Symptom question

Tagged: Unusual leg symptoms possibly from cord compression or neuropathythce

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thebird
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September 23, 2017 at 10:28 pm

Post count: 23

#26472

Hi Dr, hoping you can help with my question.

In December 2016, I injured my neck which resulted in large bugles at c5/6 and c6/7 level with left nerves severely impinged. Underwent posterior discetomy to relieve nerves immediately and at the the time I had pins and needs in left elbow and thumb, index finger. Pins and needles were gone immediately post surgery.

In July 2017, I have some how injured further and experienced pain in my upper back neck area for 2 weeks which then reduced back to a manageable level. I then started getting sensations in both legs. Primarily started in both shins as a cold/wet feeling, however to dates it shifts week to week, sometimes in my calves, and sometimes above knees. Also sensitive to clothes and can feel like a burning feeling. I had whole spine MRI done in July, thoriac and lumbar were fine. However cervical slightly worse then 2016. Latest Results below and wondering if this can be causing my symptoms? Scheduled to see nuerologist shortly but after your opinion if possible.

C5/c6 – there is a large broad based disc bulge indenting the cord. Mild facet arthropathy seen. There is mild to moderate foraminal narrowing and nerve root impingement on the left. Mild canal stenosis. No focal cord oedema seen.

C6/7 – a broad based disc bulge is seen indenting the cord. Minor facet joint arthropathy. No nerve impingement or cancel stenosis. No cord compression.

Conclusion: suspicion of mild impingement of editing c4 root. Moderate impingement of c6 left root. No cord compression or canal stenosis seen at any level in cervical spine.

I find it a bit weird that in the details it mentions canal stenosis but conclusion none seen at any level? Looking through your site canal stenosis can cause these symptoms in my legs, but I wonder if “indenting the cord” can also? Symptoms seem to be brought on by sitting, and clear up by walking around. Any feedback would be appreciated.

Donald Corenman, MD, DC
Moderator

September 24, 2017 at 9:35 am

Post count: 8660

#26473

You can have effacement of the cord with a spur but no stenosis as the canal is wide enough. Effacement is anterior cord draping without compression. Most of the time, this causes no cord symptoms (myelopathy- https://neckandback.com/conditions/cervical-central-stenosis-and-myelopathy/).

Your symptoms could be from cord compression (“a cold/wet feeling, however to dates it shifts week to week, sometimes in my calves, and sometimes above knees. Also sensitive to clothes and can feel like a burning feeling”) but also could be from peripheral neuropathy (see https://neckandback.com/conditions/peripheral-neuropathy/). This could be discerned by a careful physical examination or maybe by a neurological consult and an EMG/NCV test (see https://neckandback.com/treatments/emgncv-electromyograms-and-nerve-conduction-studies/).

You did not report current arm symptoms so any foraminal stenosis in the neck would be asymptomatic.

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.

thebird
Participant

September 24, 2017 at 3:24 pm

Post count: 23

#26482

Thank you for taking the time replying to me Dr Corenman.

I have no arm symptoms at all. Purely both legs however has not affected the feet. Shins, calves and upper thighs above the knees only. I do notice certain chairs, or sitting can bring it on more intense which makes me think it is based on movement and something touching somewhere that it doesn’t like. In regards to the cord indentation, could you elaborate on this a bit for me? For example, can sitting with head motion forward put extra pressure and cause compression from the disc bulges? It is usually always like for like too, where I suffer a stinging or burning pain in one leg, it’s equally in the same spot on the other.

Thank you for mentioning peripheral-neuropathy, would movement of my body that as mentioned above that triggers it fuether still entertain this condition?

Cheers

thebird
Participant

September 24, 2017 at 5:08 pm

Post count: 23

#26483

Thought I should provide some better background that may assist you answering my questions. I am a 30yr old male. Back in July during the 2 week painful period prior to leg sensations, I forgot to mention that I did experience the cold/wet feeling in my shoulder blades, this was only brief and occured while sitting down, leaning forward. Quickly vanished when getting up and walking around. I only experienced it in this location for around 3 days, possibly once a day before it proceeded to my legs and never returned to my shoulder blades. This triggered me to see my Nuerosurgeon who ordered the full spine MRI. He did perform a physical examination by the means of tapping on my knees and said there was slight delay. He also said, while it is possible my neck can cause this issue, he said many other things can also and referred me to the nuerologist.

While waiting for my appointment, I have experienced the cold feeling in my lower back, but only when bending over putting clothes in the washing machine. So I’ve only really experienced it twice in the 3 month period in this location as i rarely do the washing due to the issues im experiencing. But again, the primary location is my legs and it comes on it’s own without any much trigger besides sitting, but will still be present walking around unless going for a decent walk, it will clear up.

Medicines I’ve tried to no releif

1. Lyrica 75mg
2. Mobic (anti inflammortory) 7mg and 15mg to no relief. I did think i had slight relief on the 7mg so my GP upped it to 15mg but it did not do anything so I’ve stopped taking as I figured I may of just had a good day or 2 on the 7mg.

I’m scheduled to see the nuerologist next week, is there anything I’ve mentioned to you that would be most valuable to him? I guess it’s easy to blame my bulging discs on the issue and the fact that I disturbed it and all these symtoms presented, but at the same time I’m hoping the Doctor doesn’t get side tracked and will consider all options.

Further to this, it’s been occuring for 3 months while waiting for my appointment and I do worry about permanent damage, however it is hard to get into these doctors. Should I be doing more? Should my GP be doing more? the GP has only checked my blood counts at my request and wrote the referral.

I think that is everything I wanted to ask, sorry !

Again, thank you for reading my questions and providing some feedback.

Donald Corenman, MD, DC
Moderator

September 24, 2017 at 5:53 pm

Post count: 8660

#26484

Cord draping is made worse with neck flexion (hanging your head down) but what factor that works against this is the “delay” in reflex in your legs. Cord disorders would cause significant increased reflexes-hyperactive reflexes. A neurological consultation with EMG/NCV is your next step.

Based upon your intermittent symptoms, I am not too worried about permanent injury.

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.

thebird
Participant

September 24, 2017 at 6:09 pm

Post count: 23

#26485

Thank you for reviewing my symtoms Dr Corenman, it is much appreciated.

Hopefully goes well with the Neurologist next week.

Cheers
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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