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Thread: Thoracic Spinal Cord Injury: Diagnosis & Treatment

  1. #11
    Quote Originally Posted by Wise Young
    Rick, that is quite a correction from 85 to 23 degrees. Anything over a 35-degree curvature is generally considered to require correction. Most scoliosis surgeons go with the goal of keeping the curvature less than 35 degress. What did they use on the second go-around if they did not use hooks and rods?

    Let me review briefly the instrumentation that is usually used for scoliosis correction. The Harrington rod procedure places a rod on the convex side of the curve with hooks placed in the lateral vertebral process and the curve is then "distracted" to straighten out the curve. Developed in the 1960's by Paul Harrington, this approach is still being used by some surgeons. Because there is only two point fixation, this approach requires fusion of the vertebral processes and use of a body brace for 3 months or longer until the fusion is stable. In the mid-1970's, Eduardo Luque developed a system where two flexible L-shaped rods are placed on either side of the spine and wires are then threaded through the spinal canal and the rods, helping straighten the spine through multiple points of fixation. The surgery is more invasive and many surgeons are nervous about putting wires that penetrate the spinal canal but the procedure produces more stable correction of the curve. In the 1980's, Yves Cotrel and Jean Dubousset developed a flexible rod with multiple hooks, to get around the problem of having to thread wires into the spinal canal. Other orthopedic groups developed variants of this rod and hook methods, including the Texas Scottish Rite and isola system. These methods have the advantage of controlling not only scoliosis but kyphosis and lordosis. Finally, a number of surgeons do what is called an anterior procedure where they may remove discs or cut part of the vertebral bodies in order to adjust the curve. Dr. Klaus Zielke developed a rod and hook system that is on the other side of the convexity, for use with an anterior procedure. The use of each of these instrumentation systems depend on the situation and the experience of the surgeons. http://www.scoliosis.org/resources/m...ionsystems.php

    Over the years, I have witnessed a number of cases where neurological deficits have occurred as a result of scoliosis surgery. During the surgery, because the patient is anesthetized, the surgeon often does not know that something has happened. For this reason, in the 1980's, they started to use somatosensory evoked potential monitoring during surgery to assess the function of the spinal cord. Otherwise, the only method is to wake the patient up in the middle of surgery and ask the patient to move a leg. In almost all cases, damage to the spinal cord have occurred as a result of over-correcting the curvature.

    Wise.
    Anchors = screws.

    Her curve really took off after the first aborted surgery. They knew right away that something was wrong, because she was indeed being monitored and the signal went bad. They did wake her up and she could not move her legs. So they stopped the operation, removed the one hook, and sewed her up. When we looked for a second opinion, that doc knew right away that her curve was going to get much worse, and soon. He was right. It went from 71 to 85 in about 4 weeks.
    Rick

    GO FORWARD! 2 FIGHT! PARALYSIS!

  2. #12

    Alright alright

    I am pretty new to the SCI life and can't say I completely understand one point. She regained feeling because of the fusion or just because she was and inc.?

  3. #13
    Quote Originally Posted by donz
    I am pretty new to the SCI life and can't say I completely understand one point. She regained feeling because of the fusion or just because she was and inc.?
    Probably the latter. Wise.

  4. #14
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    Quote Originally Posted by Wise Young
    Routine MRI and x-rays of the spinal cord and spine are important for people with thoracic spinal cord injury.
    Under your chapter; Long-term Changes you writes that routine MRI etc. of the spinal cord are important for peoples with thoracic spinal cord injury.

    I wonder if this is valid for all kinds of spinal cord damages. I had an avm surgical removed from my thoracic cord in 2003. I did have MR and Angio just after the surgery and another examination some time after this. Right now it is over two years since I had any examinations at all. My situation is stable; I have not become any worse since the surgery, quite the opposite as a matter of fact.
    My question is; is it required or recommended that peoples like me and in stable situations also should have new MRI examinations as a routine for monitoring the cord? And if – how often is it recommended to have such examinations? And for how many years after?

    Thanks, Leif

    And thank you for your thread.

  5. #15

    MRI for AVM?

