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Thread: Broke back twice?

  1. #1

    Broke back twice?

    I have noticed for quite sometime on the FES Bike that I push a lot harder with my right leg than my left. Also the past 8 years or so I have noticed that I have a great deal of less spasticity in my left leg than my right and there is a lot more muscle atrophy in my left leg that does not seem to be being corrected (especially in the lower leg) with all the FES bike riding I do. I was told by someone who really knows about this type of stuff that I might have broken my back at a later date with a low level injury (T-12 or below and created innvervation) and not have even known it due to being Paralyzed already. Twice a Paraplegic in a lifetime is not the greatest thought to be thinking lately.

    My question is, what test would be the best test to have done to prove or disprove this secondary injury theory? I got hit by a car in 1994 and that is about the time the spasticity in my left leg kind of went away. Would it be best to have a Petscan done of my entire spinal cord? or would a MRI be better? or would just a plain x ray tell me anything? Thanx.

    "Life is about how you
    respond to not only the
    challenges you're dealt but
    the challenges you seek...If
    you have no goals, no
    mountains to climb, your
    soul dies".~Liz Fordred

  2. #2

    broke back twice

    Curtis - If you do not have any metal (rods, plates, pins, etc) in your back, the best would be to have a MRI. You could also have an electromyogram (EMG) done of the leg to determine if there is response within those muscles. CRF

  3. #3

    Hey Curtis!

    I'd get the mri, mainly to rule out syringomyelia not another break. One sided atrophy is one of many symptoms of having a syrinx, especially having had sci for so many years. Think hard about any other things that have changed, no matter how insignificant they may seem, things you may have just shrugged off like I did.

  4. #4
    Curtis, the best approach is a detailed neurological and neurophysiological examination of your lower spinal cord. This use to be done by Milan Dimitrijevic at Baylor but he is now in Vienna. Unfortunately, few places are doing this kind of detailed neurophysiology of the lower spinal cord in the United States. It is possible that you might have an older neurologist or neurophysiology-oriented physiatrist at one of the rehab centers who still do these tests routinely. It wouldn't hurt to ask. Dr. Vedran Deletis at the Beth Israel North in New York City can do such tests. Dr. Alexander Beric at NYU can also do these tests. Let me explain as briefly as I can.

    1. H-reflexes. This is also called the monosynaptic reflex that occurs when you stimulate a peripheral nerve and record from the muscle that the nerve goes to. The first response at low stimulus intensities that you see is the direct activation of the muscle and that is called the M-reflex. If the M-reflex is present, that means that the motoneurons and axons to the muscle are intact. The second response occurs at a later time and results from the sensory volley going to the spinal cord, activating motoneurons, and then coming back to the muscle. This usually occurs as one increases the stimulus intensity. If present, this indicates that the spinal cord gray matter is intact at that level of the spinal cord. This test can be applied to most muscles of the legs and should give you detailed information on the peripheral nerve, roots, and gray matter of the spinal cord. It is equivalent in some ways to doing a deep tendon reflex test of the leg muscles but it give quantitative information concerning the reflexes and is not influenced necessarily by altered muscle stretch receptor sensitivity.

    2. Flexion and Cross extensor reflexes. If you apply an intense or noxious stimulation to the bottom of the foot, this produces a flexion withdrawal of that foot, accompanied by a extension of the contralateral leg. This is clearly a reflex that involves multiple spinal cord segments and crosses the midline. This is a good test to see whether and if these connections have been disrupted by injury. It should also show which muscle groups are locally affected or not.

    3. Somatosensory evoked potential. During stimulation of the peripheral nerves, you can also record sensory potentials from the spinal cord and the brain with surface electrodes. Unlike muscle responses (EMG), these responses are of course relatively small and it will be necessary to average the potentials to improve the signal to noise ratio. Somatosensory evoked potentials will show whether the ascending volley is reaching the spinal cord, whether it is going up the spinal cord, and whether it is reaching the brainstem, thalamus, and cortex, as well as the timing of the responses. I use to do these all the time in patients with spinal cord injury.

    These are rather straightforward tests. Dimitrijevic and his colleagues published a study on the subject in the 1980's. The abstract is attached.

    Wise.

    • Beric A, Dimitrijevic MR and Light JK (1987). A clinical syndrome of rostral and caudal spinal injury: neurological, neurophysiological and urodynamic evidence for occult sacral lesion. J Neurol Neurosurg Psychiatry. 50 (5): 600-6. Summary: Patients with spinal cord injury show upper motor neuron dysfunction below the level of the lesion. Some patients with cervical and high thoracic injuries show unexpected lower leg atrophy and ankle jerk abnormalities together with persistence of urinary retention. Clinical, neurophysiological and urodynamic findings in 130 patients with cervical and thoracic injuries showed that 18 patients had additional lumbosacral dysfunction. Three patients had radiological findings demonstrating a second lesion of the lower spine. The remaining 15 patients, however, did not have any obvious bony lesion to account for the lumbosacral dysfunction. Atypical neurological findings, abnormal neurophysiological testing and aberrant detrusor behaviour were the essence of the occult lumbosacral dysfunction in cervical and thoracic spinal cord injury patients. Recognition of the presence of a double lesion was important for care of the neuropathic bladder and pain in addition to understanding the unexpected clinical signs.

