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

  1. #41
    kap, i find that when i get redness in my toes that coincides with the start of the burning. same with you , shoes cause this,even shoes that do not seem to be too tight they still compress the foot. i went to wearing open toed sandals full time now , only thing that doesnt cause pain with my afo.
    my weight bearing foot pain is night and day better, the foot and toes have less compression due to the straps of the sandals, i even feel the difference when i wear heavy socks in the sandals in winter , that causes more compression since they tighten the fit of the sandals. i have only a cauda equina injury, a lot of my S1 root is injured , calf muscle is denerved and big toe doesnt move, so some siliarites

  2. #42
    Metro, thank you for your description. I think that what you have described is very important and food for thought. Wise.

  3. #43
    i am very surprise when I read about the rest of you. I do not have normal sensation belowe 2cm down from my navel, I do not have any problems with my toes and ankles, i can move them like normal. I even drive with my feets and have full controll.

    My problems are my hips and my butt and the biggest problem are the knees, I can't straight them out and they don't keep me very long when I stand up.
    TH 12 incomplete 12-12-69.

  4. #44
    Senior Member Kaprikorn1's Avatar
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    Wise...thank you for your evaluation. Let me first answer your questions:

    1) I was a bit confused by the "...against some resistance" vs. "...against full resistance". I'm confused about the muscle names and what they each do. After spending 1/2 hr googling anatomy, now I'm more confused!

    I can stand from a sitting position, raise up onto the balls of my feet and walk a little that way, I can point my toes(but this causes calf cramps), I can squat till thigh is lower than 90 degree angle then rise again, I can stand on my heels and walk a little that way. There is some weakness compared to before my injury but I can move against some resistance, either body weight or opposite force. SO...I guess the lumbar muscle groups would be a 4/4 rather than 5/5.

    2) My anus is not flaccid. Quite the contrary it is very tight and it takes digital stimulation in order to relax it enough for BP. It does not contract when I am doing BP but if I stop dig stim for a minute it tightens back up. I don't feel any reflexive contraction when a finger is inserted nor do I have bulbocavernosus reflex. I can feel inside my bowel and know when I need to do BM, can feel stool, etc. When I do extensive BP I get sore inside bowel so I have sensation inside and of the muscles but not outside on the skin.

    3) I do have deep sensation of penis but not on the skin and have not had any erectile activity since injury, even with viagra. I had a few spontaneous retrograde ejaculations at night when first out of rehab but nothing in over 2 years. I can feel it inside when I cath and can feel squeezing of penis but very little rubbing type sensation. I only have bladder spasms when I am very full or also need to do BP. However, bladder sphincter is very spastic. It is so tight sometimes that it takes several minutes to get cath into bladder by constant cath pressure.

    I hope that answers the questions you asked. How does this change your eval?

    Regarding tethering...this would need MRI to determine, right? How could this be done as I have titanium rods on each side of spine held by titanium bands screwed to each vertibra from S3 to T8? I have long suspected that I may be tethered, as I still have "cord pain" when I am jolted or flex spine as in twisting or bending too quickly.

    Re: 4AP...if it increases sensation and spasticity, wouldn't it cause my burning feet to get worse and my bladder and bowel sphincters to lock up even tighter?

    If OEG is all I could try now...I'll wait for something more reliable. I'll only have one shot at some kind of cure surgery due to money and age. I just hope one gets here before I'm too old to do it.

    Kap

    accept no substitutes

  5. #45
    Senior Member Kaprikorn1's Avatar
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    Metro...LOL...I've gone to nothing but sandals too! I do have a pair of hiking boots that were way to wide when I bought them and I can wear them if I only tighten the laces at ankle, not on the foot part.

    I got a pair of Merrell "all terrain" sandals that are great. They're all synthetic materials, velcro on toe straps as well as ankle straps. You can wear them swimming even...LOL. Check them out, they have several different styles.

    I never noticed the redness of my toes. I'll remember to check that next time.

    Kap

    accept no substitutes

  6. #46
    What would my level of injury be described as?
    I have no sensation or movement from the waist line down

  7. #47
    Kap

    Do you not have a feeling like walking on broken glass? That is what mine feel like. then sometimes but not that often the burning will set in. I have been wearing nothing but New Balance tennes shoes. I tried a pair of the Nike shock's and the verdict is still out on those.

