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Suggest treatment for spinal cord injury

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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 1561 Questions

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Posted on Mon, 4 Aug 2014 in Brain and Spine
Question: Dear Sir,

My brother is 38 years old and is in good health. One week back he met an accident and after the MRI scan doctors confirmed that
there was a nerve rupture in his Spinal cord nerve at C6 and C7 segments. After the accident my brother lost sensation from below his stomach till his feet.
But as we live in a small village it took us almost 15 hours to reach the nearest city and doctors confirmed that he need to undergo a surgery to his nerve stress.
He couldn't get the sensation even after the surgery. He lost control on passage of Urine and stool as well. But he feel that he is passing urine. He now can feel the
sense if we touch any part of his legs and feet. If we touch any part of his legs he can name the part with out observing.
Doctors said that my brother need to under go thorough physiotherapy till he recover.


Please find below the report from MRI scan -

IMPRESSION:

** Gr - I Subluxation of C6 over C7 Vertebra
** Traumatic disc extrusion with T2 W hyperintensity noted in C6-7 causing compression
on theca, spinal cord with focal spinal canal stenosis of (9 mm ) with B/L neural
foraminal narrowing.
** Suspicious focal T2 W altered signal noted in cervical spinal cord at C6, C7 vertebral level
- Likely Cord Contusion.
** T2 W & STIR altered signal noted in posterior paravertebral muscles (Lt > Rt )
- Intramuscular Oedema
- To R/o Posterior vertebral element fracture.


Could you please answer my below questions?

1. May i know is there a possibility for him to recover and walk on his own?

2. If he can recover, may i know to what extent he will recover? I mean can he be like how he used to be before?

3. How long does it take for him to recover?

4. Is there a possibility of recover fast if he under goes Ayurvedic treatment?

5. Can he get Ayurvedic treatment with his current condition?
doctor
Answered by Dr. Dariush Saghafi 2 hours later
Brief Answer:
Some degree of recovery is likely

Detailed Answer:
Good afternoon to you.

My name is Dr. Saghafi. I would like to answer your questions and hopefully give you information that can help you feel more at ease with this terrible situation. I have copied your questions below and my answer will follow each one.

Basically the MRI shows that your brother has suffered a traumatic injury that has resulting in the loss of proper alignment of C6 over C7 in the cervical spine. There is also a herniated disk (disc extrusion) which is causing quite a bit of swelling and spinal cord compression with significant narrowing of the spinal canal (where the spinal cord runs). The MRI is showing a likely cord contusion (bruise) at C6/C7 which is exactly where the poor alignment is right now. Finally, there is swelling within the muscles of the neck (greater on the left side compared to the right). There is no mention of vertebral body fracture or transection of the cord (This is VERY GOOD NEWS).

MY INTERPRETATION: I believe that the results of the MRI are clear in stating there is a lot of swelling right now with narrowing of the space through which the spinal cord and its nerves run in the neck. I don't know what kind of surgery was performed but I would imagine it was aimed at opening up some space in the canal and around the nerves being squeezed. They likely also repaired the misalignment of the 2 vertebral bodies. I also believe that you have already mentioned and shown that some improvement is starting to happen with his being able to sense where he is being touched as well as feeling the passage of urine. These are all very good signs.

1. May i know is there a possibility for him to recover and walk on his own?

>>>> I don't think it's possible to give any firm predictions at this time of motor abilities until the swelling has begun to subside and they can get him up to test weightbearing.

2. If he can recover, may i know to what extent he will recover? I mean can he be like how he used to be before?

>>>>>I'm encouraged by the fact that the surgeons have suggested that physiotherapy is to be instituted. That suggests to me they expect him to get motor function back. But to predict how much or whether he can be as he was before the accident is just not possible to say at this time.

3. How long does it take for him to recover?

>>>>As I said in my interpretation I believe that the MRI shows there to be a lot of swelling and perhaps some damage has occurred to the spinal cord and nerves at the C6/C7 level. BUT, the good news is that they did not mention any evidence of fracture nor TRANSECTION of the cord. The latter would be particularly ominous in terms of amount of recovery and duration to recovery. I believe in this case recovery should begin within days (as you've seen already) to weeks but do not be impatient if it takes months or longer to get back his function.

4. Is there a possibility of recover fast if he under goes Ayurvedic treatment?

>>>> I understand that Ayurveda is a rather well established form of complementary medical treatment which originated in XXXXXXX However, there is concern in the U.S. that some of the medicines used in this form of treatment contain higher than acceptable levels of certain heavy metals which can be toxic if ingested regularly or as part of a treatment plan. If this were my patient to be treating I would not likely endorse its use while the patient was hospitalized. I would, however, defer to the family and patient's decisions and wishes on something like this once outside the hospital.

