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

  1. #81
    Surf-Sister,

    Raisman and Carlstedt have proposed doing such studies in human brachial plexus avulsions. For example, see http://carecure.org/forum/showthread...hlight=raisman

    Wise.

    Quote Originally Posted by Surf_Sister
    Thanks, Wise, my father and I were amazed you wrote such a referenced reply so quickly.

    The abstracts were intriguing, but with such inconsistent results, I don't think I'll be trying olfactory ensheathing glia (OEG) procedures anytime soon.
    But I have more quesions if you have time,
    Do you have any ideas of when this might be done in humans? Is OEG an invasive operation or more like the needle being used in China? I'm assuming these animal studies are similar to Dr. Huang's work, but I'm not sure on what those similarities are exactly. Hypothetically, if I were to get the procedure done in china, how would cauda equina treatment(s) be different from a higher SCI?

    Thanks Again!

  2. #82
    Where can I find evidence for the ASIA dermatome maps as opposed to the Netter dermatome maps? Thanks.

  3. #83

    Cauda Equina Symptom???

    I'm a 47 year old guy with a recent L4-L5 disc burst after years of herniation, causing cauda equina syndrome. I had an increase in back pain (worst ever), which led to some weakness and I fell on my ass, bursting the disc. My feet and groin went numb and I called 911. I was in surgery within 11 hours of falling and had a discectomy and laminectomy on 1/8/08.

    I can walk (though I look like frankenstein's monster clopping around on my heals), even though I'm weak through the outside of my legs and my glutes. I am quite weak pushing down on my toes, better pulling them up against resistance. My left side is weaker and I can only barely wiggle the toes on my left foot. I had left sided sciatica for many years. I can wiggle the right toes much better.

    My bladder and bowel have been weakened, but I can voluntarily control them. Sensation is reduced and altered, but I can tell when my bladder is full, especially if I press on my bladder. The bowel is more difficult to judge since it feels like I have a stick up my butt, and my sphincter tone is reduced.

    Both feet have a great deal of neuropathy, not well controlled with neurontin. The strangest symptom is perineal pain, however. It feels like I have a golf ball jammed in my rectum when I sit down, making sitting for any length of time very difficult. This has prevented me from returning to work more than any other symptom.

    Is this literal pain in the ass something you hear about? Is there any way to guess if this will fade, or how long this may last? I have so many questions, but I better stop here for now. I'm going to fill out the ASIA classification form asap, but know that I have more sensation than my neurosurgeon expected, and can tell pins from dull almost everywhere.

  4. #84
    Quote Originally Posted by tralain
    I'm a 47 year old guy with a recent L4-L5 disc burst after years of herniation, causing cauda equina syndrome. I had an increase in back pain (worst ever), which led to some weakness and I fell on my ass, bursting the disc. My feet and groin went numb and I called 911. I was in surgery within 11 hours of falling and had a discectomy and laminectomy on 1/8/08.

    I can walk (though I look like frankenstein's monster clopping around on my heals), even though I'm weak through the outside of my legs and my glutes. I am quite weak pushing down on my toes, better pulling them up against resistance. My left side is weaker and I can only barely wiggle the toes on my left foot. I had left sided sciatica for many years. I can wiggle the right toes much better.

    My bladder and bowel have been weakened, but I can voluntarily control them. Sensation is reduced and altered, but I can tell when my bladder is full, especially if I press on my bladder. The bowel is more difficult to judge since it feels like I have a stick up my butt, and my sphincter tone is reduced.

    Both feet have a great deal of neuropathy, not well controlled with neurontin. The strangest symptom is perineal pain, however. It feels like I have a golf ball jammed in my rectum when I sit down, making sitting for any length of time very difficult. This has prevented me from returning to work more than any other symptom.

    Is this literal pain in the ass something you hear about? Is there any way to guess if this will fade, or how long this may last? I have so many questions, but I better stop here for now. I'm going to fill out the ASIA classification form asap, but know that I have more sensation than my neurosurgeon expected, and can tell pins from dull almost everywhere.
    This pain that you are referring to is, in my experience, not common. Because it is positionally related (i.e. when you sit), it seems to be something to do with your sacral injury. If I were you, I would be carefully investigating your S4 and S5 roots.

    Wise.

  5. #85
    Thanks for your timely response. I've been told that the recovery process moves from the top down, and it doesn't get any lower than S4-5, so I suppose this may take a long time to calm down. That pressure is there when I do many things, and I can almost always feel the perineal issue. Sitting is the most painful, however. How do I investigate S4-5? Is this doing the ASIA chart or do you mean something else. Thanks again.

