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Thread: Looking for some help T12/L1

  1. #1
    Junior Member MattS's Avatar
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    Looking for some help T12/L1

    I am 24 years old and was injured in a snowmobile accident on Jan 11, 2004. I have been doing some reading now and like everybody else hoping someone has some answers.

    I was told that I had a compression fracture and dislocation of T12/L1. The doc also said I never injured the cord, but the nerves around it (cauda equina). I have pretty good movement and sensation in my left leg but not much in my right. I don't have any feeling in my butt and no control with my bowel or bladder.

    I was wonding if others have had a similar injury and regained their bowel and bladder, and of course, walked again.

    Any help would be benefical.
    Thanks
    Matt

  2. #2
    Matt, most people with just cauda equina injuries can walk, at least short distances, but may need leg braces and of course some gait training. Have you been working on this in therapy? Pool therapy or suspended gait therapy would be particularly good for you.

    (KLD)

  3. #3
    Senior Member Kaprikorn1's Avatar
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    Matt...I am an L1 burst fracture w/ cauda equina damage too. I've been injured 2 ½ years and can walk. The PT's at my hospital made me get up and start 6 days post surgery and I had to re-learn how. I can now walk OK, sometimes use a cane, but only a few blocks now. I also have numbness in butt and back of legs still and of course the typical things that come with our type injury: lack of erection, need to cath to urinate, bowel problems, etc.

    You are very newly injured and will regain some sensation and motor over the next year or so. How much is the mystery. The best thing you can do for your recovery and your attitude is to get into an intensive rehab PT program and work your butt off at it. By the time I reached 1 year post injury, I could walk a mile at a good pace. Sorry to say that I have regressed due to other medical problems, but PT and exercise are real keys.

    If you have anything you want to know...post away.

    Kap

    "It's not easy being green"

  4. #4
    MattS, you are still relatively early after your injury. In the coming months, you should see continuing improvements. Cauda equina injuries are often difficult to predict. Some people recover a lot while others do not.

    Do you remember whether you received methylprednisolone (the high dose steroid drug within 8 hours after injury?) and how rapidly you were decompressed? The original National Acute Spinal Cord Injury Study excluded patients who had cauda equina injuries and therefore there is not much information concerning whether the treatment improves recovery in such cases.

    Until recently, there have been very few studies of cauda equina injuries. Let me list some abstracts for your perusal. Perhaps these abstracts would be a good starting point for discussion of the recovery you can expect. Please ask questions concerning anything that you don't understand.

    Wise.

    • Jiang JM, Jin DD, Chen JT, Wang JX, Zhu ZG, Zhai DB and Jiang H (2002). Decompression and internal fixation in the treatment of thoracolumbar spine and spinal cord injury: report of 166 cases. Di Yi Jun Yi Da Xue Xue Bao. 22: 82-3. Department of Orthopaedics, Nanfang Hospital, First Military Medical University, Guangzhou 510515, China. OBJECTIVE: To evaluate the therapeutic effect of several internal fixation methods in the surgical treatment of thoracolumbar spine and spinal cord injury (SSI-TL). METHODS: In the 166 SSI-TL cases included in this retrospective analysis, 37 had vertebral body burst fracture, 109 had vertebral body compression fracture (with compression to a degree over 50%),14 had vertebral body fracture and dislocation and 6 had multilevel vertebral fractures or jumping fracture. In view of the spinal cord injury 59 belonged to Frankel grade A, 46 grade B, 42 grade C and 19 grade D. Posterior decompression, reduction and internal fixation were performed in 122 patients and the other 44 underwent anterior decompression, reduction and ilium bone grafting. RESULTS: Follow-up study for 3 to 18 month was conducted in 123 cases, in which RF screws cracking occurred in 4 cases, Harrington upper hook dislocation in 5 cases and Harrington rod cracking in 6, while the rest cases were free of theses incidents. In terms of the function recovery of the spinal cord, 88 cases showed improvement of the spinal cord and cauda equina of 1 to 3 Frankel grades, leaving only 35 lingering in grade A. CONCLUSION: Decompression should be performed at early stages of SSI-TL, and employment of various internal fixation instrument helps maintain and enhance spinal stability, preventing secondary lesion of the spinal cord and promoting the function recovery of the injured spinal cord.

