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Had spinal surgery. Having numbness in buttock and genitals. Have chronic back pain. Treatment?

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Are you sure ? my question is regarding CES
The following is a condition my partner has and had spinal surgery last January - she has numbness buttoc pelvic floor and sexual area, she had lcronic lower back pain for a year. MY MAIN QUESTION IS CAN NERVES BE RE GROWN OR WHAT IS THE BEST TREATMENT AVAILABLE FOR CES. MY PARTNER HAS ALSO A PROLAPS BLADDER SO LOW WE CAN NOT HAVE SEXUAL INTERCOURSE, URINE LEAKS CONSTAPATION, NOT OVERWEIGHT BUT HAS PUT HALF STONE ON SINCE SH IS UNABLE TO WALK FAR OR STAND FOR LONG. I am trying to get her seen by a spinal doctor again, waiting for appointment . I have been looking in HOPE and for a treatment for her and what can be done TO REPAIR NERVE DAMAGE and something to improve PARALYSYS.
Can nerves roots be repaired or transplanted from one area of the body and the root re grown to releave the numbness?
I believe she was suffering from
Spinal stenosis is the medical term used to describe narrowing of the spinal canal as you know can it be seen on a X-ray and MRI. The spinal canal is the space through which the spinal cord and spinal nerve roots pass. This patient had an x-ray and MRI scan, why was this not diagnoised?

Was cauda equina syndrome (CES) caused by surgery? Usually, the signs begin to show
within 24 hours of the operation, but can take as long as seven days in some cases.
Bladder problems (neurogenic bladder), are the most common symptom of cauda equina
syndrome (CES). (This patient had almost a liter of urine in her bladder as she was unable to pass and was spilling out.)

Initially, the problem may not be that noticeable. You may have problems
starting the flow of urine, but this then can move on to urinary retention (inability to
let the urine go). This then leads to over flow incontinence (her bladder was full of urine & spills out involuntarily).
Surgery for cauda equina syndrome is emergency decompression, where the surgeon
removes the cause of the pressure on the nerves. Most researchers and surgeons believe
that the decompression surgery should be done within 24 hours of the first symptoms, 24 to 48 hours at the most remember it was over 1 year.
quick surgery reduces the risk of permanent damage to the nerves
and provides the best hope for a full recovery. THERE MUST BE ANOTHER WAY TO HEAL NERVES

In general, patients with only one leg that has pain tend to do better than those who have
both legs affected. MY PARTNER HAS perineal anesthesia also have bladder problems
after surgery.
As well, doctors are finding that the extent of groin numbness can
help predict which patients may do better than others (the worse the numbness, the less likely for a full recovery). MAYBE SO BUT SOMETHING MUST BE ABLE TO BE DONE?


National Spinal Cord Injury Association Resource Center
Factsheet #5:
What's New in Spinal Cord Injury Treatment and Cure Research?

Drug Treatments For New Injuries
NOTE: It is important to realize these drugs are not a cure for chronic (long-term) spinal cord injuries. It is heart-ening to note, however, that treatments finally are available to lessen the severity of some acute injuries.
Research has shown that all damage in SCI does not occur instantaneously. Mechanical disruption of nerves and nerve fibers occurs at the time of injury. Within 30 minutes, hemorrhaging is observed in the damaged area of the spinal cord and this may expand over the next few hours. By several hours, inflammatory cells enter the area of spinal cord injury and their secretions cause chemical changes that can further damage nervous tissue. Cellular content of nerve cells killed by the injury contribute to this harmful chemical environment. This process may go on for days or even weeks. (In Imelda McDermotts case YEARS)
Hope lies, therefore, in treatments that could prevent these stages of progressive damage. Drugs that protect nerve cells following injury are now available to lessen the severity of some injuries. Other drugs and combinations of drugs are currently being tested in both animal and clinical trials.
There are really two separate issues involved in this assumption:
1.     Is the scientific question, "Why won't the spinal cord regenerate?" easy to answer?
2.     What's being done to find a cure?
Let's look at these issues and put them into the context of what scientists have been doing about SCI over the past half century.

