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  • mdt
    Participant
    Post count: 6

    First thanks for your great insights on the forums. I woke up one day with sudden pain all over my right leg and foot numbness. After initial primary consult with some pain meds went to PT next week. PT exercising helped gain flexibility. Found I could not raise on my toes at all. MRI and spine specialist gave steroid injection. Now I am at about 6 week mark and have next appt with spine surgeon in April. At this point I have almost no pain but continued foot numbness & discomfort with shoes and limp walking. Lying in bed and open feet I feel fine.
    Asking this question now to know what to expect from surgeon. Do you suggest EMG to assess nerve damage now. Here are the relevant parts of MRI-

    “At L4-L5, there is a moderate disc bulge producing mild spinal canal
    narrowing. There is contact and displacement of the traversing L5
    nerve roots without definite compression. There is minimal bilateral
    neural foraminal narrowing.

    At L5-S1, there is a small disc protrusion with annular fissure and
    large right paracentral disc extrusion which displaces and compresses
    the traversing right S1 nerve root against the facet and produces
    asymmetric mild to moderate spinal canal narrowing. There is minimal
    bilateral neural foraminal narrowing.

    Limited assessment of the visualized retroperitoneum is grossly
    unremarkable.

    IMPRESSION: Large right paracentral disc extrusion at L5-S1
    compressing the traversing right S1 nerve root.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    You note your symptoms; “I woke up one day with sudden pain all over my right leg and foot numbness”. You then note the MRI impression: “large right paracentral disc extrusion which displaces and compresses the traversing right S1 nerve root”.

    Your current situation is “At this point I have almost no pain but continued foot numbness & discomfort with shoes and limp walking”.

    The compression of the S1 nerve root probably needed a decompression at the time of occurrence if you had motor weakness of your foot (in my opinion). The chance of recovery of motor strength is somewhat limited if the root is not decompressed on a timely basis. See this and look especially at the S1 nerve root to understand what motor deficit you might have. https://neckandback.com/conditions/home-testing-for-leg-weakness/

    How long has it been since occurrence of leg pain and “limp”?

    Dr. Corenman

    mdt
    Participant
    Post count: 6

    Thank you Dr Corenman. When you say “probably needed a decompression at the time of occurrence” whch procedure do you refer to – surgery or otherwise?

    The spine physiatrist confirmed the S1 compression in MRI and suggested to do steroid injection to reduce inflammation.He did mention motor weakness concern and also setup a consult with spine surgeon. I have found some improvement after injection but not enough on numbness.He did not suggest decompression of S1.

    The chance of recovery of motor strength gets lower if not done on ‘timely basis’. This condition is now 6 weeks old. Is it getting to be outside the time limit? Does the weakness get worse over time? Should I expedite the surgery consult?

    mdt
    Participant
    Post count: 6

    To add based on leg tests, my deficit is in the raise on tip toe test. I can do on left but not on right.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    Injections work well for pain but do nothing to relieve compression that leads to leg weakness. You cannot walk on your toes on the right which is indicative of severe compression of the right S1 nerve. You need decompressive surgery soon to give you the best chance of motor strength recovery.

    Dr. Corenman

    mdt
    Participant
    Post count: 6

    Thank you Dr. Is surgery the only/best option for decompression of nerve or manual methods like traction or stretching machines worth trying?
    Spine physiatrist said injection might help clear out inflammation but as you said not compression. He did say it is just on way to surgery consult. I will try to expedite my surgery evaluation.

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