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Thread: Is this a cord injury or peripheral?

  1. #1

    Is this a cord injury or peripheral?

    Two and a half years ago my husband was hit by a car impacting his sacrum. He was catapulted and hit the ground in a sitting position. Spinal injuries were suspected but (despite obvious chance-burst fractures and malalignement at T11&12) they reported no bony injury and sent him home unable to walk. His buttocks were numb.

    He did did not urinate for 2 days but when it started he had to wait for half an hour for it to get going. It took 3 weeks to start passing stools but there was deminished control over this. We asked for an mri but were not allowed one. Seconds xrays reported satisfactory alignment and no loss of disc space height (the kyphosis had progressed from 12-40o by this stage and the 50% loss in vertebral body height had increased to 80%. At this time, leg and calf started going numb. His legs went pink then red then bruised. D-dimer was -ve. No action was taken. Tried to see a neurologist but sent for more xrays. Damage (fractures) to all vertebrae between T5-T12, L5 and sacral fracture at L3 seen.

    Having only the initial xrays to go from (canal now seems to have remodelled significantly) it looks like T12 was pushed into the canal taking up around 60% of the space on the initial xray - now it is only deforming the thecal sac and stops just short of the cord but also looks only to be 10% into the canal on x-ray now. T11 was also pushed back but crushed into the canal losing depth to the vertebral body and the whole cord area looks white on the xray presumably from the fragements. The discs seemed to remain in their original position while the vertebrae were pushed back. MRI's were done over a year post injury. They could not see any cord damage. Perhaps a slight disc problem - bulging at L4/5? Slight bulges of some thoracic discs.

    They are saying that they do not think they missed a cord injury but that the buttock problems are peripheral. It does not correlate well with the area of bruising but doesn't match a dermatome either. It has improved but is still numb all this time later. Had first incident of urinary incontinence recently. Usually its hard to get going but that had improved a lot. Wondering why the incontinence could have occured now.

    The back is still very sore. It hurts on movement, especially twisting when it clicks a bit. Bumps and potholes are painful when travelling in the car. They say it is too late for an operation. That everything will have formed callus by now & dangerous to chip apart. Is that sort of pain on jarring and twisting normal 2.5 years post injury?

    The other problems are with breathing - sleep apnea with SpO2 dropping to 70, pulse drops to 40's at the same time. No breath for up to 50 seconds repeatedly for hours. No sign of any chest movement or struggling to breath during the apneas. Pulse rises to 80's just before breath is taken. Also chokes in sleep. Fluid (sometimes reflux) goes into trachea and then gasping and making whooping noises as he tries to get air in but can't. They say they dont think it is obstructive apnea and they dont think he was unconcious long enough for it to be brain damage. Breathing problems and choking also happens in the day. His Sp02 drops to 80's and pulse to 40's and he struggles to breathe. He is also very tired and sleeps 15 hours a day on average. At its worst it was 20 hours a day. His memory is poor and he gets confused easily - its not exteme so many docs don't notice anything but its a big difference from pre accident. He falls asleep at the drop of a hat, mid conversation, mid drink etc and he does not wake to alarms, kids screaming and shouting or gentle patting on the arm. I can hoover around him fine. Hes been on Oxycontin 20mg for 2 years. They blame it all on this. Anyone had these problems on oxy? The problems predated the oxy. He started on Voltarol then tramacet. He slept like this since I picked him up from the hospital (they had dumped him in a wheelchair in reception after an hour of their 'care').

    Another problem is that he stumbles and falls all the time. He is clumsy and walks into things. Mostly he falls forward but on falling sideways he falls like a skittle - rigid like he is an inanimate object.

    He walks with sticks - leaning forward helps the pain and the sticks help in case of falls - but he can't go far due to the jarring causing pain in his back. His legs still go red and swollen - they think due to reduced activity but it does not correlate well with low activity.

    I havn't much faith in the doctors opinions. They got it all so wrong in the early days. I don't think they are investigating the problem properly now. Recently they recorded the choking episodes as coughing fits. He virtually never coughs. He seems to have a very supressed cough reflex. They do not listen and I think they think we exagerate such events. Has anyone any ideas what might be causing all these problems?

  2. #2
    Tab, I can't help you with all the obvious technical stuff you need info on, but I do have a question. Where the heck did this all happen and which hospital did you go to? Please tell me it wasn't Memorial in Springfield IL?

    I can't imagine being treated like this, well, maybe I can.

  3. #3
    The sacral injury resulting in the butt numbness, the temporary inability to urinate and pass stools, is probably peripheral. The reason why I say this is because an injury at T11/T12 would result in paralysis of the legs. However, they should have stabilized the T11/T12 to prevent development of kyphosis. That is very likely to have resulted in the pain.

