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A disc herniation compressing the L5 root will cause EHL weakness (extensor of the great toe). This is a normal finding with L5 pathology and may or may not improve over time after the disc herniation is removed. Unless you are a martial artist, football player or rock climber, this deficit will not affect your life.

You will not become fully paralyzed or impotent from an L5 disc herniation unless it fills up the entire canal and that is exceeding rare. Surgery will not affect your married life.

Lumbosacral belts can be useful for heavy lifting. This increases the core pressure to reduce the stress on the lumbar spine when lifting. Continuous use however weakens the abdominal muscles as you tend to push your belly out against it instead of contracting the abdominal muscles.

Dr. Corenman

OK- this makes more sense. The condition of foraminal stenosis of C5-6 (see website for this) would cause compression of the C6 nerve. This radiates pain and paresthesias (pins and needles) down to the thumb side of the hand. Weakness would include biceps (bending the arm at the elbow), wrist extensor (lifting the wrist up opposite side of the palm)- important for grip strength and the thumb muscle.

Foraminal stenosis would become worse with neck extension (bending the head backwards) making the radiating symptoms worse. Temperature is governed by the sympathetic nervous system that does not originate from the neck so the coldness in the hand is not related to the neck.

You could also have carpel tunnel syndrome- very common with using a mouse. I do not have a section written on that so you will have to look it up on the internet.

Dr. Corenman

First- the arm pain and numbness is not related to your spondylolisthesis.

The “heaviness” of your leg is a bothersome symptom to me. Heaviness can mean motor weakness which is a problem that needs to be addressed sooner than later. The L5 nerve is the one that is compressed in your situation and if it is not generating signals to contract the muscles that your brain is demanding, this can cause permanent damage to the nerve.

The four major muscles that the L5 nerve serves are the tibialis anterior, the extensor hallicus longus (EHL) and the gluteus medius (and occasionally maximus). There are also the peroneal muscles.

To test the tibialis anterior, simply walk on your heels keeping your foot in the air (off the ground) with each step. If you note the foot does not want to stay up, further test by standing next to a counter and balancing your weight on the counter with your hands. Lift one leg up off the ground and perform ten repetitive foot raises with the other leg. Match your “good” leg to your symptomatic leg. Are they the same or is there a significant performance difference? If the symptomatic leg is much weaker, you have foot drop and a neurological motor deficit in your painful leg.

To test the gluteus medius, you need to be undressed in front of a mirror. Lift your painful leg up and watch the level of the pelvis on that side. It should RISE UP. This means the gluteus medius muscle is working on the OPPOSITE side. Then bear weight on your painful side and lift the “good” leg. The pelvis should rise up on the lifted leg side. If it drops instead of lifts- you have a positive Trendelenberg sign and a weak gluteus medius.

The extensor hallicus longus (EHL) is a small muscle on the top of your foot. It truly is important only if you are a karate expert, a soccer player, a football place kicker or a rock climber. It is the “canary in the coal mine” for the L5 nerve root. It is easy to test as it can be overcome even when neurologically intact by a skilled examiner. Simply lift your great toe with your leg crossed in your lap (if you can do that maneuver) and try to push the big toe down with your fingers. You can easily test the strength by comparing the opposite sides.

The peroneal muscles keep the ankle from twisting. Generally, when walking, especially on uneven ground, the ankle wants to twist in. The muscles that prevent this action are the peroneals on the outside of the leg. If you feel like you are always on the verge of spraining your ankle, these muscles may be weak. Testing them during a physical examination requires a skilled examiner.

Generally, if you have EHL weakness, it is not too important but if you have tibialis anterior, peroneal or gluteus medius weakness, it is my opinion that surgery is warranted.

Dr. Corenman

You have had pain in your leg from a herniated disc for two years that increased in intensity three months ago. You were treated by a clinic that used a machine with suction cups and vibration. I am unclear about the identity of this machine but it may be an electrical muscle stimulator or an interferential current generator machine.

While being treated by this machine, you developed paresthesias into both your hands on the pinky side associated with “constant weakness”. Your doctor told you the cause was a herniated disc in your neck.

First, your hand symptoms could be generated by the neck, the shoulder, the elbow or the wrist. The disorders are called a cervical herniated disc, thoracic outlet syndrome, cubital tunnel syndrome or tunnel of Guyon syndrome. Having bilateral symptoms might make a disc herniation less likely. Bilateral thoracic outlet syndrome is common. Bilateral cubital tunnel or Guyon tunnel syndrome is less common.

I think that the machine placed on your lower back most likely did not cause the hand symptoms. You at this point need a good physical examination to determine what is causing your symptoms- not an MRI. If the examination points to your neck as the source, then an MRI might be warranted.

Dr. Corenman