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  • awritersmind
    Member
    Post count: 6

    Good afternoon,

    I shall try and keep my history brief. When I was 17, I suddenly had bilateral leg weakness and foot drop. A massive l4/l5 disk herniation was discovered and ignored. Due to my age and gender (female) they insisted the entire thing was in my head. Two years later, it became so bad I was about 90% paralyzed from the waist down, and I had a discemtomy and laminectomy. It took about 9 months to walk again, and the disc was much worse than they would even tell from the MRI. It took an extra hour, and the surgeon and his team said it was the worse they had ever seen.

    Now a month ago, while at work, I started getting weak in the legs again, with partial foot drop. It still works, but glitches in and out so I trip over it. They completed MRIs of the thoracic and lumbar, and a CT of the lumbar. No one knows what’s wrong again, just like last time… I am almost 24, female.

    Thoracic MRI:

    Shallow right paracentral disk protrusion at T4-5 and T5-6 with mild right ventral cord flattening. No cord signal changes or pathologic enhancement. Shallow disk protrusion with T8-9 (central)and T11-12(right paracentral)without significant stenosis.

    I did have a great deal of midback and neck pain that travels down my arms with elbow, wrist and finger pain quite regularly. I also get pins and needles in the mid back, and sometimes if I twist, it feels like my bones shift in that area, they crack, and I feel stunned for a couple seconds. When I was 17 and had MRIs done, the T4-5 and T5-6 abutted the cord, so I’m not sure if it has gotten worse over the years. I also have trouble with hand clumsiness. (trying to type accurately has gotten difficult even. Didn’t use to be like that.)

    Lumbar MRI:

    L4/5: Diffuse disc bulging with mild right greater than left neuroforaminal narrowing. No significant central canal stenosis.

    L5/S1: Small central disk protrusion with annular fissure.

    The CT gets more detailed.
    L4/5: Bulging of disl, slightly asymmetrically so in the anterior right. Or subarticular canal and lower neural foramen. This is the operated level. In the lower lumbar spine, the pedicles appear short. There is some lateral recess stenosis with entrapment of the L5 nerve root on the left at this level. There is nor entrapment of the L4 nerve root exiting the neural foramen.

    L5/S1: Disk protrusion into the anterior midline, and right paramedian or subarticular canal. No encroachment upon L5 nerve roots exiting the neural foramina. The disk protrusion mildly entraps the S1 nerve roots between the protrusion abnormality in the disk and the ligamentum flava on both sides with potential irritation of the S1 nerves.

    I’ve been through this before, and the doctor told me I’d never walk again the first time. Now similar things are happening, and I’m scared of that being the case again, and no one is listening or taking me seriously. I don’t know what to do…

    How big of a potential problem could these findings be? I do have trouble with shortness of breath during activity that is not asthmatic, when I used to work out for months and months, I never would get stronger, and I also have REM specific sleep apnea. I just really want to be a healthy, active 24 year old.

    Thank you for your time! I can clarify anything if need be. I just don’t want to make the post any longer.

    awritersmind
    Member
    Post count: 6

    A few more details:

    Have had neurosurgeons, ortho spine surgeons, and neurologist look at films. They say it’s nothing and I’m not getting anywhere… But I’m not confident that any of them really looked at them long, because each time I mention did they look at the CT scan, all I get is, what CT scan?

    However, the other night, the left foot was floppy (low muscle tone?) and the big toe drooped down and underneath the other toes, and the right foot instead, had the toes pointing up in the air as if a great deal of muscle pulling on the foot because I wasn’t controlling it. Sporadic things like that happen.

    I also have a small incidental syrinx that runs from T4 to the distal cord.

    My main concern is the trouble walking and abnormal gait. My legs are slow to move forward, and it seems some of it may stem from the hip area. I also have trouble with the calves spasming and feeling weak, which throws me off. My balance isn’t too great, but I have managed to avoid falls when I’ve stumbled or tripped. However, even with my AFOs and leaning on them to support my knees, my lower legs move forward slowly. It’s not quite a scissoring gait, but my hips do swing out some because I have the sensation that I’m bowlegged. Pain does occasionally shoot down my legs from my buttocks into my calves and around my knees. I feel it into my ankle, and the lower leg with throb constantly with a deep ache. Sometimes it goes into my outer toes, sometimes my big toes. I also get what I think are neuropathy pains in my outer toes and bottom of the feet.

    Supposedly the nerve conduction and EMG was normal, although some were not as good as it was been previously after surgery. I’m not sure why that didn’t puzzle the doctor. I know arm and hand pain is typically associate with cervical issues, and the MRI of cervical spine at age 18 showed early degenerative disc disease at C3/4 and C4/5 I believe. No MRI since.

