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Thread: Can Thecal Sac Injury Lead To Paralysis?

  1. #11
    Quote Originally Posted by Wise Young View Post
    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.
    Wise Firstly let me thank you for your wise explanaitions.

    It all started on the 17th of November when she first complained about headeache and numb right arm and leg. We visited our pathologist where all seemed ok so he suggested a rest and to take a paracetamol..... as by the evening the pain and numbness was still there I took my daughter to our Cardiologist where the ultrasound and the heart test were normal ..... she did compalin of pain on her neck so he suggested an x-ray which we had the following morning ..... where it showed the Kyphosis.

    The orthopedics suggested time off ballet and physiotherapy, considering that since October 2007 we had some problems with dislocations he suggested we visit a rhematologist for some rheumatology tests...... [right wrist dislocation, left foot dislocation, left wrist dislocation, right foot dislocation, left foot dislocation and right wrist dislocation (with the last one on the 26th of October 2008)]
    We never manage to go to the rheumatologist as on top of the headeaches, numb arm and leg she was feeling dizzy and she had blured vision so our Pathologist suggested that we go for an opthalmical check-up and a neurology check-up.
    The Eye check-up was ok so were the nerves of the eyes.
    [Let me add here that 4 years ago my daughter did have a similar crisys of headaches, dizzyness and blured vision and that was blamed to stress due to school pressure.]
    We visited a local neurosurgeon where he was told the whole history of what was happening latetly, he made varius questions, asked whether we have a MS history (we only have a S.L.E. and B.C. history). Reflex tests and as there was an unsteady walk, less sensitivity on the right side and he suggested an MRI scan so he can evalluate the situation. Let me also add here that the morning before the visit my duaghter fainted (1st time) during the Gym lesson (i believe u call it PE) with the teacher saying to my daughter to stop complaining and that she only uses the 30% of her lungs strength!! The good thing was that we were able to have the MRI there and then.

    The Brain MIR was clear and OK so they perforemd a Spine MRI which gave those results. Can an MRI test be wrong????????

    She wasnt invovled in a serius car accident ... as an active child she did hurt herself but we always had x-rays and checked everything. The only times I can think of that she had no x-rays were: 1. when she hurt her shoulder in a playground about 8 years ago and we only had an x-ray of the shoulder. 2. The time she hurt while playing at school 7 years ago where I was only inforemed after school day was over and she didnt complain about any pain and 3. (the most recent one) when she was kicked on the spine during school sports and she said that she lost her breath but no other complaints.


    Ballet is a gentle dance but they do have some awkward head positions and when they start with point shoes they do need strong ankles (this is our 3rd year on pointshoes) and to be honest I dont know the pressure, that can put on the spine. Modern/Jazz dance is more active with more awkward head positions. I do thank my insticts for not letting her start hip-hop dance this september..... Maybe know she can review her other interests.....

    To be exact he didnt suggest forever... but untill she is fully grown...to my daughter and me, it does look like forever. But if you ask me I agree all the way.... especially of when I think of what happend on Wednesday with the PE teacher brushing it off as a plain complaint......... I think today I was a bit harsh with him and I have all the rights of the world. This is my only child we are talking although Im not known about being over-protective, but any injury should be carefully evaluated before brushing it off as a complaint or get-away excuse. To be honest this stresses me more now as she is a very active teenager with many interests.

    Maybe he is more nervous as usuall considering that basketball, volleyball and football/socker arent the gentliest sports with jumps/kicks and balls flying around. Im not gonna mention the school bags that weight 30 kilos on a light day...... its 45 on a heavy day (my daughter only weights about 50kgs and she is 1.54 high). Also as some people will not understand the depth of damage can cause a possible injury.... I know for sure my daughter hasnt really comprehend the whole situation.... I had to find slides of the spine and the thecal sac to show her, so she can comprehen the situation .... I know its not easy all of the sudden to be robbed of your dreams but she is alive and healthy...... and thats moe important than all the dances and sports.
    She has to wear a collar for 1 month and then we will visit again for a re-evaluation ..... I did forget to ask if she can have some physiotherapy to ease the pain she is still feeling, although today with the spine collar she didnt have all the strong pains she had the previous days.
    I believe that she can swim.... although Im 100% sure that diving is out of question.....