    I can't straighten my toes or walk on the ball of my feet, Just the heel's.

    We kinda sound the same except for the penis. I can feel mine but No erectile activity.

    Bowel's are so tight. but bladder has shrunk and thatnk God I don't have to cath anymore!!! I can feel it but just can't hold it.

    Just like you though, afraid the cure will get here and I will be to old
    Doug

  8. #48
    kap i wear the water sandals when i canoe, i cant walk very far in them without foot pain maybe 10 20 feet, i wear the MBT sandals they have the most cushioning of any footwear and the most rocker bottom i have seen, also stops the foot slap , which causes pain in me,they arent good for water stuff , only for walking, but i can walk for long distance with the AFO, its a night and day difference for me.

  9. #49
    With pain symptoms similar to Cauda Equina type
    could there be compression of the root without
    disk herniation or stenosis showing on Mri?There is a cyst just right of S1-2 exiting neural foramen,15mm,perineural.

    Rob C6/7

  10. #50
    Originally posted by Kaprikorn1:

    Wise...thank you for your evaluation. Let me first answer your questions:

    1) I was a bit confused by the "...against some resistance" vs. "...against full resistance". I'm confused about the muscle names and what they each do. After spending 1/2 hr googling anatomy, now I'm more confused!

    I can stand from a sitting position, raise up onto the balls of my feet and walk a little that way, I can point my toes(but this causes calf cramps), I can squat till thigh is lower than 90 degree angle then rise again, I can stand on my heels and walk a little that way. There is some weakness compared to before my injury but I can move against some resistance, either body weight or opposite force. SO...I guess the lumbar muscle groups would be a 4/4 rather than 5/5.

    2) My anus is not flaccid. Quite the contrary it is very tight and it takes digital stimulation in order to relax it enough for BP. It does not contract when I am doing BP but if I stop dig stim for a minute it tightens back up. I don't feel any reflexive contraction when a finger is inserted nor do I have bulbocavernosus reflex. I can feel inside my bowel and know when I need to do BM, can feel stool, etc. When I do extensive BP I get sore inside bowel so I have sensation inside and of the muscles but not outside on the skin.

    3) I do have deep sensation of penis but not on the skin and have not had any erectile activity since injury, even with viagra. I had a few spontaneous retrograde ejaculations at night when first out of rehab but nothing in over 2 years. I can feel it inside when I cath and can feel squeezing of penis but very little rubbing type sensation. I only have bladder spasms when I am very full or also need to do BP. However, bladder sphincter is very spastic. It is so tight sometimes that it takes several minutes to get cath into bladder by constant cath pressure.

    I hope that answers the questions you asked. How does this change your eval?

    Regarding tethering...this would need MRI to determine, right? How could this be done as I have titanium rods on each side of spine held by titanium bands screwed to each vertibra from S3 to T8? I have long suspected that I may be tethered, as I still have "cord pain" when I am jolted or flex spine as in twisting or bending too quickly.

    Re: 4AP...if it increases sensation and spasticity, wouldn't it cause my burning feet to get worse and my bladder and bowel sphincters to lock up even tighter?

    If OEG is all I could try now...I'll wait for something more reliable. I'll only have one shot at some kind of cure surgery due to money and age. I just hope one gets here before I'm too old to do it.

    Kap

    accept no substitutes
    Kap, thanks for the info. It clarifies and confirms my previous assessment.

    1. I agree with the assessment of your plantar flexor (gastrocnemius) which should allow you to raise yourself onto the balls of your feet. This suggests that your S1 is 4/4, meaning that your spinal cord injury must is below S1 and therefore probably S2 and some of S3.

    2. The fact that have a tight spastic anal sphinceter means that your S4/5 segment is intact, arguing strongly against a conus injury.

    3. The fact that you have lost superficial sensation of your penis is consistent with damage to S2. The fact that you have some bladder sensation suggests that part of S3 may be intact. So, I may narrow down your injury to S2 with some preservation of S3.

    Regarding 4-AP, there are people who have reported that it reduces neuropathic pain for them. It should also reduce spasticity, fatigue, and improve coordination.

    The goal of OEG is to encourage sensory axonal growth into the spinal cord (to restore sensation). This may help improve sensation (particularly pinprick mediated by the spinothalamic) if the sensory axons grow into the spinal cord and make synapses with segmental gray matter.

    Wise.

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