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Dear Dr. Corenman,
Here is a brief history on my back.
History
September 2015 – Severe right side herniated disc L5 S1, resulting in partial leg paralysis (right calf and part of left foot).
October 2015 – Right side Laminectomy/Microdiscectomy L5 S1.
January 2016 – Reherniated disk on right side L5 S1.
April 2016 – Right side Laminectomey/Microdiscectomy L5 S1.
May 2016 – Reherniated disc on right side L5 S1.
Current Diagnosis/MRI Findings (Lower Lumbar)
1. At least moderate bilateral neural foraminal stenosis L5 S1.
2. Small herniated disc on right side L5 S1.
Current Symptoms
Beginning January 2016, 3 months after my first laminectomy/Microdisectomy, I have suffered from the following symptoms which seem to be getting worse as time progresses in regards to deterioration.
– Pain across the the lower back.
– Pain that radiates down the back of both legs and feet (worse down the right leg).
– Numbness and Tingling in the lower back, buttocks, scrotum, groin area, that radiates down the back of both legs and into both feet (worse down the right leg).
– Paresthesia down the back of both legs and in feet (worse on right leg and in right foot).
– Weakness in both buttocks and legs (worse down the right leg).
– Heaviness in both legs (worse down the right leg).
– Muscle Spasms in lower back and in both buttocks and down the backs of both legs (worse on right aside).
– Extreme cramping and tightness down the backs of both legs, especially in the hamstrings.
– Difficulty urinating (currently on RX for Flomax to help with urination). Pain down back of both legs and in both feet when pushing to urinate. Episode of incontinence in August of 2016, catheter inserted for 2 days, was retaining 1.3L of urine as per bladder scan in ER.
– Weakened Sphincter muscle as per Physical Examination in ER in August 2016.
– Decreased/Diminished ankle reflexes in both legs as per Physical Examination in ER in August 2016.
-My leg symptoms encompass the buttock, groin, scrotum, sphincter, genitals and inner thigh, as well as radiation down the back part of both legs to the feet. In addition to pain, leg symptoms include numbness, fatigue, heaviness, weakness, cramping and paresthesia. Neurogenic bladder symptoms are also present with a great effort to urinate (currently on RX for Flomax to help with urination). Symptoms are bilateral and symmetrical down both legs but worse down the right leg and foot (likely due to repeat L5S1 herniations on this side). I suffer from accompanying back pain but leg pain, numbness, tingling, cramping, weakness and discomfort in groin is usually more bothersome than back pain.
These symptoms are intermittent and wax and wane throughout the day and are highly sensitive to certain triggers. Sitting on a chair or particularly a hard surface for longer than 10-15 minutes increases symptoms as does standing for more than 10-15 minutes or walking for more than 10-15 minutes. When sitting, it feels like something is being pinched or compressed causing the above symptoms. Lying flat on a bed is the most comfortable. Symptoms are worse at night, at the end of the day, even when lying flat on a bed and are much less severe in the mornings upon waking.
QUESTIONS
1. Seeing as my herniations have all been right sided, surely the numbness, tingling etc. down the back of both legs, in groin and also in upper back about as high as the 3rd rib from the bottom of my rib cage (well above my surgical incision for L5S1) cannot be caused by residual scar tissue can it? My surgeon said I have a little bit of scar tissue from repeat laminectomy/microdiscectomy but nothing that should be giving me problems.
2. Completely miffed, my spinal surgeon finally suggested that we look at the thoracic spine so I have an MRI in a few weeks. He said he doubts there is an issue at anything involving T10 or around T10 would make me close to paralyzed. I have also read that a lower thoracic herniation is 1 in a million. Is this true?
3. I have read through your site and noted that surgery for the thoracic spine is very intricate and carries risk. Based on my symptoms, if this is the issue, is surgery necessary if there is spinal cord compression of any degree? Can lateral thoracic disc herniations cause the symptoms I am having or would it lean more towards a central thoracic based on my symptoms?
4. If the thoracic spine MRI comes back clean, could “at least moderate bilateral neural foraminal stenosis” be causing these symptoms I have listed above? My surgeon brushed it off as “just stenosis, everybody has that”.
My GP is also doing a referral to a Neurologist and I saw a Urologist and he said at the end of the day, bladder problems are neurologically based in cases such as mine, he also mentioned having T10 and S3 looked at. He filled my bladder and had me pass it after removing the catheter and said I was able to pass it but it was a struggle, especially for a man my age (40). He said I should not have difficulty like I did passing urine and also should not have issues with retention. He has recommended a Neurologist and put me on Flomax to help with urinating and preventing retention again, which it has seemed to have helped so far (been a couple weeks on it).