    So pain isn’t my main issue. I’m terrified about the functional loss and that no one knows what to do or will even take me serious. I’ve been through this before and I never want to end up facing the “you’ll never walk again” conversation…

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    As you probably are aware, your past cauda equina injury (large herniation at L4-5 with a congenitally narrowed canal causing severe nerve compression) at age 17 left some chronic nerve injury at that level. You eventually recovered enough function to resume your “normal” activities. Some of your symptoms can occur from that old injury.

    You make two statements however that make me concerned about your cervical spine. One; “I did have a great deal of midback and neck pain that travels down my arms with elbow, wrist and finger pain quite regularly” would not be residuals from the lumbar disc herniation but a cervical problem.

    The other; “I also have trouble with hand clumsiness. (trying to type accurately has gotten difficult even. Didn’t use to be like that” is also a potential cervical cord compression problem (myelopathy-see website).

    Spinal cord compression in the cervical spine can cause lower extremity weakness and balance problems along with hand incoordination. With your previous history of precocious disc herniation (disc herniation at a young age) along with congenital canal stenosis (inherited narrowing of the canal) leads me to think you need a cervical MRI. I would not be surprised to find compression of the cervical spinal cord.

    Dr. Corenman

    awritersmind
    Member
    Post count: 6

    Dr. Corenman,

    Thank you so much for your response!

    I had been to a chiropractor around 4-6 months ago because my neck was in bad shape. Pressure would build up very intensely, and I would get quite a few migraines.I still get that feeling of pressure in my neck and head, and with certain movements, the pressure shifts so that my hearing becomes distorted. I also get to the point where it almost feels squishy where the base of skull and spine meet (I would imagine that is just a distorted feeling), and if I rub along the spine for some relief in that area, I can feel something squish around. The info on myelopathy does sound somewhat similar to my experiences. About a week before my legs felt weak and odd, one hand was going partially numb at work and I kept dropping everything that day.

    According to what the neck X-ray showed him (I just remembered he had done them), the neck is completely straight except for a small bend in the wrong direction. I forgot the technical term. A kyphosis, I believe? There is also a great deal of degeneration in the vertebrae. I know it can’t show discs, but boney structures. I will try to get someone to take my case again and do as you recommend. I wish you were in Florida!

    I read somewhere that with spinal cord compression, it doesn’t show up on an EMG/ nerve conduction study. Is that correct, or did I misunderstand?

    One last question: is cord flattening different than cord compression? I have that in the thoracic area and I haven’t found what exactly that means.

    Again, thank you for your time! I really appreciate this resource and your amazing dedication to us here, and really taking it to heart to help as many as possible. It’s not easy to find doctors like that…

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    Significant degenerative changes in the cervical spine are consistent with formation of bone spurs that can crowd out and compress the spinal cord. This can lead to myelopathy. You are correct that EMG/NCV tests will not diagnose myelopathy. This is a diagnosis made of history/physical examination along with imaging findings.

    Cord flattening could be synonymous with cord compression but not always. If the canal is not narrower than the diameter of the spinal cord but the cord is draped over a bone spur or herniation, the cord could be flattened but not compressed. This flattening can still cause myelopathy but the chances are less.

    Dr. Corenman

    awritersmind
    Member
    Post count: 6

    Thank you for your response!

    I thought of a few more questions. I’m not sure if these are a cause for concern or not. I’ve had so much trouble with doctors trying to psychoanalyze my symptoms over the years that I’m hesitant to talk about them.

    Is it a cause for concern that when I rotate my neck, especially when tilting my head back to look up or find a pressure relief position, my neck cracks and is very painful, sometimes making me feel stuck, and it feels as if one or two vertebrae shift? I’m not sure where the spinal regions start and end, but it is around probably one vertebrae down from the one in line with the shoulders. The cracking sounds like it’s from higher up, but I know with cracking it can be hard to tell, but it’s quite painful. Also, sometimes when this happens, and other times when I turn, or just shift some, I get a twitch, and I can feel where it originates, ( similar area that gets the shifting sensation) and from there up my body gives a decent convulsion that is very brief that effects from that level up through my neck. It’s like a zap going through my back. Also, I keep getting the sensation as if hot water is being poured down my spine from the neck region down.

    The heaviness in my legs is slowly getting worse too. I feel the constant need to stretch my legs, and the stiffness sets in very quickly. Again, since I’m having trouble finding a doctor, and I only get about 2-5 minutes with a doctor, I want to make sure I mention the most crucial details when I finally get it.

    Thank you again for your dedication!!

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