    • Gok A, Uk C, Yilmaz M, Bakir K, Erkutlu I and Alptekin M (2002). Efficacy of methylprednisolone in acute experimental cauda equina injury. Acta Neurochir (Wien). 144: 817-21; discussion 821. Department of Neurosurgery, Medicine Faculty, University of Gaziantep, Turkey. In this experimental study the efficacy of methylprednisolone was investigated by neurophysiological and histopathological evaluation in a rabbit cauda equina model where injury was produced with an aneurysm clip (closed pressure 192 gr). High dose methylprednisolone (kg/30 mg) was administered by intravenous infusion in the 8th, 16th and 24th hours after injury followed by infusion of the same dosage every 6 hours for 24 hours. Nerve conduction velocity was measured before and early after trauma and 3 weeks after injury. Both neurophysiological and histopathological investigations demonstrated the neuroprotective effectiveness of methylprednisolone if it was given in the 8th hour after trauma. Although recovery was observed its efficacy was less pronounced when it was given in the 16th and 24th hours.

    • Buchner M and Schiltenwolf M (2002). Cauda equina syndrome caused by intervertebral lumbar disk prolapse: mid-term results of 22 patients and literature review. Orthopedics. 25: 727-31. This retrospective study analyzes the mid-term results of 22 patients who underwent diskectomy following a diagnosis of cauda equina syndrome due to prolapsed intervertebral lumbar disks (mean follow-up: 3 years and 9 months). Postoperatively, 17 of 22 patients had complete urinary function recovery within the follow-up period, 4 patients had a persistent stress incontinence, and 1 patient, incontinent 4 years postoperatively, required catheterization. Thirteen of 17 patients had recovery of motor deficits, 14 of 21 of sensory deficits, and 13 of 15 patients regained perianal sensation. There was no statistically significant difference concerning the time between onset of symptoms and surgical decompression and subsequent outcome. Complete evaluation must include imaging and urodynamic investigations. After an accurate diagnosis and adequate operative treatment, postoperative results of cauda equina syndrome appear satisfactory.

    • Zhu B, Xu S and Jiang J (1998). [An experimental observation of repair after transection of cauda equina fibers in cat]. Zhonghua Wai Ke Za Zhi. 36: 42-5. General Hospital of Beijing Unit, Chenese People's Liberation Army, Beijing 100700. OBJECTIVE: To explore the regeneration characteristics after cauda equina transection. METHODS: Fibrin glue was chosen to repair transected left L6,7 roots in cat, and right roots in situ of the transected ends were served as the control. The characteristics of regeneration were observed by immunohistocytochemistry and morphometric analysis. RESULTS: Regeneration was found not only in site of anastomosis, but also in corresponding spinal segments and DRGs. Sensory and motor evoked potentials (SEP and MEP) performed before and after transection and before taking specimen revealed the course of functional recovery on severed and regenerated nerve roots. The regeneration of moter roots was better than that of sensory roots, and they were mainly blocked at the site of central-peripheral transition zone. CONCLUSIONS: The method of adhesion by fibrin glue can replace traditional suture, and it is superior to suture.

    • Rutz S, Dietz V and Curt A (2000). Diagnostic and prognostic value of compound motor action potential of lower limbs in acute paraplegic patients. Spinal Cord. 38: 203-10. Swiss Paraplegic Centre, University Hospital Balgrist, Zurich, Switzerland. OBJECTIVES: To evaluate the diagnostic and prognostic contribution of motor nerve conduction studies (NCS) in addition to neurological examination in patients with acute paraplegia. METHODS: In 79 patients with acute onset of paraplegia due to traumatic or ischaemic damage of the conus medullaris/cauda equina (conus/cauda) or lesion of the mid-thoracic spinal cord (epiconal) neurological (initial and follow-up clinical motor and sensory scores; outcome of ambulatory capacity determined at least 6 months post-trauma) and electrophysiological examinations (motor nerve conduction velocity (MNCV) and compound motor action potential (CMAP) of tibial and peroneal nerves) were performed in parallel. RESULTS: Severe axonal motor neuropathies were significantly caused by conus/cauda lesions (loss of tibial CMAP in 71% and of peroneal CMAP in 68%) compared to patients with epiconal lesion (no loss of tibial CMAP and abolished peroneal CMAP in 14%). The CMAPs were deemed acutely pathological 4 - 14 days post-trauma and were indicative of the severity of conus/cauda lesion while the MNCV remained normal. Follow-up recordings (up to 1 year post trauma) revealed no significant change in the CMAP values. The clinical examination according to the American Spinal Injury Association (ASIA protocol) in contrast to the CMAP values was significantly related to the outcome of ambulatory capacity. CONCLUSIONS: In contrast to patients with an epiconal SCI almost all patients with damage of the conus/cauda present a severe axonal neuropathy of the tibial and peroneal nerves. Pathological CMAPs develop as early as 1 - 2 weeks after onset of acute paraplegia. They allow, at an early stage, to differentiate between conus/cauda or epiconal lesion and to assess the severity of conus/cauda lesion. Thereafter follow-up examinations remain stable and a developing worsening of peripheral nerve or spinal cord function, eg due to post-traumatic syringomyelia, may be indicated by a secondary deterioration of CMAP values. The clinical examination, according to the ASIA protocol, in acute paraplegia patients, in contrast to the motor nerve conduction studies, is of prognostic value in predicting the outcome of ambulatory capacity.

