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Thread: Can Thecal Sac Injury Lead To Paralysis?

  1. #1

    Can Thecal Sac Injury Lead To Paralysis?

    I have 4 levels of disc herniation, 2 levels of Spinal Stenosis, sclerosis, spondylosis and a disfigured thecal sac due to disc impingement.

    I once read about a man who had thecal sac impingement and one day he bent down to do something and became paralyzed.

    Is this possible?

    BTW, I take 60 mg Kadian bid and 30 mg Roxicodone for bt.

    Alan

  2. #2
    Yes it can happen. I met a guy at rehab who became paralyzed while bending to wash his teeth.
    Hope you can do anything to prevent it.

  3. #3
    Sure. I just won't brush my teeth! (Green color matches my teeth color!)

    Seriously, my pain is getting worse. I had shot #2 in 3 shpt ESI series (Third time I've done this with never any relief).

    I might call PM Doc tomorrow because I can't take it.

    Alan

  4. #4
    There was a guy at our hospital who became paralyzed after sneezing, so bending over could make for compression; however, compression of the thecal sac would not hurt anything, it would be the indication it gave that the cord itself might be hurt. Big vessels run in the thecal sac and if you compress those it is the same as compressing the cord essentially. I do not agree with the radiologists who claim unless there is some kind of brightening of the anterior cord on MRI that you don't have to consider the compression as serious, for the very reason you are asking about. Also, MRI is done laying down and especially in the neck, which must bear a heavy head, compression of the thecal sac may actually be compression of cord vessels or cord when sitting up. The doctor needs to really listen to the patient, ask pertinent questions, and provide warnings about notification should anything occur. Still too many people getting paralyzed who should have had notice and warning not to do anything to risk narrowing of the spinal canal ie the thecal sac. If the radiologist has to wait until the cord becomes bright before anything is called, he is missing some cases; sort of like the surgeon who only gets infected appendixes one hundred percent of the time he operates--that means he is missing some since it is not possible to call them perfectly.

  5. #5
    Alan,

    Impingement of the thecal sac alone should not be damaging to the spinal cord unless it is pressing on the spinal cord. The thecal sac is the dura and there is an inner arachnoid membrane that holds cerebrospinal fluid, which surrounds the spinal cord. Prolonged impingement of the thecal sac against the spinal cord may lead to development of adhesive scars between the spinal cord and the arachnoid/dura. This may lead to tethering of the spinal cord.

    In the case the you describe, it is likely that when the man bent over, there was further herniation of a disc that caused compression of the spinal cord. The compression has to be present for at least 30 minutes to cause substantial damage to the spinal cord. Very rapid compression of the spinal cord can of course cause damage and is called contusion. The rate of contusion must exceed 0.5 meters per second to produce substantial damage of the spinal cord.

    Wise.

    Quote Originally Posted by wolftrades
    I have 4 levels of disc herniation, 2 levels of Spinal Stenosis, sclerosis, spondylosis and a disfigured thecal sac due to disc impingement.

    I once read about a man who had thecal sac impingement and one day he bent down to do something and became paralyzed.

    Is this possible?

    BTW, I take 60 mg Kadian bid and 30 mg Roxicodone for bt.

    Alan

  6. #6
    Thank you for the reply.

    Can a disfigured thecal sac lead to pain or is likely my other problems inclduing 4 levels of disc herniations, 2 levels of Stenosis, sclerosis and spondylosis?

    My latest MRI is as follows:

    FINDINGS: Small chronic Schmorl's node endplate deformities are seen at several levels and mild Modic type 1 discogenic endplate change is present at L2-3 and L3-4. Mild spondylosis is present primarily ay L2-3. No fracture is seen. There is no spondylolisthesis. There is mild lumbar scoliosis convext to the left.

    The L1-2 disk is partially desiccrated and mildly reduced in height. Small central posterior disk protrusion deforms the thecal sac without narrowing the spinal canal. The neural foramina are patent bilaterally.

