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What causes pain post physiotherapy for spinal cord injury?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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Answered by

Neurologist
Practicing since : 1994
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Question
Dear Sir,

My brother is 38 years old and is in good health. on 9th of July, 2014 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. My brother says that he feel some sense during urinating. But Doctor says that he may not know during urinating. 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. And recently we found very very small movement of his feet. but he is feeling lot of pain on his both the legs till feet during the physiotherapy. Doctors tried to let him sit on the wheel chair and he is now sitting on the wheel chair for some time. Doctors said that my brother need to under go rigorous 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.


With the MRI scan report and X ray attached as the reports, could you please answer my below questions?

1. He is now feeling lot of pain during the physiotherapy. May i know does it mean he is recovering?
2. Since he is now able to sit on wheel chair (Not on his own, but with some one's support) do you have any idea if when he will be able to walk on his own with the support of stick ?
3. Since he is 38 years old may i know if he can recover fully and if not to what extent he will recover?
4. Looking at the progress he is making, MRI scan and the X ray reports may i know if he can come back to his normal activities in the next couple of months?
5. He is not feeling like eating and he is eating very less quantity of food. Does this impact his recovery time?

Thanks, XXXXXXX

Posted Sat, 23 Aug 2014 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 2 hours later
Brief Answer:
Recovery would occur slowly.

Detailed Answer:
Hi Mr XXXXXXX

Thank you for posting your query.

I have noted your brother's history and treatment received so far. It is unfortunate that he suffered an accident involving injury to spinal cord, and has to suffer disability at this young age.

However, he is on correct treatment, although there was a delay in surgery due to unavoidable circumstances.

Regarding your questions, my answers are below:

1. Presence of pain is a good sign, which means his sensations are coming back. For relief of pain, he may be given pregabalin or gabapentin capsules, which help relieve nerve-related pain.

2. The exact time frame for recovery can not be predicted, as it differs between different people and it also depends on the severity of injury, the promptness of surgery, etc. However, the recovery would take several months. It is possible that he would be able to walk with the help of stick at a future date.

3. Yes, younger people recover better than older people, but as i said, it is difficult to predict the exact amount of recovery. He is unlikely to recover fully, as he has suffered significant nerve damage, and we can expect partial recovery at best.

4. It is difficult for him to come back to normal in a couple of months, it is likely to take much longer, say six months or more.

5. Yes, inadequate food intake may impact his recovery. Please encourage him to have small quantities of food, but at more frequent intervals.

I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.

Wishing you good health,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in

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