Lower Limb Weakness

Tagged: Lower Limb Weakness, Meralgia Paresthetica

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mmstoner
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March 19, 2022 at 1:09 pm

Post count: 1

#34959

Could I be missing something?

timeline of lower limb weakness….
July 2020-Noticeable weakness in left leg, buckling sensation with exercise and walking not sure where it was coming from (knee or hip)?
July 10th-Panorama Orthopedics, Dr. Folk (knee specialist), Dr. Folk thought it was my hip. Hip MRI scheduled.
August 13th-Hip MRI
August 17th-Manitu Incline (2,700 steps with 2,000 feet elevation gain), weakness progressively worse after.
August 27th-MRI reviewed with Dr. Ellman (hip preservation specialist) Panorama Orthopedics, labral tear diagnosed, surgery scheduled.
A few weeks before surgery began using crutches and work discontinued due to left leg weakness, abnormal gait, and lower back pain.
October 5th -Hip Arthroscopy done, crutches for 8 weeks, physical therapy twice a week, ahead of protocol for strength and hip mobility, limb weakness and lower back pain persisted.
December 10th-Lumbar MRI.
December 17th-Spine visit Lumbar MRI review Panorama Orthopedics Dr. Vanderheiden (suggests it is neurological and refers to Dr. Lersten.
January 5t 2021-Interventional Spine visit, Panorama Orthopedics Dr. Lersten. Dr Lersten agrees is neurologic and neurology consult suggested.
February 15th-EMG
February 17th-Neurology visit (Alpha lipoic Acid, B12 and Magnesium started). Neurology suggested it was a “stretch” injury from surgery and will take time.
March 24th-Functional Medicine visit Pelvic MRI ordered.
April 14th-Pelvic MRI
April 27th-Meeting with Dr. Wong, Denver Spine Surgeons. He sees many “small issues but none that screams at him that is the problem” (spina bifida occulta, overlapping facet joint, areas of arthritis and the tarlov cysts). I asked if the cysts were a concern and he stated, “no those are considered benign” Dr. Wong suggested ruling out MS, Lyme disease and Lupus and then addressing the lower back pain with prescription arthritic medications or injections. Suggests Brain, cervical and thoracic MRI, scheduled for Saturday 5/8/2021.
I can work restricted shifts at my job as a circulating Urologic nurse at The Urology Center of Colorado with a stabilizing knee brace. I can use the elliptical machine and stationary bike, but it is difficult to keep weight in my heel. I am unable to walk with a “normal” gait, I cannot run or hike. When I stand, walk, or sit for an extended period my lower back aches with pain into my gluteal region. I have warmth and numbness in my left foot, hip, groin, and coccyx. If pain were the only issue, it would not restrict me from further activity. However, the weakness and abnormal gait does.
Other Therapies
Physical Therapy from October 7th through February, Chiropractic, Acupuncture, Dry Needling, Massage and Muscle Activation Technique. Functional Medicine Dr. March 23rd, Pelvic MRI 4/14, Tarlov cysts at S3 bilaterally and S4. Could this be the cause of continued weakness and lower back pain?
Dr. Feigenbaum (Dallas, Texas) neurosurgery consultation 5/17/2021. States I am a surgical candidate but sees cysts at S1 and S2 as well. Surgery would involve opening and decompressing the perineural cysts and cover with a “sleeve” made of bovine pericardium. Also suggested a diagnostic nerve root block without sedation at S1, S2 before committing to surgery.
Dr. Vilims Colorado Pain Specialists 6/18/2021. Diagnostic nerve root block. Complete pain relief for four plus hours on the right side (desired effect).
Dr. Feigenbaum 6/28/2021 follow up consultation after diagnostic nerve root block. Surgery suggested for repair of the Tarlov cysts is discussed. Wheels in motion to schedule surgery in Dallas.
10/12/21
Sacral Laminectomy with repair of 6 Tarlov Cysts and 1 large meningeal cyst and sacral reconstruction
Physical Therapy of The Rockies 11/15/2021 I resumed physical therapy with this group because they advertised a specialty in gait therapy.
I am currently seeing a physical therapist in Boulder that is focusing more on sensory issues and gait vs. strength etc.
I continue to have numbness on my lower later thigh, tingling and warm in both feet and pain in my left groin along with swelling and tightness in my left knee. I use a full-length leg brace(locked out) for walking when I am out in public, and I use a cane.
I feel like I am at a loss for continued recovery, and I wonder if I am missing something like “femoral nerve entrapment”?
Any insight you could offer would be greatly appreciated.

Donald Corenman, MD, DC
Moderator

March 19, 2022 at 5:24 pm

Post count: 8660

#34960

“July 2020-Noticeable weakness in left leg, buckling sensation with exercise and walking not sure where it was coming from (knee or hip)”? You might not remember, but what buckled, the knee or hip (the knee would buckle if the hip hurt to protect it.

Neurology suggested it was a “stretch” injury from surgery and will take time”. What did the EMG specifically note? You noted; “A few weeks before surgery began using crutches and work discontinued due to left leg weakness, abnormal gait, and lower back pain”. If the symptoms did not substantially change after surgery, this would be an incorrect assumption.

“I can work restricted shifts with a stabilizing knee brace. I can use the elliptical machine and stationary bike, but it is difficult to keep weight in my heel. I am unable to walk with a “normal” gait, I cannot run or hike. When I stand, walk, or sit for an extended period my lower back aches with pain into my gluteal region. I have warmth and numbness in my left foot, hip, groin, and coccyx. If pain were the only issue, it would not restrict me from further activity. However, the weakness and abnormal gait does”. This indicates you don’t have pain inhibition weakness. When you walk, does your left hip drop when you weight your left leg (trendelenberg gait)?

“Dr. Colorado Pain Specialists 6/18/2021. Diagnostic nerve root block. Complete pain relief for four plus hours on the right side (desired effect)”. My understanding is you don’t have much pain and no pain inhibition but weakness especially of your knee as you wear a locking knee brace. If this is not a pain condition, be very careful using a pain injection as proof of “the problem”.

I would be exquisitely careful of having Tarlov cysts repaired. This is a direct surgical manipulation of the sequestered nerve roots and great malfunction can occur. I generally leave these cysts alone unless they are eroding the bone of the sacrum. I’m not convinced these cysts are causing your weakness.

I think a new consultation with a neurologist who performs the EMG him or herself would be your next step. Make sure this individual has great experience and is adapted to discovering rare disorders. There are many neurological disorders that need to be ruled out.

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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Donald Corenman, MD, DC

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Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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