/Pin Prick
    * * * R/L * * * R/L
    C2* * * * * * * 1/1
    C5* * * * * * * 1/1
    C6* * * * * * * 2/1
    C7* * 0/0
    C8* * 1/1
    T1* * * * * * * 1/1
    T2* * * * * * * 0/0
    T3* * * * * * * 1/1
    T4* * * * * * * 1/1
    T5* * 1/2
    T8* * * * * * * 1/1
    T11 * 1/1
    T12 * 1/2
    L1 * 0/1 * * * 1/1
    L2 * 1/2
    L4 * 0/0 * * * 2/1
    L5 * * * * * * 2/1
    S1 * 1/0 * * * 1/0
    S2 * 1/1 * * * 1/1
    S3 * 1/1 * * * 0/0
    S4-5* 1/1 * * * 0/0

    (Ignore the little stars above. They are just place holders as for some reason the numbers keep collapsing when posted.)

    No = voluntary anal contraction; Yes = anal sensation.

    Motor = all 5/5 except wrist extensor L =4 and ankle plantar flexors = 4. I fell down my front steps(1/2 flight) backwards head over heels at 1 1/2 yrs post and fractured left wrist, so it's probably from nerve damage from surgery on metacarpal.

    I am a bit concerned about the impairment of C5-C8 also. Possibly did something to neck in fall but have never had MRI or x-ray of C-spine so don't know. X-ray of T and L spine showed no damage to fusion.

    I am curious if this indicates cauda equina and conus injuries as well as SCI. If you couple this data with my previous post and drawing of my injury...what's your opinion?

    Also...can you tell what my neurological level of injury and function are from this, even though my vertibral level is L1?

    Kap

    accept no substitutes

    [This message was edited by Kaprikorn1 on 05-19-05 at 12:41 AM.]

    [This message was edited by Kaprikorn1 on 05-19-05 at 12:45 AM.]

  7. #27
    Kap,

    The data you present would be reason to hospitalize you immediately. You should not have any loss of sensation above your injury level. 0/0 for C7 would be very worrisome. Are you sure that you are totally numb to touch in that dermatome?

    One recommended way that the ASIA examinations is done is that one first touches the face with the cotton wisp or pinprick so that the person understands what a touch and pinprick feels like and then the examiner touches or pricks the point for each dermatome. There are tremendous differences of normal sensitivity to touch and pinprick in different parts of the body and this must be taken into account.

    Let me study your chart and write more later.

    Wise.

  8. #28
    if you use the q-tip on your face and then compare to the rest of below where I was injured, feeling my leg's will be almost non-existant. especially the back-sides of my leg's and butt. No anal sensation or contraction.

  9. #29
    duge, please use your common sense. The touching of the face is so that people will know what the feeling is qualitatively like. The application of the cotton wisp and the pinprick to an area of the body that is still sensitive is just to remind people what light touch and pinprick (pain) feels like.

    If people are going to do the ASIA examination on themselves, go to their web site (and others) and read the explanation of the examination. The scoring is on a scale of 0-2 and I put some comments in parentheses.

    0 = no sensation (numb, can't feel light touch or pinprick at all, don't know that it has happened)
    1 = abnormal sensation (increased or decreased, you know that you have been touched but the sensation is definitely abnormal)
    2 = normal sensation (expected for the area of the body)

    Wise.

  10. #30

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