    I will have to look up the Larsen's syndrome, Cushing's syndrome, or diastrophic dysplasia? As this is the first time I come accross these....

    Thank you

    Antonia
    Last edited by Ant0niaZ; 12-05-2008 at 03:08 PM.
    Anima Mia, Vola Via!

  2. #12
    I didn't take time to read through this entire post, but I would give you this advice: Be careful with herniated discs! Chronically herniated discs can cause calcification. I received my SCI because of a calcium deposit that broke when I bent over and tried to pull some wet laundry out of my washing machine.
    "The truth will set you free. But first, it will piss you off." -Gloria Steinem

  3. #13
    Quote Originally Posted by Ant0niaZ View Post
    Wise Firstly let me thank you for your wise explanaitions.

    It all started on the 17th of November when she first complained about headeache and numb right arm and leg. We visited our pathologist where all seemed ok so he suggested a rest and to take a paracetamol..... as by the evening the pain and numbness was still there I took my daughter to our Cardiologist where the ultrasound and the heart test were normal ..... she did compalin of pain on her neck so he suggested an x-ray which we had the following morning ..... where it showed the Kyphosis.

    The orthopedics suggested time off ballet and physiotherapy, considering that since October 2007 we had some problems with dislocations he suggested we visit a rhematologist for some rheumatology tests...... [right wrist dislocation, left foot dislocation, left wrist dislocation, right foot dislocation, left foot dislocation and right wrist dislocation (with the last one on the 26th of October 2008)]
    We never manage to go to the rheumatologist as on top of the headeaches, numb arm and leg she was feeling dizzy and she had blured vision so our Pathologist suggested that we go for an opthalmical check-up and a neurology check-up.
    The Eye check-up was ok so were the nerves of the eyes.
    [Let me add here that 4 years ago my daughter did have a similar crisys of headaches, dizzyness and blured vision and that was blamed to stress due to school pressure.]
    We visited a local neurosurgeon where he was told the whole history of what was happening latetly, he made varius questions, asked whether we have a MS history (we only have a S.L.E. and B.C. history). Reflex tests and as there was an unsteady walk, less sensitivity on the right side and he suggested an MRI scan so he can evalluate the situation. Let me also add here that the morning before the visit my duaghter fainted (1st time) during the Gym lesson (i believe u call it PE) with the teacher saying to my daughter to stop complaining and that she only uses the 30% of her lungs strength!! The good thing was that we were able to have the MRI there and then.

    The Brain MIR was clear and OK so they perforemd a Spine MRI which gave those results. Can an MRI test be wrong????????

    She wasnt invovled in a serius car accident ... as an active child she did hurt herself but we always had x-rays and checked everything. The only times I can think of that she had no x-rays were: 1. when she hurt her shoulder in a playground about 8 years ago and we only had an x-ray of the shoulder. 2. The time she hurt while playing at school 7 years ago where I was only inforemed after school day was over and she didnt complain about any pain and 3. (the most recent one) when she was kicked on the spine during school sports and she said that she lost her breath but no other complaints.


    Ballet is a gentle dance but they do have some awkward head positions and when they start with point shoes they do need strong ankles (this is our 3rd year on pointshoes) and to be honest I dont know the pressure, that can put on the spine. Modern/Jazz dance is more active with more awkward head positions. I do thank my insticts for not letting her start hip-hop dance this september..... Maybe know she can review her other interests.....

    To be exact he didnt suggest forever... but untill she is fully grown...to my daughter and me, it does look like forever. But if you ask me I agree all the way.... especially of when I think of what happend on Wednesday with the PE teacher brushing it off as a plain complaint......... I think today I was a bit harsh with him and I have all the rights of the world. This is my only child we are talking although Im not known about being over-protective, but any injury should be carefully evaluated before brushing it off as a complaint or get-away excuse. To be honest this stresses me more now as she is a very active teenager with many interests.

    Maybe he is more nervous as usuall considering that basketball, volleyball and football/socker arent the gentliest sports with jumps/kicks and balls flying around. Im not gonna mention the school bags that weight 30 kilos on a light day...... its 45 on a heavy day (my daughter only weights about 50kgs and she is 1.54 high). Also as some people will not understand the depth of damage can cause a possible injury.... I know for sure my daughter hasnt really comprehend the whole situation.... I had to find slides of the spine and the thecal sac to show her, so she can comprehen the situation .... I know its not easy all of the sudden to be robbed of your dreams but she is alive and healthy...... and thats moe important than all the dances and sports.
    She has to wear a collar for 1 month and then we will visit again for a re-evaluation ..... I did forget to ask if she can have some physiotherapy to ease the pain she is still feeling, although today with the spine collar she didnt have all the strong pains she had the previous days.
    I believe that she can swim.... although Im 100% sure that diving is out of question.....