The Search For the Cure
The search for a cure involves one of the most complex parts of the human body. The spinal cord is an integral part of the body's most specialized system, the central nervous system (CNS). The CNS consists primarily of the brain and spinal cord.
Most of the cells in the human body have the ability to repair themselves after an injury
Nerve regeneration will depend on how long those nerves were crushed and how much damage has been done. The only way to know is to wait. (This patient is waiting and is still waiting as her condition after surgery is NOT IMPROVING. What can be done to help REGENERATION?
When a nerve is crushed there are three possible outcomes, which is closest to Imelda’s?
1.     The nerve may be "asleep" when there is enough pressure to cause it to completely shut down. It will come back if the pressure is removed soon enough. (PATIENT/IMELDA FEELS PARALYSYS IS SPREADING)
2.     The second possibility is when there is a little more pressure and the nerve branch, called an axon, is destroyed, but the insulation, called the myelin is still intact.

The nerve can re-grow it's axon if the myelin sheath is still there to give it a guide back to where it is supposed to go. The rate of growth under the best conditions is 1mm per day. That is about one inch per month.
3.     The third condition occurs when the axon is crushed and the myelin sheath is disrupted. The nerve will try to grow it's axon, but doesn't have a guide to find it's way back to where it belongs. In this case nerve regeneration is not possible, at least not at this time.

Development of New Therapeutic Approaches
Ongoing research using animal models to test possible new therapies is progressing more rapidly than ever before. This type of research takes several forms that can best be explained as they apply to solving certain types of damage that result from SCI. There are three major classes of damage to neural tissues that have been identified, each requiring a different therapeutic approach:
1.     Death of nerve cells within the spinal cord
Disruption of nerve pathways.
When the long axons carrying signals up and down the spinal cord are cut or damaged to the point where they break down after an injury, the parents nerve cells and axons often survive up to the point where the injury occurred.
Demyelination, or the loss of the insulation around axons.
Although specific human injuries may involve any or all types of damage just described, therapies developed to combat any one of them might restore important functions. The "cure" for spinal cord injury may take the form of multiple strategies, each in turn restoring functions that make important improvements in the quality of life for a spinal cord injured individual.
The approach to "cure" research then, is to concentrate on techniques that hold the promise of repairing specific types of spinal cord damage. With the explosion of efforts and progress in the fields of Neuroscience and Molecular Biology (sometimes called genetic engineering), the scope of possible new therapies is wider than ever before.
Replacement of Nerve Cells
Mature nerve cells cannot divide to heal a wound as skin cells can. Replacement of nerve cells requires transplantation of new nerve cells into the site of the injury with the hope that they will mature and integrate themselves into the host nervous system.
line development without a need for fetal tissue donors.
Regeneration of Damaged Axons
Nerve cells in both the central and peripheral nervous systems are associated with helper cells called neuroglial cells. After injury, the CNS helper cells largely inhibit regeneration, while those of the peripheral nerves, the Schwann cells, stimulate regeneration, even in humans.

Few treatment approaches have raised as much hope as the announcement by the National Institute of Health that the steroid, methylprednisolone, reduces the degree of paralysis if administered shortly after spinal cord injury.
In clinical trials, an extremely high dosage of methylprednisolone was used in a double-blind study (neither patients nor doctors knew who was getting the exper-i-mental drug). The improvement in some patients was so remark-able that the National Institutes of Health felt it was important to "break the code" (i.e., determine who was getting the drug and who was not) so more patients could potentially be helped.
Overall, the trial showed that while the methylprednisolone treated group retained significantly more function than the placebo group, subjects in both groups experienced chronic loss of function due to their injuries.
Methylprednisolone is effective only if used in high doses within eight hours of acute injury. It is hypothesized that this drug reduces damage caused by the inflammation of the injured spinal cord and the bursting open of the damaged cells. The contents of the damaged cells are believed to adversely affect adjacent cells. High doses of methylprednisolone can lead to side effects, such as suppression of the immune system, but no serious problems have been reported when it is used over a short term as in this study.
Because the success of the methylprednisolone trial had changed the "standard of care" in the United States, subsequent drug trials are now testing the effectiveness of other drugs in combination with methylprednisolone administration. Thus, to demonstrate significant effectiveness, new treatments will have to surpass the functional sparing effects seen with methylprednisolone alone.
A large clinical trial with humans is currently underway comparing 48 hour treatment of methylprednisolone with or without added tirilizade. Study results are anticipated to be available in late 1995. (18YEARS AGO, WHAT CAN BE DONE NOW FOR THIS PATIENT?)