    The L2-3 disk is partially desiccated and mildly reduced in height. Small left paracentral posterior disk protrusion is again identified, narrowing the left lateral recess. There is additional contralateral small right posterolateral foramina disk protrusion. There is mild to moderate bilateral neural foraminal encroachment. The canal is within normal limits.

    The L3-4 disk is desiccated and reduced in height. Mild to moderate paracentral posterolateral disk protrusion is again identified. There is underlying posterior disk bulge, facet hypertrophy, mild spinal stenosis and bilateral neural foramina encroachment, mild right, moderate left.

    The L4-5 disk is desiccated and reduced in height. Small central posterior disk protrusion is present. there is facet hypertrophy, mild spinal stenosis and mild bilateral neural foraminal enroachment.

    IMPRESSION
    1.SMALL CENTRAL POSTERIOR DISK PROTRUSION AT L1-2
    2.LEFT PARACENTRAL POSTERIOR DISK PROTRUSION AT L2-3, NARROWING THE LEFT LATERAL RECESS AND NEURAL FORAMEN; CONTRALATERAL RIGHT FORAMINAL DISK PROTRUSION AS WELL.
    3.MILD TO MODERATE LEFT PARACENTRAL POSTEROLATERAL DISK PROTRUSION AT L3-4
    4.SMALL CENTAL POSTERIOR DISK PROTRUSION AT L4-5

    All comments welcome!

    Currently I am using 60 mg Kadian bid with 30 mg Roxicodone for bt. Frankly, the Roxis are the only thing that gives me consistant relief. Someone on another board said that I was undermedicated, as hard as it is to believe.

    Also, you would think that since the Oxycodone works best for me, my PM Doc would use OxyContin as my base med, but he will not Rx it.

    Alan

  7. #7
    Alan,

    Reconsider your thoughts of oxycontin as a base medication. I speek from experience. I've been dealing with degenerative disc disease for 28 years. My spine is pretty much trashed from top to bottom.

    I got a RX for oxy in 1997 when it first came out. It was called a wonder drug. It did kill the pain. It also does something they don't tell you about. It is a synthetic version of morphine. Being a synthetic it has the strange ability to actually intensify the back pain you experience. I don't know if it was designed this way or not but it does guarantee that you will continue taking the product,, not because your adicted to it, but, because the pain becomes so much worse the longer you take it.

    I took oxycontin for 10 years!! For the last 12 months I was taking 480 mg per day. The roxi's you are taking are equivelent to about 15 mg of oxycontin.

    The back pain had become so intence, I was also given a RX for Dilodid which is ( mg for mg ) 100 times stronger than oxy. On top of the oxy I was taking 8 mg of Dilodid every 2 hours and 3000 mg of Soma (carisaprodol,,,a mussle relaxer) per day. normal dose is 350 mg bid.

    I stopped taking everything 3 months ago. I had to go to detox cause I was hopelessly adicted as you can imagine. They said they never saw such a violent withdrawal from oxy. After stopping the oxy the back pain subsided. I'm still in a lot of pain but nothing like when I was taking oxy.

    I hope this helps you make a better decission on meds.

    dave
    Last edited by dave823; 01-29-2008 at 11:17 AM.

  8. #8
    My MRI has sad completely flattening the thecal sac and they were not disturbed by that at all, so I guess not.

  9. #9

    narrowing of thecal sac

    Im new to this so please be patient.....
    My 14 year old daughter was diagnosed yesterday with an abnormal kyphosis of the Cspine associated with a posterior disc bulging at C3/C4 and C5/C6 level causing a mild narrowing of the thecal sac.... the Doctor advised us that she must give-up all dancing and sport activities..... can some-one please help me comprehen the severity of this so I can find a way to comfort my daughter. She is an active child that all of the sudden she was advised to give-up 10 years of ballet and jazz dance with plans on dance studies and also volleyball that she adores......

    Of course things could have been worst...... but only us adults can understand that.
    Thank you

  10. #10
    Quote Originally Posted by Ant0niaZ View Post
    Im new to this so please be patient.....
    My 14 year old daughter was diagnosed yesterday with an abnormal kyphosis of the Cspine associated with a posterior disc bulging at C3/C4 and C5/C6 level causing a mild narrowing of the thecal sac.... the Doctor advised us that she must give-up all dancing and sport activities..... can some-one please help me comprehen the severity of this so I can find a way to comfort my daughter. She is an active child that all of the sudden she was advised to give-up 10 years of ballet and jazz dance with plans on dance studies and also volleyball that she adores......

