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  • Avatarmnjody
    Participant
    Post count: 11

    Good evening,
    I have pain from my butt area down, and my left foot is numb. When raising my toes, my right foot is fine, but my left toes barely raise up. I notice while going on eliptical that I am using much more right foot/leg strength. Other issues I have noticed are lots of leg cramps in the back of my leg, and my toes are more curled on my left side. All of my issues are on my left. The MRI mentions right side. Does this make sense?

    Notes from last GP visit neuro exam performed on lower:
    Manual Strength Testing:
    Hip flexion (L2): 5/5 on the right and 5/5 on the left
    Knee extension (L3): 5/5 on the right and 4/5 on the left
    Ankle dorsiflexion (L4): 5/5 on the right and 4/5 on the left
    Great toe extension (L5): 5/5 on the right and 3/5 on the left
    Plantar flexion (S1): 5/5 on the right and 5/5 on the left
    Sensory Testing (light touch) dermatomal patterns:
    Medial thigh (L2): normal on the right and normal on the left
    Medial knee (L3): normal on the right and normal on the left
    Medial malleolus (L4): normal on the right and diminished on the left
    1st web space dorsal foot (L5): normal on the right and diminished on the left
    Lateral malleolus (S1): normal on the right and normal on the left
    Reflex Testing:
    Patella (L4): normal on the right and normal on the left
    Achilles (S1): normal on the right and absent on the left
    Ankle Clonus: absent on the right and absent on the left
    Plantar response (Babinski): toes downgoing on the right and toes downgoing on the left

    MRI:
    L5-S1: Disc space narrowing with desiccation of the disc with central and RIGHT

    paracentral disc protrusion encroaching upon the RIGHT side of the thecal sac

    and S1 nerve root. There are mild degenerative changes of the posterior facets.

    There is also foraminal stenosis on the LEFT.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7684

    Your MRI notes a right disc herniation affecting the right S1 nerve root. Your symptoms don’t reflect the right S1 nerve but do indicate the left L5 nerve. Failure to raise your toes is an L5, not an S1 nerve disorder. You do have an S1 reflex deficit on the left (“Achilles (S1): normal on the right and absent on the left”) but that sometimes does not indicate a significant problem. The motor weakness is a pure L5 root deficit (“Ankle dorsiflexion (L4): 5/5 on the right and 4/5 on the left…Great toe extension (L5): 5/5 on the right and 3/5 on the left”

    What is significant from the MRI report is “There is also foraminal stenosis on the LEFT” at the L5-S1 level which will compress the left L5 nerve root. Typically, the worst symptoms of foraminal stenosis come from standing and walking and improve with sitting and bending forward. However, when symptoms have been present for some time, sitting can be problematic. See https://www.neckandback.com/conditions/foraminal-collapse-lumbar-spine/

    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.
    Avatarmnjody
    Participant
    Post count: 11

    In your opinion are most issues like this resolve without the need for surgery? Or does it continue to get worse?

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7684

    This can go either way but what is concerning is your motor weakness. Generally, I recommend surgery if there is motor weakness as surgery is the best chance to gain better function of the disabled nerve root.

    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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