    I will have to look up the Larsen's syndrome, Cushing's syndrome, or diastrophic dysplasia? As this is the first time I come accross these....

    Thank you

    Antonia
    The repeated dislocations suggest that she may have a predisposing reason for the disc herniations. Let me post later about this in detail. Wise.

  4. #14

    cervical issues continues

    Wise,
    How the warm applications can help?
    or the Spinal gymnastics for the training of the spinal muscles?

    A Visit to a german N.S. placed light as to how it happend.... my daughter was born like that...and he also insisted on giving up dance lessons...... and practically anything that has jumps...
    Anima Mia, Vola Via!

  5. #15
    Quote Originally Posted by Ant0niaZ View Post
    Wise,
    How the warm applications can help?
    or the Spinal gymnastics for the training of the spinal muscles?

    A Visit to a german N.S. placed light as to how it happend.... my daughter was born like that...and he also insisted on giving up dance lessons...... and practically anything that has jumps...
    Sorry that I did not post some more on the subject as I promised. The fact that your daughter has serious spinal problems at a young age suggests that presence of a genetic disorder where she is not producing normal cartilage and bone. There are many such conditions.

    Warm compresses may help relax the muscles if she is very tense but this would be mostly for comfort reasons. I don't think exercise of the neck will help and, if overdone, may be harmful.

    Wise.

  6. #16

    AntOniaZ

    AntOniaZ: You mentioned your daughter has also had chronic dislocations. Did they test her for Ehlers-Danlos Syndrome? Check this out for more information: http://en.wikipedia.org/wiki/Ehlers-Danlos_Syndrome Overstretched ligaments don't support the skeleton properly which can lead to dislocations and cervical spine instability which would allow the spine to move out of position more easily. It can also cause headaches and vision problems among other neurologic issues since too much movement of the spine may cause it to basically shift more than it should and affect surrounding nerves and also cause muscles to tighten more to try to hold it in place since the ligaments aren't doing their job. (very basic explanation).

    If she were found to have this, there isn't a cure; BUT there is a procedure called prolotherapy that my daughter and I have had for overstretched ligaments due to injuries. It helps by strengthening the ligaments. There is a lot of information on the internet about this.

    One other thing, I have a straightening of the cervical spine (lordotic curve), disc herniations, bone spurs, spinal stenosis etc... and have had headaches and other symptoms for several years believed to be caused by a car accident. The prolotherapy has helped some of my symptoms since the ligaments in my neck became overstretched by whiplash, but I still have pressure in my head. I am considering artificial disc replacement of two discs in my neck since I was told that the blockage of the cerebrospinal fluid and indention of my spinal cord may be what is causing it. I pray you find answers and solutions quickly for your daughter - I know how frustrating it can be.

  7. #17

    Exclamation Ant0niaZ, Be Careful about Ballet

    Quote Originally Posted by Ant0niaZ View Post
    Wise, Firstly let me thank you for your wise explanaitions...


    Ballet is a gentle dance but they do have some awkward head positions and when they start with point shoes they do need strong ankles (this is our 3rd year on pointshoes) and to be honest I dont know the pressure, that can put on the spine. Modern/Jazz dance is more active with more awkward head positions. I do thank my insticts for not letting her start hip-hop dance this september..... Maybe know she can review her other interests.....

    Antonia
    Hi, Antonia,

    I feel for your daughter. I agree with Wise that what she has going on sounds serious.

    Actually, ballet is not gentle, especially en pointe. While beautiful to watch (unless you know what's really going on), ballet can ruin spines, hips, ankles, feet. Ballet trains dancers to be able to do things bodies are not naturally meant to do. From destabilizing the pelvis and spine due to hyper-turnout of hip flexors (and more); to toe shoes automatically throwing the spine out of whack; to neck attitude that is hard on C-spine discs; to poor movement -- like relying too heavily on momentum and leverage instead of muscle strength and proper posture. It can ruin a body, especially if not augmented by something like carefully instructed classic Pilates.