Any other insight? Once I get my Thoracic MRI, if there is no stand out cause, I would like to send you all my imaging to have a look.
I understand Thoracic spine Herniation is very rare but just reading up on it, it seems I fit some of the criteria. I also have numbness and tingling basically from the belly button down in the front, lower abdominals. Again, all symptoms wax and wane but are there more often than not, 20 out of 24 hours I would say.
I also tried pressing on my spine and it is very tender again to touch and press on about mid lower back, 3rd or 4th rib up.
Any input is very much appreciated. Thanks so much!
The back of legs pain and paresthesias (tingling) could be from the foraminal stenosis at L5-S1 (see foraminal collapse or foraminal stenosis on the website). Scar should not cause opposite sided symptoms unless there was a large hematoma with scar formation (very unlikely). The wide distribution of pain throughout the back and groin could be from a lower brain stem globalization syndrome (like a thalamus malfunction) but this is conjecture and cannot be proven.
I am glad that a thoracic spine MRI will be ordered. Lower thoracic herniations can cause your symptoms (but there would be long tract signs on your examination that would draw attention to this potential disorder).
Foraminal stenosis at L5-S1 can cause your back of leg pain (but not groin and perineal pain). Bilateral selective nerve root blocks at L5-S1 with a pain diary can help to answer that question.
I am unclear as to the origin of the groin and scrotal pain as the nerves from L5 and S1 do not travel to this area. This is L1-2 and S2-4 and there was no evidence of either of these nerve groups being affected by the lower lumbar herniations.
Your complaints of bowel and bladder function may be more pain or medication related than on any neurological basis. There was no severe caudal equina compression (by your record) which is necessary to cause caudal equina syndrome (see website for explanation).
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.Hi Dr. Corenman,
Thank you so much for your response!
Just to be clear, the numbness, spasms and tingling start just above my lower lumbar, by feel, I would say T9-T12 and go down both sides of my spine, into my buttocks, sphincter, groin, scrotum, genitals and down the backs of both legs and into the bottom of both feet.
When I push to urinate or have a BM, I get an increase and shooting numbness, tingling down the back of both legs and into both feet when I push.
The numbness, pain and tingling waxes and wanes but is always the worst when I stand or sit for more than 10-15 minutes and when I lay down at the end of the day.
Also, in regards to sexual function, there is not erectile dysfunction but any sexual activity increases numbness everywhere, groin, genitals, back of legs, buttocks, scortum, sphincter etc. So I have not been sexually active at all.
I will keep you posted on the Thoracic MRI results but something just feels terribly wrong, I mean, residual pain and numbness, weakness down my right leg I can accept due to the repeat herniations on that side but all of this numbness and tingling in both legs, buttocks, genitals, scrotum, sphincter, and down lower back staring just above the lumbar is troubling. It is progressive and I have a lot of tightness and pain in hamstrings and feet.
If the Thoracic does not reveal anything, I will definitely send my imaging and fill out your questionnaire to see if you can identify a cause.
If I were to send you my imaging, is there any other testing that you would like to see done? Discography, EMG, Flexion X-Rays etc.? If I pay your fee for a thorough consult, please let me know if you require or would like to see anymore tests done prior to a consult. I could give you my GP contact info in private and you could forward requests to them for further tests. I have full OHIP coverage here in Ontario, Canada.
Regards,
If there is any suspicion of cord compression, I would have a cervical MRI included in this imaging study. I understand this is Canada and the symptoms could be originating from the thoracic cord but it is much more common to have cervical cord compression.
If there is no compression found in your thoracic or cervical spines, a metabolic disorder needs to be worked-up. Anything from B12 deficiency to SLE/MS to Lyme disease should be on the table. I would be happy to give an opinion but without evidence of cord compression, you would not need me but a thorough neurologist.
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.Thank you again!
Full spine imaging has been ordered and I should have results by end of October. Imaging is on the 23rd of October.
They are doing full cervical and thoracic as well as contrast.
My GP is also looking into a Neurologist referral.
I thought the cervical only involved upper body and upper extremities, my symptoms are basically below T10-T12 I am wagering. I will read up on the cervicaland below the waist numbness.
I will be in touch and thanks again for the other suggestions regarding work up.
I hope it is not something untreatable like a neurological disease. Not even going to speculate though. One step at a time.
Best,
It is rare but the cervical spine canal compression can skip some symptoms in the upper extremities and only display problems in the lower extremities.
Please keep us informed.
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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