    [This message was edited by Wise Young on Oct 11, 2002 at 04:44 AM.]

  5. #5

    Thanks everyone I really appreciate it

    I guess the Syrinx is the thing that scares me even more than if I did break my back again at some point, at least if this is due to a secondary SCI it is something that probabley has stablized at this point and does not require attention, where as a Syrinx, that is another story. I better see my Doctor when I get home from Ohio, heading back home tomorrow, I almost hate to leave here, everyone at Electrologic is so nice and really made me feel at home the last week. All of our trial testing is done and we have one heck of a FES bike. Myself and a Paraplegic Woman did all the testing. Thank you Dr. Young for all the time you put into your response.

    "Life is about how you
    respond to not only the
    challenges you're dealt but
    the challenges you seek...If
    you have no goals, no
    mountains to climb, your
    soul dies".~Liz Fordred

  6. #6

    syrinx

    Curtis - try to take one day at a time and have some testing when you get home. I am sure you will ultimately feel much better when you have an explanation for your observations. If you haven't, would suggest that you try to put in writing your observations with a time line (if you can do this retrospectively); this will be helpful diagnostically for your doctor.

    Keep in mind that for some people, a syrinx will present, then stabilize and not be a problem while for others it does require management. CRF

  7. #7

    Thanks CRF

    I did not think about that it could have been a Syrinx that has stabalized. That would probabley be about the best news given the situation. Something definately changed in that especially the lower muscles in my left leg have atrophied a lot and do not respond to electrical stim. I still get those foot tapping type of spasms in my right leg, but not in my left leg since I was hit by a car at my gas station as I remember. I originally thought the leg was injured and had that checked out at the time and found nothing wrong, now it all makes sense that it was more than likely the nervous system that was further damaged around that time. I hope Newport Hospital can help me out, if not I'll go to Boston, this is definately important.

    The good news is I pulled a 4.5/8 for one hour straight on the new bike so my right leg is in real good shape thats for sure. the quads and the Hams still work to a certain extent in the left leg, just not as good as the right leg.

    I cant think of any other symptoms I have that would indicate a syrinx, so that is good news. I am feeling real strong lately in both my legs (except lower left) and my arms. I think having built up my legs so much it makes the lower left leg atrophied part stand out that much more and thats another reason I am really noticing it now and that it bothers me more.

    The other person in the test program was exactly the same age as me (44) and has used FES since she was injured 10 years ago, you would never know she was paralyzed if she did not tell you, you would think she was a/b sitting in a wheelchair, her legs look great. Thank God for progressive Doctors that recommend the right things for their patiants. She has not had to be hospitalized once since her injury and she attributes this to FES. If only the insurance companies would catch on more and give more coverage (Medicare) they would be saving money in the long haul.

    "Life is about how you
    respond to not only the
    challenges you're dealt but
    the challenges you seek...If
    you have no goals, no
    mountains to climb, your
    soul dies".~Liz Fordred

  8. #8

    broke back twice

    Curtis - Your observations re: the young woman who has been on an FES ergometer (bike) for 10 years is completely consistent with my own experience. I coordinated a CFES program for 10 years and have numerous patients that can report the same. When my program was unfortunately closed (due to overall changes at the free -standing multidiscipline clinic) I had patients who could not afford a home unit. They 'jumped over hoops' and found used bikes and ways to borrow money so they could continue this long term therapy.

    While the general thinking is that "insurance will not pay", I was not willing to take "no" for my patients. With persistence, documentation and supportive research articles, etc., we were able to get reversal of some denials. There are many insurance companies who will reimburse. If a stationary ergometer costs approximately $13,000 that is far less money than the $100,000 that a single hospitalization costs for a skin flap repair! This latter cost could buy 7 ergometers, keep 7 persons with SCI, pressure ulcer free and save the insurance community $700, 000. These type arguments are heard by insurance!!

    Are you continuing to use an ergometer at home? Your resistance is giving you a great workout. Keep up the good work. CRF

  9. #9
    Member
    Join Date
    Jan 2002
    Location
    Phoenixville, PA, US
    Posts
    75

    fes improvements

    I waiting for an fes bike evaluation. So, I hope to be buying one in the next few months. Will they be incorporating your improvements by then? Are most of the developments with software? With all of this publicity about CR, is Electrologic having difficulty keeping up with production?

  10. #10

    FES ergometers

    Just a note since this previous post mentions only Electrologic and CR. Since early 2001, CR has been using the ERGYS 2 Home Rehabilitation System, manufactured by Therapeutic Alliances, Inc. The use of this particular ergometer was seen in his recent documentary.

    Curtis - That is great that your experiences and visions could be incorporated into the this valuable piece of equipment! CRF

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