    Of course things could have been worst...... but only us adults can understand that.
    Thank you
    Ant0niaZ,

    The thecal sac is the membrane (called dura mater) that covers the spinal cord. It usually holds the cerebrospinal fluid that surrounds the spinal cord. When there is spinal canal narrowing or a herniated spinal disc that is bulging into the spinal canal, the bone or disc may impinge on the spinal cord. Usually, when a radiologist says "mild" narrowing of the thecal sac, this means that something is just indenting it.

    I am surprised that the doctor is nixing all dancing and sports activity forever. Perhaps he or she is just recommending no sports for a period of time until a followup study can be done to ascertain whether the condition is progressive and requires surgery. The first question that you should ask is whether this condition is progressive. If it is, then surgery may be necessary.

    The levels of the disc hernations (C3/4 and C5/6) are probably what is causing the doctor to be nervous. The breathing centers of the spinal cord are at C3/4 while C5/6 innervates the biceps and wrist extensors. So, if the discs were to herniate further and compress the spinal cord at those levels, there may life-threatening loss of function.

    I wonder why your daughter has this problem? Did your daughter have any neck problems as a baby, have a traffic accident involving the neck, have Larsen's syndrome, Cushing's syndrome, or diastrophic dysplasia? Larsen's is a genetic condition associated with abnormal vertebral development, knee dislocations, and club feet. Cushing's syndrome results from excessive cortisol due a pituitary tumor secreting ACTH. People with diastrophic dysplasia have narrow spinal canals, may have dark intervertebral discs (suggestive of early degenerative changes) on MRI, and often have exceptionally wide foramen magnum (Source).

    Does your daughter have low calcium? Some young athletic women suffer from stress fractures of the spine although these tend to occur in the lumbar and sacral spine. There has been a rash of stress fractures in women who are specializing in one particular sport, such as running, tennis, gymnastics, basketball, or volleyball. Women athletes need to cross-train and take 1200-1500 milligrams of calcium and 800 international units of vitamin D3 daily (Source).

    Did your daughter have pain or a neurological deficit that prompted the visit with the doctor? If so, the compression of the spinal cord may have been more significant that it appears on the MRI. MRI's are only a snapshot of the structure in one position (usually lying down). It may be different when the neck is up and supporting the weight of the head. If your daughter has any of the above predisposing condition to cervical kyphosis, I think that the better part of valor would be for her to find some other activity that that involve less stress of the neck, at least until appropriate corrective actions can be taken.

    The cervical spine normally has a lordotic curve, i.e. the curve goes towards the front. Kyphosis occurs when a vertebral body or disc has been damaged. The collapse of the damaged disc or vertebra causes a kyphotic curve that is convex towards the back. In the case of your daughter, she seems to have damage to discs at C3/4 and C5/6, enough so that the discs are actually herniating into the spinal canal and pressing against the spinal cord.

    Should surgery be done? Removing herniated portions of the discs is not difficult. Likewise, the spine can be fused at C3/4 and C5/6 so that these two levels will not pose any more risk. However, fusions reduce flexibility of the neck and concentrate movements of the neck on remaining moving joints of the neck. This may cause more stress and wear on the other vertebral levels. So, most experienced surgeons are reluctant to fuse unless there is neurological deficits.

    In summary, this is a potentially dangerous condition and one that should be taken seriously. I am a little surprised that the doctor nixed all dancing and sports, especially since your daughter is considering a career in dance. On the other hand, she has a cervical kyphosis and disc herniations at two levels. This is not something that should be ignored. I wonder why your daughter has this condition and tried to suggest a couple of possible reasons If she has neck pain now, a cervical collar, rest, and re-evaluation after 6 months may be a reasonable approach.

    Wise.
    Last edited by Wise Young; 12-05-2008 at 07:00 AM.

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