Question
I have a previous fractured sacral iliac dislocation of my pelvis with both sides of my pelvis permanently set now at different vertebraic levels which together with left leg fractures has resulted in an overall 3cm leg shortening [measured by xray], previously fractured L4/5 transverse processes, have a current displaced fracture of S5 [following a fall 8 weeks ago] together with left sided progressive quad and gluteal muscle wasting following my accident 30ys ago, which has worsened since my recent sacro-coccxygeal injury. [interestingly tho the body scan showed current inflammation in the coccyx area not S5 yet S5 is displaced ?? recent or old injury of S5?].I also have developed bilateral medial bone on bone degeneration of the medial meniscus,with a bilateral medial meniscal tear

It makes sense that these sacro-coxccygeal and spinal injuries have contributed to my leg weakness & muscle wasting but In the light of my complicated spinal & pelvic anatomy I am hesitant about what beneficial treatment can be done that will not cause any further permanent nerve damage will be incurred as a result of treatment.

Both my GP & I are concerned that my displaced fracture is very close to the chordae equina, worrying manipulation could cause permanent nerve damage, with resultant loss of body function..  As I have an actual displaced fracture of the 5th sacral vertebrae, together with irreversible misalignment of spinal/pelvic structures that are set we are unsure what exactly could be done to remedy the pain & muscle weakness I am experiencing.

Answer
Dear Moira,

The primary thing that I notice that is missing from your narration is the mention of a spinal MRI.  Yes, you have trauma to bony structures, as you described, but what about the discs, ligaments, etc.?  What is it, exactly, that is causing neurological symptoms?  Without a clear picture of the nerve tissue (MRI), it is pure conjecture.

There are many things that can be attempted to ease symptoms once the neurological irritation/compression is found or ruled out.

My understanding of Cauda Equina syndrome is that it is usually the result of cauda equina damage, most commonly occuring in the lumbar spine region... and usually the result of a severe disc herniation and protrussion.

The lower sacrum and the tail bone is where the Filum Terminalae is... which is the remnants of the meningeal sheaths, coming to a final connection at the tail bone.  Neurological symptoms are typically not caused, in my mind, by tail bone injuries.

This is a complicated case.

You should consult with a neurologist or neuro surgeon to see what things can be done. You are right in that this is beyond the scope of the GP.

Good luck,

Keith Biggs, DC
http://www.eastmesachiropractor.com
http://www.arrowheadhealth.com