    Once begun, the wear and tear only exacerbates unless the dancer stops dancing. Have you ever read American ballerina Gelsey Kirkland's book Dancing on My Grave? She quit ballet about 30 years ago. She now teaches ballet in Australia, so I assume she has learned to teach in a way with proper kinesiology in mind.

    Did I read a few posts back that your daughter is 14, and has been studyiing ballet for ten years? If true, potentially I say Yikes! I'd have to know more, but if she's been pushing herself hard from a young age, that could account for a lot -- especially en pointe. That's not to suggest she doesn't have some other process/es going on.

    Her contact sports are, as you already identified, problematic. Sounds like she needs to lay off activity as recommended by your doctor. I know what it's like as an adult to be forced to give up vital activities upon which your happiness depends, so I do not say that lightly. As a child used to doing all those things, it will hurt. At times it might be confusing.

    On the other hand, kids can be pretty adaptable. You and your daughter have quite a journey. You'll learn things along the hard way, sorting out what's what. Care providers aren't always right, and aren't always right for each person. But best that at 14 your daughter begin this journey now while she can absorb information quickly and make changes as you discover to be appropriate.

    Best to her, and to you.

    MrsPeel

    P.S. What Wise says. I wish I'd had his wisdom when I ran into trouble seven years ago.

  8. #18

    Unhappy Really really nervous

    Hello again-- I am very very nervous---I have written before BUT I need some expert advice Please. My MRI taken on 1/26/2010 - says as follows-- PLEASE READ--
    1.Schmorls node formation is seen along the superior endplate of L1,L2 and L3.
    L1-2 -there is a reduction in disc signal intensity.There is a disc bulge but no evidence of foraminal or thecal sac impingement.

    L2-3 There is a central disc herniation with anterior thecal sac impingement. There is left foraminal impingement. There is no right foraminal impingement.

    L3-4 There is a disc bulge and bilateral foraminal impingement. There is no thecal sac impingement.

    L4-5 There is a disc bulge and bilateral foraminal impingement. There is no thecal sal impingement.

    L5-S1.-There is no bulge or herniation. There is left sided facet hypertrophy resulting in left foraminal impingement.

    I went to an orthopedist and he does not seem worried???
    I am also getting treatment from my Chiropractor/sports MD(traction to decompress the spine and TENS and ultrasound) who also does not seem worried???


    BUT - today after initially geting this injury about 3 and 1/2 weeks ago-lifting a heavy weight.. I am again in severe discomfort - due to my having to shovel snow in NY- used the snow blower- but had to help my inlaws--- and had to pick up the snow blower and put it into my car- to bring it to their home-- suffice it to say-- I am back to square one- with my pain that had subsided a bit since the injury first happened.

    So I was at a family gathering today and my brother-in-law was there. He is a very good attorney and I might add a very smart man- REALLY smart. I told him about my injury and he recommended I see a doctor in NYC at the hospital for special surgery as a second opinion!! The name he gave me is ----

    Dr. Patrick F. O'Leary
    1015 Madison Avenue
    New York, NY 10021


    My brother in law being an attorney has handled many many accident cases and he says that this doctor has treated many of the sports figures that we all know about. He said anyone from his practice is very good at what they do. When I sent my brother -in-law a copy of the MRI- he seemed to be more worried about my condition than the doctors I have been too up to this point in time.
    If I may- here is the response from my brother-in- law to my MRI finding--- please read his response below-------

    "As you know I am not a medical doctor. However, for what it is worth, in addition to having a central disc herniation at L2-L3, this herniation also impinges on the thecal sac. Further, your disc bulges are not simple bulges, Your bulges impinge on the foramina, bilaterally. (Without reading a medical reference, I don't know the ramifications of the multi- level Schmorl's node formation.
    Bottom line, I believe that what they will do for a proper diagnosis is to try to track the pain existing pain paths. If this proves too difficult because of the multi-level disc programs, they may suggest performance of a discogram. This is an old procedure - "tried and true" according to many othopedic surgeons. This is a minor surgical procedure done under a very controlled setting where the surgeon tries to duplicate the pain you are experiencing by stimulating nerves at various disc levels so as to determine which particular problem is the cause of your pain. "

    Now here is my dilemna-- Both the orthopedist I am seeing and the chiropractor- have not said anything to me even resembling what my brother-in-law is saying!! Why not-- is my brother-in-law wrong -- or are the doctors taking this too lightly. I mean I am in a ton of discomfort-- and really need this fixed.
    If you can - in laymans terms and I mean in laymans terms- tell me what my brother-in-law is saying I would appreciate it. About this discogram?? and duplicating the pain to find out what?? and how dangerous is this procedure???

