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Neurology (Expert Forum)
Burst fracture of lumbar spine
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Burst fracture of lumbar spine
by TCN, May 18, 2007 12:00AM
Thank you for your time. I am a 39yr.f. On Dec.30th I fell down a flight of stairs and burst my L-1. I had fragments in my spinal chord, and required surgery to place a cage.
Due to coumadin and pulmonary edema, I had to lay still for 10 days before surgery was done. They went in anteriorly, removed a rib, placed a cage filled with the bone fragments. I was intubated and had a chest tube for several days. I was in rehab. for just over two weeks.
I know I have made great progress, but I am discouraged and really don't have any answers as to what to expect. My lower left abdominal area where they cut is completely numb all the way to my upper thigh, and my abdomen protrudes. My belly button is moved to the right side. I have seen no improvement, and it is uncomfortable.
Questions:
Should I see a general surgeon about the protrusion?
My PT said I have plateaued in therapy. I still need a walker.
Will I get better? I assumed I would be back to normal, but now I feel that is less likely.
I really am not getting answers from the neuro. team. They are hard to reach, and vague with answers.
What is the usual outcome for these types of injuries?
Will I eventually walk without aide?
I know these answers are hard to answer as you dont know me, but I wonder if there is a general prognosis for patients with this type of injury.
Thanks so much for your time.
Due to coumadin and pulmonary edema, I had to lay still for 10 days before surgery was done. They went in anteriorly, removed a rib, placed a cage filled with the bone fragments. I was intubated and had a chest tube for several days. I was in rehab. for just over two weeks.
I know I have made great progress, but I am discouraged and really don't have any answers as to what to expect. My lower left abdominal area where they cut is completely numb all the way to my upper thigh, and my abdomen protrudes. My belly button is moved to the right side. I have seen no improvement, and it is uncomfortable.
Questions:
Should I see a general surgeon about the protrusion?
My PT said I have plateaued in therapy. I still need a walker.
Will I get better? I assumed I would be back to normal, but now I feel that is less likely.
I really am not getting answers from the neuro. team. They are hard to reach, and vague with answers.
What is the usual outcome for these types of injuries?
Will I eventually walk without aide?
I know these answers are hard to answer as you dont know me, but I wonder if there is a general prognosis for patients with this type of injury.
Thanks so much for your time.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Jun 14, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
From your description of the injury it sounds like you are blessed to be walking at all and I am encouraged to hear that you are up and using a walker. People are vague about prognosis in these cases, because we donot know for sure. Injury to the central nervous system, which includes the brain and spinal cord is permanent and can not be repaired. That does not mean that you will not get some better. When the spinal cord is injured neurons that controlled muscles die and the muscles shrink and degenerate. Then the neuron that are left can sprout axons to help compensate for the lost neurons. This only works in a partial injury (not a complete transection) like it sounds like you had. We do not know how to make the repair process better or faster, but we do know that rehab is important. We also know that it takes time, often years of hard work. I would see a general surgeon about your abdomen protrusion, since weakening of your muscles with your injury may have caused a hernia. I would get an EMG of your legs to assess whether your legs are showing sings of recovery or if they show active dennervation.
I hope this has been helpful.
From your description of the injury it sounds like you are blessed to be walking at all and I am encouraged to hear that you are up and using a walker. People are vague about prognosis in these cases, because we donot know for sure. Injury to the central nervous system, which includes the brain and spinal cord is permanent and can not be repaired. That does not mean that you will not get some better. When the spinal cord is injured neurons that controlled muscles die and the muscles shrink and degenerate. Then the neuron that are left can sprout axons to help compensate for the lost neurons. This only works in a partial injury (not a complete transection) like it sounds like you had. We do not know how to make the repair process better or faster, but we do know that rehab is important. We also know that it takes time, often years of hard work. I would see a general surgeon about your abdomen protrusion, since weakening of your muscles with your injury may have caused a hernia. I would get an EMG of your legs to assess whether your legs are showing sings of recovery or if they show active dennervation.
I hope this has been helpful.
The plateau you have reached with the PT is also normal, rehab is not a straight path upward, its often got leaps and bounds and many plateau's to it, (I am an occupational therapist and I have seen this in loads of patients). Its about recognising what has changed and how much you have gained rather than what is still limiting you. Sometimes taking a few wks break in therapy (still doing your home program) helps you move fwd again.
As far as your belly button and belly protusion is concerned, I have no real suggestions, except to say that if your back muscles are not working well (which they will not be) then often your belly muscles are slack too, so it takes time and you need to be doing the stomach muscle exercises religiously as much as your back exercises. Also as for prognosis, not sure about that, but my guess is that you will be back to close to normal at some point.
I have got 5 fractures in my vertebrae from osteoporosis induced by meds. I break bones easily. I am a 42yo f. I have been dealing with this for the past 18mths or so in addition to a few rib fractures along the way, plus some other serious health conditions involving my heart,lungs and adrenals. I have been in a wheelchair and on a walker for many mths last year. So I hear you on how frustrating it can be, but truthfully, the best thing to do is just push through the frustration with determination and know in your heart what you are aiming for, for me, it was not negoitable that I would remain on a walker....I would not even consider it, so I just kept pushing myself and the medical and PT team and I viewed the walker as a temporary state. It worked but it took a LONG time and I am still not there yet but I am a long way from where I was this time last year.
Wishing you well, I am sure you will get back close to normal soon.
Hope that helps.
Fiona
Fiona
Sounds like you maybe pushing yourself a bit too hard, if its making you feel nauseated. One of the things that I did along the way, was acupuncture which I found gave me a bit of pain relief. I also went on a low dose antidepressant to help with pain relief, which shifted it a bit, but ultimately not enough, but its worth trying if you are still dealing with alot of pain issues, I have chosen to stay on it, because I also think it helped me stay a bit more optimistic through all my health challenges.
The other thing that I found was that my body responded really well to cranial-sacral therapy, its a special very gentle form of physio, the PTs train specially in that area in order to offer it, it is done to you, rather than you doing exercises. Some massage therapists offer it, I think, but I went with PTs since I have worked so much with them in the past. My old PT offered it in conjunction with a traditional PT prog and some basic yoga poses. I found it by using a PT practice with a sports medicine focus.
It would be worth googling and having a look at who offers it in your area.
Additionally, ask your Dr if s/he knows of a physiatrist, they are a specialised form of MD in orthopedics, the one I originally saw in AZ was helpful in that he was patient, encouraging and was specialised in his way of xrying what was going on. Have been searching for one in CO but no luck yet in my town.
I check in here fairly often so post back if you want more support.
Fiona