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Dr. Corenman –

I have been dealing with a myriad of symptoms for 2 years. It is easier to chronologically summarize my journey. Prior to the onset of these symptoms, I have been in excellant health. My question is do you have thoughts on a cause of my current symptoms (see 1/11 entry).

7/2009: acute onset of bilateral foot (level of arch to toes) tingling, burning pain
6/2009: acute onset of bilateral hand/finger(1-4) burning, tingling pain
12/2009: having much difficulty walking & using my hands from pain. No hand/foot weakness. MRI: Chiari Malformation with very small cervical syrinx
2/2010: underwent Posterior fossa decompression for CM, all symptoms completely resolved initially then gradually returning
5/2010: all original symptoms returned
8/2010: developed tingling in posterior upper/lower legs, buttocks, ba20ck, arms
8/2010: Lumbar MRI results “disc degeneration of the L4-5 and L5-S1 with probable L5-S1 annular tear. Mild to mod central canal stenosis at the L4-5 level secondary to facet hypertrophy and ligamentum flavum thickening”
9/2010: developed significant tightness in both feet, L>R. eventually both great toes began turning up (hyperextension of 60+ degrees)
after multiple tests, doctors..still do not know what is cause of symptoms.
11/2010: consulted with neurosurgeon who determined I had severe cervical stenosis (8-9.5 mm). physician states stenosis may be common with Chairi Malformation
12/2010: Underwent ACD with fusion of C4-C7.
1/2011: hand/arm symptoms primarily resolved. feet/leg symptoms continue with worsening (tightness in feet, big toes turning up, decreased sensation to pain & temperature in both feet, burning in posterior and medial section of upper/lower legs, buttocks. (No radiating symptoms)
5/2011: referred for EMG of lower ext to r/o tarsal tunnel syndrome. EMG (knees to toes) shows tibial nerve impairment. referred to podiatrist for injections & PT
6/2011: Podiatrist does not believe it to be TTS. Tinel’s sign negative; in 30 yrs of practice has never seen bilat TTS much less with the same onset of symptoms in each foot; dermatones affected do not match with TTS. referred for repeat Lumbar MRI
6/16/11: Lumbar MRI completed. all physicians who previously reviewed the 8/10 lumbar MRI state cause not originating in Lumbar region. Today I viewed both lumbar MRI’s for comparison & do not see any real change.

Will be seeing another neurologist with new Lumbar MRI in a few weeks.

Thank you for any thoughts you have!

I have this condition. Disc herniation, left leg pains. Numbness, pins and needles, tight hamstring. Also major lower back pains. Left side of my back is full tensed up.

I’ve been doing a lot of hydrotherapy and core activation exercises. Any more ideas to speed up recovery?

Hello Dr. Corenman,

I am a 55 year old female, very athletic. I have been diagnosed with a Grade 1 L5-S1 anterior spondylolisthesis with bilateral chronic pars interarticularis defects at L5. My symptoms are essentially all on my left side with pain in my lower left back and down to my left buttocks. I have no pain in the leg, but then extreme pain and discomfort (tingling/burning) along the outside of my left foot. My MRI shows that I have a stable grade 1 L5-S1 spondylolisthesis of approximately 3mm with evidence of bilateral pars inter articularis defects at L5 (L5 spondylolysis). There is no central or formainal stenosis from L1 through L5. There is a diffuse pseudo disc bulge but no central canal stenosis. There is a mild left side foraminal stenosis with contact with the exiting left nerve root.

I have received differing opinions as to surgical options. I have seen several surgeons who believe I should have a fusion with hardware. I am very concerned about this extensive surgery which could be more problematic because I have severe osteoporosis. I have also received the opinion that I could be helped by a foraminotomy of the left side without hardware. This would obviously be less invasive. I am wondering whether I truly need the more extensive surgery with hardware. I have seen several articles in the literature recently where patients with seemingly similar symptoms and defects to mine have been helped without hardware. Since my symptoms seem consistent with the left side foraminal stenosis, could the foraminotomy be sufficient for relieving the pressure on the nerve? Afterall, I likely lived pain free for years with the small instability and only likely developed the pain from the left side stenosis that developed. I realize you can not make a determination without an exam, but I would value your opinion and thoughts on my surgical options. I have had several series of steroid injections and they did not really help.
Thank you for your time.

Aloha from Hawaii,
I had gotten a final report of my MRI ( granted I waited 3-4 months before the Dr. finally ordered one) I have been dealing with pain in my neck, back and shoulder for about 6 months and after looking at my report I am quite worried.
is as follows:
at c3-4 there is a mild to moderate right para central focal disc protrusion. this is associated with hypertrophic spurring. this impress upon the ventrolateral aspect of the thecal sac and compressed the spinal cord in this area. there is mild to moderate narrowing of the right foramen at this level due to uncovertebral spurring and facet arthrosis. c 4,5 level is unremarkable
at C5-6 there is a tiny central disc protrusion and mild disk bulging without cord compression or spinal stenosis. there is mild narrowing of the right foramen at this level
the C6-7 level demonstrates maderate narrowing of the foramen on the right due to uncovertebral spurring. the left is mildly narrowed. there is no focal disc protrusion or extrusion.
the c7-T1 is unremarkable.

The cervical spinal cord appears normal in course, caliber.and signal intensity. there is no cord contusion or myelomalacia noted.

Impression:
muscular spasm with no fracture or subluxation.
Mild to moderate right paracentral disc protrusion at C3-4level with associated hypertrophic spurring. compression of the thecal sac and right ventrolateral aspect of the cervical cord is noted. ( these are under lined and is written neurosurgeon)
Disc bulging with small central disc protrusion at C5-6 ( under lined as well)no cord compression
Several levels of foraminal narrowing, as described above.

First your site gave me a better understanding of what and how is affected but I am still in a big grey area ( thanks for the info on your site)

can you explain this and any severity to this ( if any)
there is one neurosurgeon on the island and the closest I can get to him is in August ( 2 more months of pain)
I would appreciate advice or opinion.

My wife particularly is very worried ( as am I)

HELP!

I have been prescribed muscle relaxer, anti inflammatory, pain pills and PT Would rather fix it than keep going through this, even little movement cause cracking and crunching in my neck.