    The problems with breathing and sleeping are worrisome. Likewise, the memory problems and clumsiness is suggesting a different problem that is not related to the spinal cord. They may be drug related. Although you mention oxycontin, is he taking other drugs, including sleeping pills? Has he been exposed to environmental toxins?

    Wise.



    Quote Originally Posted by tab70
    Two and a half years ago my husband was hit by a car impacting his sacrum. He was catapulted and hit the ground in a sitting position. Spinal injuries were suspected but (despite obvious chance-burst fractures and malalignement at T11&12) they reported no bony injury and sent him home unable to walk. His buttocks were numb.

    He did did not urinate for 2 days but when it started he had to wait for half an hour for it to get going. It took 3 weeks to start passing stools but there was deminished control over this. We asked for an mri but were not allowed one. Seconds xrays reported satisfactory alignment and no loss of disc space height (the kyphosis had progressed from 12-40o by this stage and the 50% loss in vertebral body height had increased to 80%. At this time, leg and calf started going numb. His legs went pink then red then bruised. D-dimer was -ve. No action was taken. Tried to see a neurologist but sent for more xrays. Damage (fractures) to all vertebrae between T5-T12, L5 and sacral fracture at L3 seen.

    Having only the initial xrays to go from (canal now seems to have remodelled significantly) it looks like T12 was pushed into the canal taking up around 60% of the space on the initial xray - now it is only deforming the thecal sac and stops just short of the cord but also looks only to be 10% into the canal on x-ray now. T11 was also pushed back but crushed into the canal losing depth to the vertebral body and the whole cord area looks white on the xray presumably from the fragements. The discs seemed to remain in their original position while the vertebrae were pushed back. MRI's were done over a year post injury. They could not see any cord damage. Perhaps a slight disc problem - bulging at L4/5? Slight bulges of some thoracic discs.

    They are saying that they do not think they missed a cord injury but that the buttock problems are peripheral. It does not correlate well with the area of bruising but doesn't match a dermatome either. It has improved but is still numb all this time later. Had first incident of urinary incontinence recently. Usually its hard to get going but that had improved a lot. Wondering why the incontinence could have occured now.

    The back is still very sore. It hurts on movement, especially twisting when it clicks a bit. Bumps and potholes are painful when travelling in the car. They say it is too late for an operation. That everything will have formed callus by now & dangerous to chip apart. Is that sort of pain on jarring and twisting normal 2.5 years post injury?

    The other problems are with breathing - sleep apnea with SpO2 dropping to 70, pulse drops to 40's at the same time. No breath for up to 50 seconds repeatedly for hours. No sign of any chest movement or struggling to breath during the apneas. Pulse rises to 80's just before breath is taken. Also chokes in sleep. Fluid (sometimes reflux) goes into trachea and then gasping and making whooping noises as he tries to get air in but can't. They say they dont think it is obstructive apnea and they dont think he was unconcious long enough for it to be brain damage. Breathing problems and choking also happens in the day. His Sp02 drops to 80's and pulse to 40's and he struggles to breathe. He is also very tired and sleeps 15 hours a day on average. At its worst it was 20 hours a day. His memory is poor and he gets confused easily - its not exteme so many docs don't notice anything but its a big difference from pre accident. He falls asleep at the drop of a hat, mid conversation, mid drink etc and he does not wake to alarms, kids screaming and shouting or gentle patting on the arm. I can hoover around him fine. Hes been on Oxycontin 20mg for 2 years. They blame it all on this. Anyone had these problems on oxy? The problems predated the oxy. He started on Voltarol then tramacet. He slept like this since I picked him up from the hospital (they had dumped him in a wheelchair in reception after an hour of their 'care').

    Another problem is that he stumbles and falls all the time. He is clumsy and walks into things. Mostly he falls forward but on falling sideways he falls like a skittle - rigid like he is an inanimate object.

    He walks with sticks - leaning forward helps the pain and the sticks help in case of falls - but he can't go far due to the jarring causing pain in his back. His legs still go red and swollen - they think due to reduced activity but it does not correlate well with low activity.

    I havn't much faith in the doctors opinions. They got it all so wrong in the early days. I don't think they are investigating the problem properly now. Recently they recorded the choking episodes as coughing fits. He virtually never coughs. He seems to have a very supressed cough reflex. They do not listen and I think they think we exagerate such events. Has anyone any ideas what might be causing all these problems?

  4. #4
    Thanks for the info. He is taking Gabapentin (should be 1800mg but he usually takes 1200mg due to memory problems), and 40mg of Omeprazole - but he only started these a year post injury and the problems were already well established by then. He takes nothing else but did try Fluoxetine (to wake him up they said - it didn't) and Amityrptiline (that resulted in the 20 hours of sleep per day). It happened in the UK - the doctor was a young newly qualified medic (not Homer).
    Last edited by tab70; 03-13-2008 at 03:24 PM.

