tecnotesMemberSeptember 27, 2013 at 8:40 amPost count: 1
1 year ago, I had an ACDF to fuse C 4/5 and 5/6 with donar graft. Although i was relatively asymptomatic other than some tingling in the left arm, my MRI revealed significant central stenosis. I was diagnosed with myelopathy and myelomalacia and multiple surgeons recommended surgery. The surgery was considered successful, but within 2 weeks I developed burning/cold/tingling feet and hands. My feet are also very sweaty. Many thought it would all calm down in time, but it has not. I’ve had all sorts of blood work performed as well as a negative EMG. MY neurologist feels that the spinal tract might have suffered damage upon decompression, but other knowledgeable doctors do not believe that I can have a symmetrical stocking/glove distribution of parasthesia from the cervical spine. Blood sugar and all autoimmune tests are normal. vitamin and mineral levels appear normal. it has been difficult. i’ve tried lyrica and neurontin unsuccessfully and am currently at 30mg nortryprylyne daily and it is not working. the only thing that comes close to alleviating the pain is xanax when it gets sever. any thoughts would be GREATLY appreciated. Basically, I’m at the point where i believe that the anesthesia had a neurotoxic effect or that the event of surgery set off a cascade of peripheral nerve inflammation. have you ever seen or heard of anything like this? I can’t wait to hear your thoughts. I’m willing to try anything. thanks!Dr. CorenmanModeratorSeptember 27, 2013 at 6:52 pmPost count: 3547
Your symptoms could be from a number of different sources. The most common source of “stocking and glove” paresthesias is peripheral neuropathy (see website) but normally, these symptoms come on gradually and not overnight. Also EMG/NCV will generally show some type of sign with that extent of symptoms.
Cord damage can create these symptoms but that is distinctly unusual. With myelomalacia, the cord has been damaged by years of compression and unusual symptoms can occur. These symptoms would go along with long tract signs (see website) which I presume are present.
The decompression can alter the already impaired spinal cord blood circulation and theoretically cause some symptoms.
Finally, there is complex regional pain syndrome (CRPS-priorly called reflex sympathetic dystrophy or RSD) which also could be causing your symptoms. Normally, this syndrome is found in only one extremity but conceivably can be found in more than one. Your symptoms do match this syndrome and your “sweaty feet” are sympathetically mediated (from the sympathetic nervous system) which is the origin of CRPS.
Dr. CorenmantecnotesMemberSeptember 27, 2013 at 10:28 pmPost count: 1
Thanks so much for your speedy response. Yes, my symptoms came on very quickly after surgery and are symmetric, bilateral and in both hands and feet. At the very least, my case seems to have the neurologist and surgeon a bit stumped. I’ve given up further investigation other than a follow up EMG and MRI because it seems finding a true underlying etiology will be unlikely. thanks agai. it made my day to get such a quick response from a knowledgeable professional.
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