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

  1. #31
    Senior Member MikeC's Avatar
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    Dr Young, thanks again for your help. It helps to know exactly what my injury is. Another question, you say in your article that "Lower thoracic, conus, or cauda equina injuries often result in flaccid paralysis and muscle atrophy. Can it be reversed or prevented? Most of the atrophy that occurs is very likely to be due to non-use." Is there a way to tell whether the atrophy in my calves is due to non-use? I wear my AFO's when I'm out of bed and wonder if I should do that or if I could strengthen my calves by not using AFOs all the time (I'm starting to go to the pool again and I don't wear AFOs and can walk in the pool).

    Kap - thanks for posting your scores. It was interesting to compare them with another T12/L1. Sure do hope you can resolve the problem with C7.

    Mike

    T12 Incomplete - Walking with Crutches, Injured in Oct 2003

  2. #32
    MikeC,

    The calf muscles are called gastrocnemius. If you have any reflexes or spasticity in your gastrocs, you are likely to have S1 gray matter and also intact S1 spinal roots. The gastroc reflex is the ankle jerk, resulting from tapping of the Achilles tendon. Flaccid paralysis and absence of reflexes suggest damage to gray matter or the spinal roots.

    Based on your questions, I am getting a little worried that you are not understanding the main point that I am trying to make. Let me try again to make sure:

    If you look at the figure, a T12 burst fracture will damage the S2/3 cord (yellow colored part of the spinal cord). However, note that there are one green (thoracic T12), some blue (lumbar L1-L5), and some yellow (Sacral, S1-2) spinal roots that are passing alongside the spinal cord at T12. They might have been damaged, too. I drew a semi-opaque box where I think the injury is. Can you see how the roots are involved in a T12 injury?

    Wise.
    Last edited by Wise Young; 09-28-2006 at 04:18 AM.

  3. #33
    Senior Member Kaprikorn1's Avatar
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  4. #34
    Junior Member Pluto64's Avatar
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    Dr Young

    Thank you for the intelligence insight of the paper that you have posted. I to have a T12 burst SCI and what you have put forth has given me grater insight it to the level and area were I am damage at. It also appears that my injury is some what similar to the others that have posted there questions here as well.

    My observation is that you put forth "sensory points" were to test as the level of injury, but what about the actual movement of the muscle themselves? For instance on my left side all muscle groups work but with little or patchy sensation below the knee. While on my right side most muscle groups work (but weaker) with "more sensation". I can not bring my right foot large toe toward my knee on my right side but I can contract my calf's (stand on my toes) with having no or very little reflexes by tapping the Achilles tendons.


    So, if I am missing sensation and have muscle movement or visa versa, how would this determine what exact level that I am at or my chance for more recuperation? I.e. I'm 9 month post injury.

  5. #35
    Senior Member MikeC's Avatar
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    Thanks Dr Young - that did clear it up. I was misunderstanding. I'm still not sure if the S2 (for example) is damaged that it matters whether it was damaged at the T12 level or lower. In other words, does it make any difference that my injury is a T12 versus Conus? Or does this question show that I still don't understand?

    Kap - glad to see your new figures. Look a lot more like mine. I'm going to compare later - it's surprising to me that you can walk unaided but I'm still using crutches. I guess the motor scores are more important than the touch scores when it comes to walking. Mike

    T12 Incomplete - Walking with Crutches, Injured in Oct 2003

    [This message was edited by MikeC on 05-20-05 at 03:38 PM.]

  6. #36
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    Dear Dr. Young;

    Thank you for this information, very interesting. I have an incomplete T11 T12, would like to know how can I contact Dr. Shaocheng Zhang. I am schedule to have Surgery with Dr. Huang on September 14th. and will also like to contact Zang to send my MRI and hear his opinion on the possibility of nerve rerouting.

    I am form Argentina and will travel to the United States in July, I will like to have an appointment with you, could you please direct me on how to schedule this?

    Thank you

    Regards

    Lauratipsusa@msn.com

    Laura

  7. #37
    Senior Member Kaprikorn1's Avatar
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    Mike...yeah...the second time I did the test is much more accurate. I was tired and med'd up pretty good and my wife was half-asleep the first time...LOL. What a scare when I was getting nothing in the C dermatomes! She just wasn't touching me right....hahahah (sounds kinda kinky). I'm anxious to hear what Wise says about my injury when he finds the time to reply.

    Ever since they made me get up and walk at 6 days post surgery, I've been getting better. It's just the damn neuro burning pain that keeps me from walking more.

    Kap

    accept no substitutes

  8. #38
    kap .....is the burning pain that keeps you from walking more only there when you are standing or walking? walking pain sucks whe you have the muscles function to walk, but it hurts to much..
    fortuanely i got a good handle on mine..

  9. #39
    Senior Member Kaprikorn1's Avatar
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    Metro...the burning pain mostly kicks in if I walk or stand for too long. Also, wearing any kind of shoes that are slightly tight causes it too. What's a drag is that I don't really realize that I've been on my feet for too long until it's too late. By the time they start to burn, even when I get off them they just keep on burning. The neurontin and oxycontin handles it most of the time except when I just plain overdo it. Lately, I've been getting bad cramps in my calves for some reason too. Not spasms but muscle cramps like mad.

    How did you get your burning under control?

    Kap

    accept no substitutes

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