    Quote Originally Posted by Leif
    Under your chapter; Long-term Changes you writes that routine MRI etc. of the spinal cord are important for peoples with thoracic spinal cord injury.

    I wonder if this is valid for all kinds of spinal cord damages. I had an avm surgical removed from my thoracic cord in 2003. I did have MR and Angio just after the surgery and another examination some time after this. Right now it is over two years since I had any examinations at all. My situation is stable; I have not become any worse since the surgery, quite the opposite as a matter of fact.
    My question is; is it required or recommended that peoples like me and in stable situations also should have new MRI examinations as a routine for monitoring the cord? And if – how often is it recommended to have such examinations? And for how many years after?

    Thanks, Leif

    And thank you for your thread.
    Leif, you probably don't require routine MRI followup of a surgically removed AVM more than 2 years after surgery. Of course, if you have changes in symptoms, you should get MRI.

    I recommend regular MRI followups for people with traumatic thoracic spinal cord injury because of the relatively high incidence of
    1. progressive bony deformity including scoliosis for young people
    2. development of syringomyelic cyst

    Wise.

  6. #16

    how often is regular?

    I am T4 complete (pillion passenger in motorbike accident 5 years ago) and had my last MRI just over 2 years ago. Should I be looking to get another done soon, irrespective of whether I have/have not any new symptoms?
    Also can I take advantage of this post to ask you another question? All my surgery/rehab was in done in Ireland (Belfast & Dublin) but now I have moved to France. I have my Xrays and MRI's and some final reports but I don't have copies of the surgery notes/intensive care notes - should I try to get them? I didn't have any metalwork put in my back, but quite a bit of orthopedic surgery on legs/hip/elbow. Thank you for any input on this.

  7. #17
    Quote Originally Posted by carbar
    I am T4 complete (pillion passenger in motorbike accident 5 years ago) and had my last MRI just over 2 years ago. Should I be looking to get another done soon, irrespective of whether I have/have not any new symptoms?
    Also can I take advantage of this post to ask you another question? All my surgery/rehab was in done in Ireland (Belfast & Dublin) but now I have moved to France. I have my Xrays and MRI's and some final reports but I don't have copies of the surgery notes/intensive care notes - should I try to get them? I didn't have any metalwork put in my back, but quite a bit of orthopedic surgery on legs/hip/elbow. Thank you for any input on this.
    Carbar, there have unfortunately been little or no studies on the subject of how often MRI's are needed after spinal cord injury. The way to judge is the incidence of findings on routine MRIs and this of course must be balanced by the cost and risk of MRI's. So, for example, if 10% of MRI's done at 2 year intervals after spinal cord injury show an actionable change, I would consider it worthwhile. After all, they recommend colonoscopy every two years for people over 50 years old and the incidence of findings is probably lower than 10%. The need for MRI's may also decrease with time after injury.

    I don't know. After having spent 8 years listening to people reporting changes, I get the impression that over 50% of the people show changes such as spinal cord atrophy within 2 years after injury, perhaps 20% show bone deformation during the first four years, and 15% or more get asymptomatic syringomyelic changes during the first 8 years. For that reason, I think that people with traumatic spinal cord injury probably should get MRI's every year for two years, then every two years for 8 years, and then at longer intervals particularly if there were no changes for several years. This is just me and probably insurance companies would not agree with me. There is a need for a systematic risk-benefit analysis of followup MRI's.

    Regarding surgical and other information about your injury, I would strongly urge you to gather that information and keep it in a folder that you can show your doctors. This is a recommendation that I would make for everybody. It helps a lot when you have your own medical chart that you carry with you.

    Wise.
    Last edited by Wise Young; 07-26-2005 at 10:54 AM.

  8. #18
    Many thanks for your very speedy response. Much appreciated.

  9. #19
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    Many thanks from me too. I also had me surgery done abroad, in Phoenix, AZ. I’m also missing the surgical notes; guess I have an email to write too Thanks for the advice. I’m learning all the time on this web site.

  10. #20
    Thanks to you from me also Wise. I didn't mean to hijack your thread, hope you'll forgive me.

    JTOL...lol

    Rick
    Rick

    GO FORWARD! 2 FIGHT! PARALYSIS!

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