    • Chang HS, Nakagawa H and Mizuno J (2000). Lumbar herniated disc presenting with cauda equina syndrome. Long-term follow-up of four cases. Surg Neurol. 53: 100-4; discussion 105. Department of Neurological Surgery, Aichi Medical University, Aichi-gun, Japan. BACKGROUND: Cauda equina syndrome is a relatively rare presenting symptom of lumbar herniated discs. Early operative decompression is advocated, but it may not always restore the bladder function. In such cases, knowing the long-term outcome of bladder or sphincter disturbances is quite useful in planning the management of these patients. METHODS: Hospital records of patients operated on for lumbar herniated discs were reviewed. Charts and imaging studies of those patients who presented with classic cauda equina syndrome were analyzed. RESULTS: There were 4 patients (2.8%) of 144 consecutive surgical series of lumbar disc herniation, whose presenting symptom was classic cauda equina syndrome. Postoperatively, the patients had been followed at the clinic for a mean period of 6.4 years. Certain characteristic findings were noted on patients' neurological and radiological examinations. Although the recovery process of bladder function was very slow, taking months to years, all four patients achieved almost normal voiding with no major impairment of daily activities. CONCLUSIONS: Even if short-term recovery of bladder function is poor after lumbar disc surgery for cauda equina syndrome, the long-term outcome is not necessarily so. We should follow up on these patients with such measures as intermittent self-catheterization and drug therapy, expecting slow but steady recovery of bladder and sphincter function.

    • Cifu DX, Huang ME, Kolakowsky-Hayner SA and Seel RT (1999). Age, outcome, and rehabilitation costs after paraplegia caused by traumatic injury of the thoracic spinal cord, conus medullaris, and cauda equina. J Neurotrauma. 16: 805-15. Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Medical College of Virginia Hospitals, Richmond 23298-0661, USA. The object of this study was to investigate the relationships of age on neurologic and functional outcome, hospitalization length of stay (LOS), and hospital charges after spinal cord injury (SCI). At 20 medical centers, 2,169 consecutive adult patients with paraplegia SCI were assessed in acute care and inpatient rehabilitation. Outcome and treatment measures included the ASIA motor index score, functional independence measure, discharge to community ratio, LOS, and hospital charges. Age differences were examined by separating the sample into 11 age categories and conducting one-way analyses of variance on treatment, medical expense, and outcome measures that included the Functional Independence Measure (FIM) and ASIA motor index scores. Cramer's statistic was used to derive a chi-square value that indicated whether variables differed significantly in terms of age. Post-hoc Tukey tests were also performed. Age-related differences were found with multiple demographic variables. Significant differences between age categories were found with regard to the following treatment measures: ASIA motor index scores at acute-care admission and at discharge, rehabilitation LOS, inpatient rehabilitation hospitalization charges, total LOS, total hospitalization charges, FIM scores at inpatient rehabilitation admission and discharge, FIM change, and FIM efficiency. In conclusion, in patients with paraplegia, age appears to adversely affect functional outcome, rehabilitation LOS, and hospital costs. However, neurologic recovery as defined by the ASIA motor scores does not appear to be related to age.