    Tralain

  6. #86
    Quote Originally Posted by tralain
    Thanks for your timely response. I've been told that the recovery process moves from the top down, and it doesn't get any lower than S4-5, so I suppose this may take a long time to calm down. That pressure is there when I do many things, and I can almost always feel the perineal issue. Sitting is the most painful, however. How do I investigate S4-5? Is this doing the ASIA chart or do you mean something else. Thanks again.

    Tralain
    The fact that your pain is positional, i.e. it is worse when you sit, suggests that sitting may cause the roots to be compressed. I guess that I would first look on MRI to see if there is anything unusual that may affect those roots, such as a disc or narrowing of the foramina for S4/5. Was this where the break occurred?

    Wise.

  7. #87
    Quote Originally Posted by Wise Young
    The fact that your pain is positional, i.e. it is worse when you sit, suggests that sitting may cause the roots to be compressed. I guess that I would first look on MRI to see if there is anything unusual that may affect those roots, such as a disc or narrowing of the foramina for S4/5. Was this where the break occurred?

    Wise.
    No, I had an L4-5 rupture hitting the cauda equina. There is always tightness and pressure at the perineum, but it is much worse when I sit. I have an MRI coming on Monday, since my neurosurgeon wants another peak. So we should pay attention to S4/5? OK.

  8. #88
    Quote Originally Posted by tralain
    No, I had an L4-5 rupture hitting the cauda equina. There is always tightness and pressure at the perineum, but it is much worse when I sit. I have an MRI coming on Monday, since my neurosurgeon wants another peak. So we should pay attention to S4/5? OK.
    Tralain,

    As I tried to explain in this thread, the spinal cord ends just below the L1 vertebral segment. Below that point, the spinal roots from L2 through S5 are all present in the spinal canal. Thus, a herniated disc at L4/5 vertebral level can press on the S4 and S5 roots.

    Wise.

  9. #89
    Hello,

    I am a new member of this post. I have had a L5-S1 discectomy 50 days back for a large para-central disc herniation. I also have a disc bulge at L4-5 and it was left alone by my surgeon.

    Till 45 days, everything proceeded nicely till I started the spinal toning and strengthening exercises. From the next day, I started losing a bit of feeling in my penis. Also, sometimes I cant feel when I am passing the urine. I can feel when the bladder is full, and also can hold it. I had a Post-void residue test done and it showed that the post void was 30cc, while pre-void was 440cc. I also have an erection problem. I also lost a bit of feeling when passing bowels.

    I got scared and then got a repeat MRI done but it shows no nerve compression at L3, L4 and L5 vertebrae levels. L4 disc bulge is still present but it is small, the cut disc at L5 is still within the vertebrae bounds and no pressure is seen on any of the nerves. And he is not able to understand the reason for it ?

    Will MRI confirm cauda equina symptoms ?

    From the description, it seems I have CES but MRI shows no nerve decompressions. Then what could be the reasons for it ?

    Would really appreciate if you could let me know what to do ?

    Regards
    Misbah

  10. #90
    Quote Originally Posted by misbahuddinka View Post
    Hello,

    I am a new member of this post. I have had a L5-S1 discectomy 50 days back for a large para-central disc herniation. I also have a disc bulge at L4-5 and it was left alone by my surgeon.

    Till 45 days, everything proceeded nicely till I started the spinal toning and strengthening exercises. From the next day, I started losing a bit of feeling in my penis. Also, sometimes I cant feel when I am passing the urine. I can feel when the bladder is full, and also can hold it. I had a Post-void residue test done and it showed that the post void was 30cc, while pre-void was 440cc. I also have an erection problem. I also lost a bit of feeling when passing bowels.

    I got scared and then got a repeat MRI done but it shows no nerve compression at L3, L4 and L5 vertebrae levels. L4 disc bulge is still present but it is small, the cut disc at L5 is still within the vertebrae bounds and no pressure is seen on any of the nerves. And he is not able to understand the reason for it ?

    Will MRI confirm cauda equina symptoms ?

    From the description, it seems I have CES but MRI shows no nerve decompressions. Then what could be the reasons for it ?

    Would really appreciate if you could let me know what to do ?

    Regards
    Misbah
    Misbah,

    I am not sure what is happening. One possibility is that a disc is not herniating when you are lying down (the position that the MRI is taken) but only when you are sitting up. This can happen. Are you symptoms worse when you are sitting up or standing?

    Wise.

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