[Donald Corenman]

#4496

I began having bilateral numbness in both quads but decided I was simply tight so I began stretching more. My quads became more and more stiff. Next I had pins and needles in my feet and then my hands. Eventually, my legs felt like lead weights, very week, stiff, and felt like I would fall at any moment. And I could barely walk. MRI showed a C 5/6 disc protruding into the left anterior spinal cord.

Prior to surgery I had developed proprioception problems in my arms and legs and I was losing dexterity in my hands. My neurosurgeon suggested my sx’s were “atypical” and not “classic myelopathy,” but that the surgery was necessary based on my reported sx’s and the MRI. He suggested I had a good prognosis for a full recovery because it appeared to have been “caught early.’ I awoke with more sx’s, decreased sensation and pins and needles in lower waist/back, upper back burning, bilateral forearm pain (never any neck pain). So, after a few years my strength has mildly improved, however, I have global neuropathic pain that is exacerbated by activity.

I am unable to be active and even basic household chores continue to be difficult. Surgeon says I do not have myelopathy. 2 neurologist say I do that I had severe cord damage and only tx is to “ignore the static going to my brain.” I finally was able too see a physiatrist who seems to go back and forth as to whether she believes my problem is related to my spinal cord or just my CNS being “hyperexcitable.” A small dose of clonazepam muffles the stinging and burning and essentially has saved me from losing my employment. Recently, I had to report bladder urgency with periods of to total emptying. Urology confirmed “bladder spasms” most likely because of spinal cord. My physiatrist sort of has given up and suggested an “academic neurologist.”

I finally have an appointment next week. I have tried many PT’s, chiropractors, etc… and all say I am “atypical.” A spinal cord doctor told me that if sx’s are myelopathic activity should not increase sx’s. In my case, activity leads to increased
neuropathic pain – typically peaks 2 days after increased activity.
Any suggestions?

Any type of diagnostic tests? I’ve only had MRI’s and emg/ncv.

[Donald Corenman, MD, DC]

#4502

By the sounds of your symptoms, it does seem like you did had myelopathy caused by compression of the spinal cord. Most of your symptoms are associated with “classic” myelopathy. I would worry about advising achieving full recovery as when the symptoms become severe enough to cause significant imbalance and loss of fine motor skills, that is an indication of more severe compression. Awakening with more symptoms is unusual but can happen even with a well done surgery as the decompression can change the cord vascularity and sometimes cause more problems.

Neuropathic pain is unusual for myelopathy as the cord does not have pain receptors in its substance but I have read case reports of this condition occurring. I don’t understand the mechanism of the pain generation other that the spinothalamic tracts being injured. By the symptoms you still present with, it sounds like you do have myelopathy. A new MRI of the neck would be helpful to look for myelomalacia- a condition where the cord becomes more narrowed from tract drop-out. Also- there is a condition called syringomyelia- a cavity that occurs within the cord and can create more symptoms over time.

What are your physical examination signs? Do you have clonus, hyperreflexia, Hoffmans sign, dystonia (chronic painful muscle contractions) Rhombergs or adiadochokinesia? The cord can remain irritable for years and become aggravated with stretching your neck or maintaining odd positions.

Ask you physician about membrane stabilizers like Lyrica, Neurontin and Tegretol to see if they think these can help you.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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