Viewing 2 posts - 1 through 2 (of 2 total)
  • Author
    Posts
  • Addison
    Participant
    Post count: 7

    Hello doctor, I had a fall in January from which I received a bulging disc at L4-L5 that is causing muscle weakness in my right leg. Here’s the summary from my MRI:

    At L4-L5, there is moderate to large sized broad-based posterior
    left foraminal/left far lateral disc protrusion which moderately
    narrows the left neural foramen and impinges on the exiting left
    L4 nerve root. There is mild degenerative spurring about facet
    joints with mild right neural foraminal narrowing.

    At L3-L4 and L5-S1, there is mild degenerative spurring about
    facet joints. Mild neural foraminal narrowing is seen at both
    these levels as described.

    I have several areas of muscle weakness. On my affected leg, I cannot raise up on my toes at all, even though I can duck walk just fine. Also I have trendelenburg gait.

    When I went to the neurosurgeon at the VA, he basically told me my inability to raise up on my toes comes from the L5-S1 nerve, and therefore to hold off on surgery. This I didn’t understand, because on your website it says that inability to stand up on your toes is listed under both the L4 and L5 nerve root home testing for motor weakness. Also my disc at L5-S1 is totally fine.

    I have another appointment with him next month, what is he not understanding? What can I tell him? Next month will be 6 months of symptoms for me, and as an athlete, I don’t want to keep having this delayed and lose my ability to use my lower leg

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    To understand the neurological issue, standing on your toes is the calf or gastric-soleius muscle group which is an S1 nerve issue. Walking on your heels (duck walk) is an L4 or L5 nerve issue to the tibialis anterior (TA). Lifting the great toe (EHL muscle) is a pure L5 nerve issue. The L4 nerve that you have compressed is going to affect either the TA (can walk on your heels) or the quadriceps femorus group (the muscle that allows you to get up from a deep knee bend by straightening the knee joint). Read this section to understand: https://neckandback.com/conditions/home-testing-for-leg-weakness/.

    If you have weakness from an L4 nerve standpoint, you need surgery in my opinion. This option gives you the best chance for strength recovery. If you have weakness and the nerve does not match up with the weakness, get a neurological (not neurosurgical) consultation with an EMG/NCV test. See: https://neckandback.com/treatments/emgncv-electromyograms-and-nerve-conduction-studies/.

    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.
Viewing 2 posts - 1 through 2 (of 2 total)
  • You must be logged in to reply to this topic.