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Your “pulled muscle” in your neck that you suffered with for years most likely was an annular tear or small herniation of one of the discs. Many individuals report annular tear symptoms to feel like a “pulled muscle”. Most likely, the intense pain you experienced starting 8 days ago was a complete herniation compressing the nerve root.

The muscle strength deficit is again, most likely from nerve compression. Your physician apparently performed a skilled motor examination and found the strength deficit. One hand should not be significantly weaker than the other normally.

I cannot comment on your sister and why she is the way she is currently but most likely, your life will not follow hers if you treat this condition appropriately.

Follow your physician’s advice. You should have an MRI of your cervical spine. You may be a candidate for physical therapy and an epidural steroid injection or you may need surgery. The treatment decision depends upon your examination and the findings on the MRI.

Most people with this condition and appropriate treatment have significant or complete resolution of their symptoms.

Dr. Corenman

You note three areas in the lumbar spine with spinal stenosis- most likely at L3-4, L4-5 and at L5-S1 (the three lowest segments of the lumbar spine).

You note leg symptoms as the most intense and that there is no position that tends to be the worst (between walking and standing). I assume that either walking or standing cause symptoms and sitting, bending forward or lying down, especially in a fetal position relieve symptoms.

These symptoms are typical for neurogenic claudication caused by spinal stenosis (see website under these topics). The diameter itself can have some bearing on the need for surgery but symptoms do too. If the canal is so tight that the nerves are being crushed, there is the possibility of the onset of arachnoiditis (see website). The appearance of the MRI with experienced eyes will be the most helpful to determine that possibility.

I have many patients with spinal stenosis that continue to function well without surgery using epidurals and a flat back posturing program in physical therapy to avoid surgery. Admittedly, each year some of these individuals desire surgery but there are still some that I monitor each year that continue to do well without surgery.

Stenosis in the cervical spine is occasionally associated with lumbar stenosis but it is in the range of 10%. Symptoms of cervical stenosis include myelopathy (check website for that information) and rarely, central cord syndrome.

Dr. Corenman

Let’s start with why you had a microdisectomy after 10 years of pain. Where was your pain? Was it buttocks and thigh pain or was it lower back pain? The reason I ask is that buttocks, thigh and leg pain is typically caused by nerve root compression and lower back pain is typically caused by problems with the disc itself. What did the surgery do for you? Are you better, is the pain more intense, less intense or changed in quality? What are your current symptoms? Do you have more pain with standing and walking or with sitting?

No exercise for 10 months after surgery causes deconditioning of the cardiovascular system and muscles. If you were more active prior to the surgery, did you reduce activity secondary to recommendations?

I suspect that your surgery was at the L5-S1 level as you report a preexisting herniation at the L4-5 level that was not operated on. How big is this herniation, what side is it on and why did your surgeon indicate that it was not causing symptoms?

Please let me know about your current symptoms and we can look further into the potential causes.

Dr. Corenman

You report that you injured your back in July- some 3-4 months ago. You have pain in your back that radiates into your left leg and report degenerative disc disease in the L5-S1 level. You have tried chiropractic care but the symptoms did not improve. The MRI did not note nerve compression so a discogram was completed. The levels L3-4, L4-5 and L5-S1 were tested. L3-4 and L4-5 did not cause pain but L5-S1 was extremely painful and apparently reproduced your typical pain but at increased intensity. The test prompted your surgeon to recommend a fusion of L5-S1. Do I have it correct so far?

Some questions. Do you have more pain in the left buttocks and leg than you do in the back? If so, is the pain worse with standing and walking or with sitting and bending? Do you have more back pain than buttocks and leg pain? What happened with the spidural steroid injections? Did you keep a pain diary (see website for this)?

If you have more leg pain than back pain and the pain is increased with standing, you may have lateral recess stenosis or foraminal stenosis. There are various surgical treatments for these diagnoses and fusion could be one of them. It all depends upon the pain generator involved.

Dr. Corenman