Houston Methodist. Leading Medicine

Upper Spine FAQ

Question:

My partner is in the hospital with a bad disc pressing on his spinal cord. He may be in danger of leg paralysis. He's even been warned that he might lose his ability to have an erection. He's asked me to research this for him and find out just what are the chances that this might happen to him.

Answer:

Spinal cord injury from trauma is caused first by car accidents, then by falls, violence, and sports accidents. It seems that men in their 40s and 50s experience spinal cord injuries from all causes more than any other age group. Disc degeneration is more common in older adults, especially in the lumbar spine area. Pressure on the spinal cord, the spinal nerve roots, and/or any compromised neural tissue can cause a set of signs and symptoms referred to as cauda equina syndrome (CES) or conus medullaris syndrome (CMS). The word "syndrome" tells us that each one of these conditions is defined by a set or collection of signs and symptoms that are always present. The cauda equina syndrome affects the spinal cord where the main cord ends and a "tail" of nerves forms down to the tip of the tailbone and down the legs. The conus medullaris syndrome occurs when the injury has affected the area between the spinal cord and the spinal nerve roots. Clinical signs and symptoms of these two syndromes can be so similar as to be confused and misdiagnosed. The clinical presentation may vary slightly depending on where the damage has occurred. In the case of the cauda equina syndrome, there is often an asymmetric presentation. In other words, the symptoms occur on one side (not both sides). In the conus medullaris syndrome, symptoms are more likely to occur symmetrically (evenly on both sides). At first, the spinal cord may go into "shock." The patient loses all function below the level of the injury. There may be paralysis of the legs, loss of bowel and bladder control, and for men, loss of penis erection. These symptoms may last a short time with recovery in 24 to 48 hours or there may be a longer period of time for recovery (several weeks). The negative risk factors (those that predict poorer outcomes and less chance of recovery) include older age (over age 65) and a previous history of back and/or leg pain (sciatica). Long duration of symptoms from the disc problem also increases the risk of poor outcomes. Some men report getting back the ability to have an erection but have a loss of penis sensation. Studies report between 25 and 50 per cent of patients with either of these syndromes may experience persistent sexual problems. That may not sound like a good prognosis but the positive way to view those statistics is to say that up to 75 per cent of men recover fully. Hopefully, with successful treatment, your partner will recover completely, though this could take weeks to months so be prepared to wait patiently before judging the final outcome. Lawrence A. Delasotta, MD, MPH, et al. Current Management Review of Thoracolumbar Cord Syndromes. In The Spine Journal. September 2011. Vol. 11. No. 9. Pp. 884-892.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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