Posted Tue, 23 Jul 2013 in Brain and Spine
Answered by Dr. Sandhya Manorenj 13 hours later

thank you for writing in.

It is unfortunate that your wife is suffering even after surgery for lumbosacral canal stenosis.

She had bilateral sciatica symptoms since 1 year.Underwent surgery XXXXXXX 2013 when she had bowel , bladder symtpoms and worsening paraethesia.that itself indicates delay .We can help you better if you could update MRI spine done prior to surgery and following surgery(if repeated) to know that whether spinal cord is effected or is it only roots.If not done should be repeated.

Her symptoms of constipation, overflow incontinence,numbness in pelvic ,perineal and buttocks region indicates involvement of sacral roots (s2 ,s3,s4,s5 roots).Bilateral sciatica indicates involvement of multiple roots as they together form sciatic nerve (L4,L5,S1,S2,S3 roots).

Proper neurological examination (sensory testing,deep tendon reflexes, motor power) and assesment should help one to arrive at a diagnosis rather than waiting for worsening .Clinical diagnosis should be supported by MRI spine (as mentioned lumbar canal stenosis).

Since she has worsened after surgery in term of weakness, parathesia and sensory symptoms one need to consider conus cauda syndrome (where tip of spinal cord along with roots are effected, which can explain weakness).

I still feel that a high dose of methylprednisolone trial to be given for 3 days ,even though it has passed 6 months and watch for response.There is still chance of recovering with neuralgic drugs, and pelvic exercises ,though it may take time in view of multiple root involvement.Need patience and confidence

I treat my patients with such symptoms with short course methylprednisolone, Lumbosacral belt, Neuralgic drugs pregabantin 75 mg /gabapentin300mg for neuralgic pain(dose to be adjusted based on weight and pain), along with nerve regenerating medicines like vitamin B12,B6,B1 combination.

Also require Urodynamic study to assess bladder function,for this I would refer to urologist. Cholinergics to be started based on urodynamic functions.She also requires pelvic floor strengthening exercises,physiotherapy of limbs.

Your query regarding nerve grafting.It should be emphasized that spinal cord is part of central nervous system.Brain and spinal cord axons are myelinated by oligodentrocytes, this cells does not regenerate,whereas peripheral nervous system, peripheral nerves that supply limbs are insulated(myelinated) by schwann cells,that has the ability to regenerate.Hence a damaged nerve in the body's peripheral nervous system heals over time but a damaged axon in spinal cord does not regenerate.Roots from spinal cord again is peripheral nervous system

Hence schwann cell transplant( taken from ones own peripheral nerve in limb to be cultivated invitro)can be transplanted and that improves some of the neurological functions if associated spinal cord injury is present .Improvement is seen better in those transplant done immediately after weakness.

Presently FDA has given approval for such transplant and is under phase I trial (Miami Project to Cure Paralysis,July 2012)
But it’s not an option to wait a year or two before volunteering for a Schwann trial either, since the window for improvement can close quickly.

In animal models of spinal cord injury (SCI), grafting Schwann cells or peripheral nerve into the lesion site has been shown to promote axonal regeneration and myelination. However, axons do not regenerate beyond the transplant due to the inhibitory nature of the glial scar surrounding the injury. To overcome the glial scar inhibition, additional approaches such as increasing the intrinsic capacity of axons to regenerate and/or removal of the inhibitory molecules associated with reactive astrocytes and/or oligodendrocyte myelin should be incorporated. Clearly, Schwann cells have great potential for repair of the injured spinal cord, but they need to be combined with other interventions to maximize axonal regeneration and functional recovery.

Hence please update the MRI reports

Hope this would help you .I apologize for delay in response

Please get back if you require additional clarification

Dr Sandhya Manorenj

Neurologist, Hyderabad , India
Above answer was peer-reviewed by
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