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Spine and Back Health

Bicycling accident: disk between t7 and t8

07/29/2008

Question:

On June 6, 2008 a car pulled out in front on me while I was riding my bicycle. I sustained a compression fracture of my T8 vertebrae, but more importantly the disk between the T7 and T8 vertebrae was ejected out of its space, went above the T7 body, and is pushing my spinal cord to the left.

From what my neurosurgeons are saying, the MRI is quite remarkable. And this is a very unusual injury (without causing paralysis.) My first neurosurgeon asked me if he could, in his words “cut it out for me”.  My second surgeon said we would try the conservative approach first, using steroids, oxycontin, and valium, and wearing an extension brace.

The accident was about 6 weeks ago now. The horrible pain is gone from my pelvis and legs, and I can walk. I went from not being able to feel my bladder at all to almost normal feeling and empting with some effort. My Bowls still are not working on their own, but it could be the pain meds. I still am in horrible pain, but it is controlled with the meds. I still have brief moments of weakness in my legs, strange burning sensations down the front of my left shin, and slight numbness/tingling in my toes that doesn’t stay around too long. And some pain in my hips. The disk mostly intact is still on my spinal cord and I have heard different opinions about how long it may take my body to “reabsorb the disk” (weeks, months, 1 year or up to 5 years).

My question is: during this time of waiting, if I were to fall, or twist wrong, or sneeze, do I have a chance of causing more damage to my spinal cord and/or paralysis? If so how big is the risk? I have an option of surgery, but they tell me it is bad because they have to go through the front of my body and break ribs and collapse a lung just to get to my spine. I really can find nothing about this surgery on the web. I am an extremely active mother of a 5 year old boy and owner of a cycling tours company. So activity is my life and livelihood.

If I just let the disk reabsorb, what happens to the space between t7 and t8? I was told that it will naturally fuse together over time, but never completely and many people have said it will cause pain by compressing spinal nerves, and be a source of chronic pain.

If I was your daughter what would you recommend? Surgery or sit and wait for a year or so, doing nothing? I am so confused. Thanks for you time.

Answer:

Hello, thank you for your questions. I obviously cannot answer all of your questions without seeing you, and your MRI, for a full and appropriate medical evaluation. Once again, the purpose of this website is not to diagnose or treat people's individual medical problems. For example, I can't tell you whether you are at risk for more spinal cord damage in the event of an accident (or sneeze) without seeing just how bad your MRI is.

The surgery is much more challenging than it is for cervical (neck) or lumbar (lower back), but it is no longer necessary to remove a rib, etc. The surgery can now be done "thoracoscopically". You can also look up "thoracoscopic spine surgery" or "transthoracic thoracoscopic discectomy". This is still a major surgery, but is done like laparoscopic surgery, with four small "portals" placed between the ribs. An endoscope (a digital camera and light source on the end of a rigid rod) is put in through one portal, a device to keep the lung out of the way through the second, a suction tube through the third, and the fourth is used to insert instruments to remove the disc.

The advantage is that there is much less pain after surgery, no rib is removed, and you get four small (about 1") incisions instead of a big foot-long scar. It is a very technically demanding surgery, and relatively few spine surgeons are trained to do it. If your symptoms are steadily improving, you might consider the option of just waiting to see what happens, but obviously I can't advise you what to do without seeing your MRI and performing a physical examination.

If you need information you can contact me through the NetWellness website, let me know where you live (and how far you'd be willing to travel) and I might be able to recommend someone to see, if not myself. Good luck.

For more information:

Go to the Spine and Back Health health topic, where you can:

Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University