  5. #5
    Quote Originally Posted by tab70
    Thanks for the info. He is taking Gabapentin (should be 1800mg but he usually takes 1200mg due to memory problems), and 40mg of Omeprazole - but he only started these a year post injury and the problems were already well established by then. He takes nothing else but did try Fluoxetine (to wake him up they said - it didn't) and Amityrptiline (that resulted in the 20 hours of sleep per day). It happened in the UK - the doctor was a young newly qualified medic (not Homer).
    Omeprazole (Prilosec) should not have these types of effects and should be helpful in reducing his esophageal problems. Gabapentin should not have such effects on his brain function. However, if it is not doing him any good, I would probably stop the Gabapentin. It sounds as if his pain is not neuropathic but noxious pain from his T11/T12 deformity. Gabapentin should have little or no effect on noxious pain of this sort and the dose is too low to have much effect. In my opinion, he needs an orthopedic consult to figure out what surgergy can be done to relieve his deformity and pain.

    Wise.

  6. #6
    The gabapentin is for the shooting pains. They go down his thigh from his buttock and up his back from his buttock. They are both intermittent. One day he had sharp pain shooting up his leg - but only the one day. Do you think the Gabapentin could be helping with these? The buttock pain occurs when he sits. The Omeprazole largely controls his reflux but not completely. If he does not take it, he breaths the refluxed fluid into his lungs several times a night. With the Omeprazole it is only once or twice a week.

    He saw a surgeon. He was covering someone temporarily. He offered surgery but then when he left the person who took over signed him off her books without ever having seen him. I think I annoyed her because the x-ray report had said anterior compression fractures and satisfactory alignment and their report just said compression fractures and I asked her to review this diagnosis. I never spoke to her, I just wrote in asking her to review it. I don't think she liked me asking to look at things again. She just said everything was correct (even though the first report that no-one seen until a year after the accident said kyphosis and Chance fractures but the second xray report said anterior compression fractures). We saw another doctor recently and he reported them as burst fractures but he did not do such surgery. It has all been very confusing and the notes still contain all these varying reports. Most people who see them are a bit confused. We hope to see another surgeon soon. The surgery sounds scary though. They made it sound very complicated and risky once things have healed. We looked into a spinal cord stimulator but they said the pain was too widespread and not neurological enough. If he does have the operation but still sleeps all day and can't sit down due to the buttock pain he will still be very disabled. Has anyone had the surgery so long after traumatic injury? How did it go?

  7. #7
    tab70,

    Thank you for describing the pain. Perhaps gabapentin can help that kind of pain although I must say that I am puzzled as to what is causing it. Usually, this kind of intermittent pain comes from compression of the spinal root, sometimes called sciatica. I don't think that it is usually responsive to gabapentin.

    Regarding his back, your description suggests that he has a kyphosis and that he is having trouble walking and sitting, due to the pain. This seems to be sufficient reason to see a surgeon to see if there is anything that can be done to relieve the pain surgically.

    If he has a disc pressing on the spinal cord or a root, it should be removed. If he has a kyphosis that is pressing on his spinal cord or cause tethering of this spinal, it should be corrected. There are many types of surgery and approaches.

    He needs an experienced surgeon to look at it. I am concerned that you are saying that a doctor is "annoyed" because you requested confirmation of a diagnosis. This is what doctors are supposed to do. In any case, you should get another opinion.

    Wise.

    Quote Originally Posted by tab70
    The gabapentin is for the shooting pains. They go down his thigh from his buttock and up his back from his buttock. They are both intermittent. One day he had sharp pain shooting up his leg - but only the one day. Do you think the Gabapentin could be helping with these? The buttock pain occurs when he sits. The Omeprazole largely controls his reflux but not completely. If he does not take it, he breaths the refluxed fluid into his lungs several times a night. With the Omeprazole it is only once or twice a week.

    He saw a surgeon. He was covering someone temporarily. He offered surgery but then when he left the person who took over signed him off her books without ever having seen him. I think I annoyed her because the x-ray report had said anterior compression fractures and satisfactory alignment and their report just said compression fractures and I asked her to review this diagnosis. I never spoke to her, I just wrote in asking her to review it. I don't think she liked me asking to look at things again. She just said everything was correct (even though the first report that no-one seen until a year after the accident said kyphosis and Chance fractures but the second xray report said anterior compression fractures). We saw another doctor recently and he reported them as burst fractures but he did not do such surgery. It has all been very confusing and the notes still contain all these varying reports. Most people who see them are a bit confused. We hope to see another surgeon soon. The surgery sounds scary though. They made it sound very complicated and risky once things have healed. We looked into a spinal cord stimulator but they said the pain was too widespread and not neurological enough. If he does have the operation but still sleeps all day and can't sit down due to the buttock pain he will still be very disabled. Has anyone had the surgery so long after traumatic injury? How did it go?