    • Kennedy JG, Soffe KE, McGrath A, Stephens MM, Walsh MG and McManus F (1999). Predictors of outcome in cauda equina syndrome. Eur Spine J. 8: 317-22. Department of Orthopaedic Surgery, University College Dublin, Mater Misericordiae Hospital, Ireland. This retrospective review examined the cause, level of pathology, onset of symptoms, time taken to treatment, and outcome of 19 patients with cauda equina syndrome (CES). The minimum time to follow up was 22 months. Logistical regression analysis was used to determine how these factors influenced the eventual outcome. Out of 19 patients, 14 had satisfactory recovery at 2 years post-decompression; 5 patients were left with some residual dysfunction. The mean time to decompression in the group with a satisfactory outcome was 14 h (range 6-24 h) whilst that of the group with the poor outcome was 30 h (range 20-72 h). There was a clear correlation between delayed decompression and a poor outcome (P = 0.023). Saddle hypoaesthesia was evident in all patients. In addition complete perineal anaesthesia was evident in 7/19 patients, 5 of whom developed a poor outcome. Bladder dysfunction was observed in 19/19 patients, with 12/19 regarded as having significant impairment. Of the five patients identified as having a poor overall outcome, all five presented with a significant sphincter disturbance and 4/5 were left with residual sphincter dysfunction. There was a clear correlation between the presence of complete perineal anaesthesia and significant sphincter dysfunction as both univariate and multivariate predictors of a poor overall outcome. The association between a slower onset of CES and a more favourable outcome did not reach statistical significance (P = 0.052). No correlation could be found between initial motor function loss, bilateral sciatica, level or cause of injury as predictors of a poor outcome (P>0.05). CES can be diagnosed early by judicious physical examination, with particular attention to perineal sensation and a history of urinary dysfunction. The most important factors identified in this series as predictors of a favourable outcome in CES were early diagnosis and early decompression.

  5. #5
    Senior Member Kaprikorn1's Avatar
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    Matt...please join our topic in the Life Forum called "SCI T-12"

    Kap

    "It's not easy being green"

  6. #6
    Junior Member MattS's Avatar
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    Thanks for the help. Yes, I received a steroid about 6 hours after my accident and was decompressed about 18 hours after my accident. From what I have read, both of these should improve my chances of recovering.

    Does anybody know anything I can do to help my bowel and bladder return?

    Thanks
    Matt

  7. #7
    MattS,

    Can you perhaps describe your bowel and bladder function a little bit more? Cauda equina injuries may have damaged the sphincter muscle. For example, what is your anal sphincter tone? Is your problem constipation, incontinence, difficulty controlling the timing? What or are you using something to stimulate bowel movements?

    What are you doing regarding your bladder?

    Wise.

  8. #8
    i have cauda equina syndrome...ces.
    my bladder started to return at around 1 year and stopped intermittent cat by 24 months..
    bowels are problamatic still.. going on 3 years

  9. #9
    Junior Member MattS's Avatar
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    First with my bowels, I don't have any feeling in my anus. I have not been having incontinence trouble for about a month now, since I quit taking "milk of magnesia" which was supposed to help my bowels work. Currently I have a nurse come in and manually disempact me and as of yet can't feel it. I tried suppositories in the hospital but did not get any help from them. My other problem is that if I get the disempaction by 8:00, it's ok, but if it's 8:30, then my bowels start to empty while I am on my way to the bathroom and I can't feel that either. As for my bladder, I do intermitent cathiders about every 4 hours except over night and I do one when I go to bed and then first thing in the morning. Sometimes I can feel that I am kind of full while other times I can not. I am going for a urodynamics test on my bladder next week. They say they can tell if my bladder does somethings like it is supposed to or not and then there might be some medication to help.

    Matt

  10. #10
    Senior Member Broknwing's Avatar
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    Matt-
    It sounds like you are getting some good medical help already. I was injured in November, also L-1, and just finally had a urodynamics test done on Thurs. Something that may help your bowel issues is Sennakot. I was originally on nothing to help out, except the Dulcolax suppositories which never worked as well as they should have. I was switched to Colace which didn't help much but at least I finally had a dr who was trying to help. I was then switched to the Sennakot and everything works so much better now. I also don't have feeling & can't tell when I've gone, but I've gained the ability to tell when I need to go. It's more of a stomach feeling of needing to go. Since I started the Sennakot, I've had very minimal accidents(which I had consistantly before) and also have sort of a known time frame when I'll need to go.
    Hopefully some of this will be of some sort of help for you. Feel free to ask any more questions, I'll try to help. I'm new at all this too, but am learning a lot along the way & I'm learning fairly quickly.

    'Chelle

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