5. Can he get Ayurvedic treatment with his current condition?

>>>Once again, my knowledge of this form of medical treatment is not enough to make a good recommendation or answer your question. If he were under my care I would not likely allow such treatments to be mixed with any other medicines or interventions since we do not really know the interactions that could occur.

I hope these answers help you understand the situation a bit better and hope that your brother has a speedy and complication free recovery. Please feel free to let me know if anything else can be clarified at this time.


Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Dariush Saghafi 19 hours later
Thank you for your prompt reply doctor. Actually i got the surgery information and doctor said that he performed ANTERIOR CERVICAL DISCECTOMY AND FUSION surgery to my brother. Also i am not sure of whether he is feeling sense during urination. My brother said he feel some sense when urinating. But doctors said he may not know when he is urinating. on top of it he is really feeling pains all over his body from neck till his feet, and those pains are unbearable. He feels pain when we pinch on his left leg and feel sense when we touch anywhere on his left leg. but the sense is little low on his right leg. But he can't really move or control his legs on his own. With this in mind could you please answer my below questions?

1. With the surgery information and his current situation could you please let me know if he can recover in the next few weeks?

2. Since he is feeling pains on his body and legs does that mean he is recovering?

3. does the swelling goes off with the physciotherapy?


Thanks XXXXXXX
doctor
Answered by Dr. Dariush Saghafi 1 hour later
Brief Answer:
Recovery seems to be occurring. That's great News!

Detailed Answer:
Dear Sir,

I am pleased to hear that your brother seems to have come through the surgery without complication and from your description is clearly able to feel pain. I believe this shows he is moving in a positive directions. I will answer your questions now as you have posed them.

1. With the surgery information and his current situation could you please let me know if he can recover in the next few weeks?

>>> Once again, there is no reasonable way I have of gauging his likelihood of "recovery" as related to full potential walking or regaining normal sensory function in any specific amount of time. As I explained in the last message the swelling in the spinal cord area where he suffered damage coupled with any postsurgical swelling are going to be the biggest obstacles at present for ANYBODY to accurately predict (including his surgeons) how quickly your brother will regain any of these functions. Also, we must be aware of the fact that until that swelling goes down sufficiently even something as sensitive as an MRI machine cannot tell what real damage may have happened to the cord or the nerve roots due to the amount of swelling in the area. In similar situations I have ordered repeat scans of his neck in 10-14 days to see if any clearing can be seen. Of course, that also assumes that any hardware placed by the surgeons is compatible with MRI studies.

2. Since he is feeling pains on his body and legs does that mean he is recovering?

>>>YES to a point. The fact that he had no sensation when the accident first happened and now is reporting painful sensation suggests that the system from the nerves in his skin leading to the spinal cord are INTACT. Furthermore, his appreciation of pain itself is clinical proof that signals are being transmitted from the spinal cord centers up to the appropriate areas of the brain for processing and interpretation and that these interpretations seem to be accurate as far as anybody can tell. In other words, when you pinch he may say, "Ouch!" and so forth. Therefore, I believe this tells us that some amount of recovery is in progress.

3. does the swelling goes off with the physciotherapy?

>>>> Swelling after an accident such as this reduces according to each person's bodily functions and speed of response/adjustment to the consequences. Remember, this is probably your brother's first attempt at really putting his body to THE TEST....am I correct? We have nothing to compare to which is similar to determine how fast or how slow his drainage and control systems are to deal with this type of calamity. But you are seeing in action in real time and witnessing improvements as they occur. At the same time because your brother is also recovering from surgery some degree of unavoidable inflammation and swelling has occurred because of this action and so while the body is dealing with trying to calm one side of things down by draining the fluid accumulation another (his immune system) has been ramped up due to the surgery. However, in time this should also quiet down and both systems will synchronize themselves in time. In my opinion PHYSICAL THERAPY in and of itself probably does not play a large role in dealing with swelling per se but it is very important that they get in to work with your brother just as soon as the doctors feel he has recovered enough from the surgery since encouraging his limbs to start moving will definitely fire up some more of the neuronal connections and begin stimulating areas of the brain to which will then, hopefully lead him to the next part of his rehabilitation which will be moving about and eventually bearing weight to start walking again.

Hang in there and I believe you will notice even more improvements as time goes on. Your brother seems to be in the hands of good people who are doing their best for him.

Please feel free to relay any other concerns you may have, however, if you believe I have satisfactorily answered your questions I would very much appreciate a rating of our interaction and CLOSING THE QUERY at your earliest convenience.

Cheers and again....much health to your brother and family.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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