  8. #8
    Thanks for finding the time to answer my posts. I wish I could ask his doctors but he has not been under the care of spinal specialists who I can ask for around 9 months now. We have been waiting to get a referral but it is a long slow process - we have to ask a GP who will take a while to respond but then get put on a long waiting list then see someone who cant help but will refer us on then get put on another long waiting list etc. I think we are nearly there now but last time we got to see the spinal surgeon we only spoke to him for about 10 minutes. He did write in the notes that although he had not arranged follow up (as he was going to restart physio first (they had stopped that when they discovered the spinal injury) and see how he got on with that) he would see him again if we asked. We did not therefore expect to be removed from their care for asking about the diagnosis. There had been rather a lot of mistakes along the way after all.

    Some doctors are really sympathetic but others seem to assume that the problem must be with us and that the notes could not be wrong.

    I would like the sacrum to be investigated more. We do not know why it hurts his buttock and sends shooting pains up his back when he sits down. We can see a fracture at S3 but that looks to have good alignment. The GP requested a sacral and low lumbar mri but they only investigated L4 and 5 discs instead. On the L5 mri the two wings of the pelvis do not seem symmetrical and when they did this disc they visualised the very top of the sacrum. It looked a little forward on the sacroiliac joint but I do not know if these are both within normal variations. As the mri's were taken over a year post injury I suppose it is hard to know what is going on. We only have a few xrays from the accident and they are not very clear. We just know the pain has not gone away as expected. The sacral pain was by far the worst in the early days. They say this is why they missed T12 but they did not examine L5 clearly either and they only xrayed S1, missing the S3 injury. We now know T12 was bad and progressing so what was going on with the sacrum to make it hurt more and why does it still hurt so? So long at there is no neurological progression no-one seems very interested in finding out why he is in pain. They would rather suggest he is depressed. As their records show he complained bitterly about this pain in his sacrum and only a little about the T12 pain from the day of the accident I can not see how that could make sense.

    His legs swelled after the accident but were functional (he crawled into the house on them on the day of the RTA). He could not bear weight on them because of his pain. The bruising tracked down his legs reaching his left foot a month post injury. A week later it was fading and had gone by about 6 weeks post but they then swelled again when his physio pushed him to try and walk daily. It was when he did that he started to loose feeling in his foot and calf. It goes numb sometimes and tingles sometimes. The exact position changes. Most recently it was on the top of his foot just above the normal area. His legs were very itchy when the redness first occured and the initial pink cross hatch pattern looked bruised after a few weeks. They are now just a little redder than the rest of his leg but still swell up. He wears stockings to help with the swelling but one time the area under the stocking was swollen but the area immediately above was absolutely fine so I am not sure if they are doing any good. The main problem with his legs is that they seem to give way. When this happens he has no idea why. He has no unusual sensation in them it just happens. The doctors say it should not happen so we are wondering why it does. He loses his balance a lot too but the legs giving way seems to be an additional problem. Both legs seem to do it but left is worse.

    The bowel and bladder had opposite problems. Although he felt constipated, he wasn't - he had normal stools - but he had accidents for the first 16 months then OK so long as his stools stay normal. His numb buttock means that he can't always feel it when he does have accidents. His bladder has improved significantly. When function restarted, he had the urge to go but had to sit and wait it out for half an hour for it to get going and then it came out in a trickle. Six months ago it was a 15 minute wait but now the wait is variable being worst in the morning but only about 5 minutes usually. Stream is sometimes a bit slow but not too bad now. He had never had any urinary incontinence until recently when he had a full bladder (perhaps left to get too full) but the bathroom was occupied. He went to sit down and as he sat he felt the wet patch on his leg. The odd thing is that he had not felt this happening. The widespread buttock numbness is much more localised these days to a big patch around the sacral area but the widespread area that used to be completely numb feels strange now.

    He often has increased problems after hydrotherapy (increased pain, fatigue, legs giving way, falling, more neurological symptoms) but this week it seemed to cause a problem in his skin over the T12 and sacral/L5 areas. He developed broken vessels in his skin. The ones over T12 are red and tiny but the ones around the top of the sacrum look like large deep veins perhaps or some sort of deep bruising. The area has a bluish grey tinge to it with intense spots??? I had not noticed anything as he went into the pool but saw it when he came out very faint. The colour has deepened over the last few days. These areas are also hot to the touch. We do not know what is going on there.





    Last edited by tab70; 03-19-2008 at 07:51 PM.

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