[MichaelZ]

#28796

Dear Dr Corenman, I’m dealing with a rather puzzling issue and I would really appreciate your insight. I herniated an L5/S1 disc around 2013, L4/L5 was bulging too. Both are damaged on the left-central side. Originally I had bad sciatica, partial drop foot, and numbness in the first web space of foot. All that on the left side of my body. While I was waiting for surgery, my symptoms started to improve rapidly: I regained full muscle strength and pain went away. Unfortunately the numbness did not fully go away and my second toe is still numb. The improvement was confirmed by MRI too – the herniation shrunk from ~1cm to perhaps 5mm and I canceled the microdiscectomy. Before the herniation I was an amateur athlete and my work is mostly sedentary, in front of a PC (I’m a scientist). After the injury I was able to go back to light-to-medium weightlifting, swimming, and cycling.

Recently I had a minor recurrence of sciatica. By MRI results, L4/L5 disc is bulging and pressing L4 root and L5/S1 is pressing L5 and S1. L5/S1 is mildly dessicated and thinner, but not very thin and it’s height did not change since 2013. I also have small cysts on S2. The herniations are less than 5mm and the cysts are smaller than 8mm. The cysts were not mentioned previously, but comparing the images I can see that they are not new; if one grew, then not more than 1.5mm in those 5 years; all are left-centrally located and I don’t know if they affect roots. My neurosurgeon and PT also noticed that I have notable disc bulges in cervical spine.

Now, to my issue – I usually feel pretty good if not great now, and my PT claims that these changes are normal stages of age-related degeneration (I’m 41). (I can accept that, although I dreamed about going back to martial arts.) However, one thing that I find worrying is that I get strange sensations whenever I heavily flex my neck. This typically starts after a longer walk and has a form of buzzing. I typically feel it below tailbone, near coccyx or left buttock or left calf. Sometimes it can switch sides and I’ve felt it on the opposite side, although my discs seem to be fine on the right side! I can even feel a kind of pins and needles in what I understand to be a saddle area, if I run for half an hour or so. These sensations are sometimes present, sometimes not. If I don’t walk much, they’re not there. If I walk a lot (several hours), they can disappear too.

So far no one has been able to give me any explanations of this issue. My PT says that it’s most probably benign and I should just ignore it and the doctor’s advice was to get tested for Lyme disease. From my very amateur research on Internet it looks a bit like L’Hermitte sign. I don’t have optic neuritis or any other problems typical for MS though.

(I should also probably mention that I had a version of this problem before, 5 years ago, during the original herniation.)

I would really appreciate your insight here.

[Donald Corenman, MD, DC]

#28798

Neck flexion stretches the spinal cord in the cervical and thoracic spine and nerve roots in the lumbar spine. In fact, the orthopedic test called the Brudzinski’s test does just that looking for paresthesias in the arms or legs (where a positive sign includes the hips actually involuntarily flexing to relieve symptoms).

Having irritable nerves in the spine will trigger these paresthesias (pins and needles) with neck flexion. Herniation or even neuropathy can irritate the nerves and cause these symptoms. A L’hermittes signs you refer to is the test for either MS or spinal cord compression and it is a “lightening bolt” type of electrical pain that radiates down the spine or arms originating from the neck. You do not have that positive sign.

As long as your examination has no long tract signs (which I would assume would be negative or you would have been told about them), there probably is not much to be concerned.

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.

[MichaelZ]

#28800

Thank you for the response. Indeed, long tract signs were never mentioned in my examination and having checked what they are I don’t think that I ever had anything like that. You have mentioned “irritable” nerves. My PT suggested that too, comparing them to a kind of antennae that can respond to various stimuli. What’s interesting, he claims that while many patients report that they flare up from “general inflammation” (e.g., sore throat), the mechanism for this is not fully known… It was nice to hear your opinion, as it also confirms my belief that my PT is a good specialist.

Thank you for creating this great platform for patient support and education!

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