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  • mmstoner
    Participant
    Post count: 1

    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
    Post count: 8455

    “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

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