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Thread: Mary-on-Wheels: Decompression & Smoking

  1. #1

    Mary-on-Wheels: Decompression & Smoking

    From MaryonWheels:

    Wise,
    I have had CT lumbar with contrast. They had to tilt me 70-degrees. The contrast colum became obstructed at T10 also radiographs were obtained as well as ct scanner of mid and lower thoracic and lumbar spine. I have had posterior fusion by rods and transpedicular screws. They found that there is a moderate kyphotic deformity created in the lower thoracic spine where a presumed severe compressure fractuere involveds T10. There is a complete obstrution of the spinal canal due to posterior protrudind bone fragment into the canal , particularly on the left which prevents the contrast from extending above the T9-T10 level. It said that if surgery is concerded then correlation with radiographs and appropriate level is strongly recommended.

    The DR that said he would take all of this out of my back never looked at this. You know I will show him. I have postponed this surgery for three months but The pain is excrusiating. The screws catch on flesh when I streach or bend at T8&9. Where I have a 30 degree curve It has started to hurt day and night where I use to get relif when I layed down. At the curve it feels like sand paper is being rubbed on that area and keeps me awake at night.
    Different subject: Can you tell me what smoking cigarettes does to people with sci? Because my legs are freesing cold and kinda hurt when I pick one up.
    My guestion is can you explain all this to me? What the bone frag. could cause. What if they take it out.
    The ortho DR I have is very good and his colleague which is simi retired speciality is scolioses. But he does not explain anything. He said he didn't know if it would help or not.
    What guestions should I ask? I just want to be active again.
    Thanks Wise

    Mary Sibley
    Mary, I am glad that you got the contrast CT study. I think that it provides a strong reason for doing the surgery, in addition to all the other symptoms that you have described. You should not be delaying. I think that it should help. In any case, you don't want to leave your spinal cord compressed. Note that if they reduce the kyphosis and decompress the spinal cord, they may have to leave some of the instrumentation on board. You should ask them whether they are planning to take out the fragment, whether they will approach this from the front or back, and what instrumentation they will take out and what they will put in.

    I think that people with spinal cord injury should not be smoking cigarettes for the following reasons:
    1. It greatly increases the risk of bladder cancer, particularly in people who have indwelling catheters. Some studies suggest that the incidence of bladder cancer in people with SCI who smoke may be as high as 4%. That is about 1 out of 25 people. That risk is high.
    2. Smoking is not good for your lungs. People with higher thoracic and cervical spinal cord injury, smoking and compromise of coughing function, are sitting ducks for pneumonia. That is not good, as you know. In addition, smoking increases your risk for lung cancer.
    3. Smoking reduces healing rate after surgery. If you are going to undergo surgery, you should stop smoking.
    There are many other reasons of course but if the above three should be more than enough.

    Wise.

  2. #2
    good luck Mary

    stop smoking too

  3. #3
    He said he would be going in from the back. He would be taking equipment out not puting any in but maybe leaving some where needed. Also, that he might be adding bone to fuse.
    Yes, smoking is so stupid. If God intended for us to blow smoke out he would of made us a Dragon.
    Thanks, Mary

    Mary Sibley

  4. #4
    DR Wise,
    I dropped you a note in the wrong place.I'm not sure if you got it. So, I will try again.I really need to learn how to use this web-site.
    I got the result of my mri and it said marked thoracolumbar scoliosis with hardware at t8-L2. Old compression fracture ofthe vertebral body of T10 is noted with mild retropulse encroaching the canal and there appears to be sibilance of the cord. Due to scoliosis these strustures are not in alignment.There is a slight disc bulging that appears to be located between T7-T8,.slightly encroaching the anterior epidural space. Can you tell me what all this means and what kind of trouble this can cause me. I don't know what to ask or how to talk to this neuro-surg. He said that he didnot mind going in after the orto got through but didnot want to make things worse. Said that it could tear the cord and did not know if it would do any good. Dr Wise I am on a mission for my life or a better quality of life. I use to be more active. I am getting an app. at LSU in Shreveport, LA. with neuro-surg. If you have any suggestions I would so appreciate it. Should I go to Dallas or am I over reacting? Could you tell me your oppion of phantom pain?
    Thank you, Mary

    Mary Sibley
    Based on my reading of the description of your mri scan, it does not appear that you have significant compression of your spinal cord. You may have some disc bulging at T7-8 and the description suggest some encroachment on your canal but this may not necessarily mean compression. It sounds as if your neurosurgeon may be willing to operate after the orthopedic surgeon places his instrumentation. However, given the apparently minor compression (if any) of your spinal cord and the lack of any specific structural repair, he is correct to warn about side-effects.

    It is hard to tell whether your pain is due to the scoliosis and is nociceptive pain (i.e. pain that is coming from your scoliosis, disc, and instrumentation) or neuropathic pain. If it is nociceptive pain, removal or revision of the instrumentation may help reduce the pain. If it is neuropathic pain, removal of the instrumentation may not help.

    I am confused by your description because in the contrast CT scan, you had earlier described a complete obstruction of the spinal canal and the presence of a posterior protruding bone fragment into the canal. However, in your most recent MRI description, there was no mention of either of these. Were they fixed? What happened?

    All the above illustrates why it is a bad idea to try to evaluate medical conditions with fragments of conversations and incomplete descriptions of imaging studies. You really must find a doctor that you trust and spend enough time with the doctor to figure out what is going on with your spinal cord, and come up with a rational plan of action with backup choices.

    Wise.

  5. #5
    DR Wise
    The mri is over a year old and the ct was done four months ago.

    Mary Sibley

  6. #6
    Mary, if the CT scan is the most recent study and it shows a complete block, I think that you should get it fixed. Wise.

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