    My brother-in-law says that now they can fix herniations with a microdisectomey--and they have this laser procedure and they have this glue that they now use that is almost like bone???Not saying that I have to go this way-- but from what you read of MY MRI results-- how worried would you be??-- also as of now I have NO leg pain at all!!! My pain is felt right at the top left part of the pelvic area--and no place else- but can that change--??

    I know that this is a long letter- but I really want to stop this injury and it effects on me ASAP--- please explain all what I have written about above and let me know if you know of this MD in NYC-- and tell me who is closer to being correct about my condition-- my chiro and ortho- who do not seem too worried-- or my brother- in law- who seems a bit more alarmed???
    Thanks so much for your patience--

    As I sit here very nervous and worried- I fear always the worst and am crying uncontrollably.
    I await you reply with trepidation.

    P.S.-- I just read about microdisectomey on the spine-healt site- BUT it keeps saying that this procedure will stop all leg pain caused by the nerve-- AGAIN - I want to repaeat that as of right now-- I have NO leg pain at all!! So I am totally confused....!!!????????I really need some sort of professional exp,lanation before I see this new MD- Please reply.
    Last edited by montek; 02-15-2010 at 12:29 AM. Reason: more info

  9. #19

    Question

    my MRi says ive got a benign anterior wedge "compression fracture" at the T8 there is disk desiccation at the T7-8 T8-9 with intervertebral disk space narrowing at the T7-8. there is buldgeing at the T7-8. There is elivation of the posterior longitudinal ligament and impingment upon the ventral sac. There is approxamation of the spianl cord. Bilateral nural foraminal stanosis.
    T10-11 Right nural forminal stenosis
    cervical spine there is congenital narrowing of the spinal canal." there is streigtening of the cervical spine sugestive of underling musscle spasm.
    in the lumbar total buldging disks T4-5 T7-8 T9-10 T10-11 angular disk buldging L3-4 L4-5 L5-S1
    there is marked imingment of the bilateral lateral recesses but my first question is there is no significant "spinal stenosis" this might be becuse the impingment of the bilateral lateral recesses has to be quite severe to be considered stenosis? the congenital narowing of the cervical spine is that short pinical syndrome " stenosis"? and what is approxamation of the ventral spine. Why dose the Dr say that aint that bad? Is he just useing some kind of funny statement or just being plain neglegent?bilateral lateral recesses and congenital narowing of the cervical spine why dont my mri say cervical spinal stenosis? like the thorasic spine say's stenosis? im 29.
    My dr dint mention paralisis and the ortho i went to played dumb like i could shake it off. that should be mentioned so ill let you know? wolfmute@live.com
    thank you

  10. #20
    Wolfmute - you are reading your MRI report which was dictated or written by a Neuroradiologist. He sits in a dark room in a nice chair, possibly an Aeron chair, and looks at shadow pictures all day. He doesn't examine or talk to patients except when they are on the gurney and he threads a catheter up their groin artery and squirts some dye up there.

    On the other hand, your neurosurgeon or spine surgeon sees, examines, operates, and follows patients. He sees what is written on the films and most often looks at the films and makes his own opinion and reading. His opinion is based on the accumulated experience of seeing real people in the flesh over time. Included in that is the accumulated experience from operating and actually looking at the tissue and spinal abnormalities , doing surgery, and then following these people over time and correlating the MRI findings to what he sees in surgery and then how the patients fair over time.

    The neurosurgeon's interpretation of your MRI is more important. He has examined you and can tell you what on the MRI is clinically relevant. Now this is assuming that he is an experience, thoughtful, neurosurgeon. That may not be the case and it is not uncommon that people go get a second or third opinion.

    In summary, I just wouldn't hold the neuroradiologist's reading as gospel necessarily. He is not a 'clinician'.

    Is your neurosurgeon a good communicator? Does he have a good reputation? What about getting a 2nd opinion?

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