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  • AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481
    in reply to: Walking on Heels #4642

    Heel walking is mediated by the gastroc/soleus group of muscles (the calf muscles). These are innervated by the S1 nerve. Inability to walk on your heel could indicate that these muscles are weak from nerve root compression. However, there are many other causes of inability to walk on your heels. Therapy is based upon the cause of the inability to heel walk.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    Wechsler’s Memory Tests I believe are the standard for measuring memory function but I am not an expert in this field. A spinal cord injury will not by itself cause a poorer test score on this battery of tests. Brain injury is the normal cause of test score gradation drop. However, if chronic pain has occurred in the face of cervical injury, this in my opinion can change the test scores as concentration suffers in the face of chronic pain.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    I’ll start with interpretation of what has occurred.

    Symptoms started in mid 2009 from spinal cord compression at the base of the skull. You mention Arnold Chiari Malformation which is an alteration of the normal relationship of the brain stem with the skull base. There is overcrowding in this region and symptoms of myelopathy with brain stem dysfunction occur. The posterior fossa decompression surgery enlarges the foramen magnum and possibly part of the back of C1 is removed. The symptoms abate but not completely (not uncommon).

    You start with symptoms again in both upper and lower extremities but suspicion is given to lower back as there is mild-moderate stenosis. You however do not give a history of pain or numbness that starts out in the sacrum and extends to the buttocks and then posterior thighs with walking that is relieved with sitting or bending forward. These are the symptoms consistent with lumbar stenosis.

    Tightness occurs in both feet (not a typical symptom of stenosis) and you develop up-going toes (could be a Babinski sign) which could indicate a cord problem. There is no cord in the lower back below L1. Cervical stenosis is diagnosed (a possible cause of your unusual symptoms). Cervical stenosis would be easily visible on an MRI. 12-2010 you undergo an ACDF at C4-7 for the stenosis. Surgery did help the upper extremities but not the lower extremities. Lower extremities exhibit loss of pain and temperature and develop burning symptoms.

    You have a neurologist (I presume) perform an EMG/NCV test which demonstrates bilateral tibial nerve involvement. You do not indicate where the lesion is suspected but indicate it is bilateral. Another lumbar MRI is performed with no change in images. Do I have it right?

    Everything written here is on assumption. You don’t state your age but i assume you are in your 50-60s. The symptoms in your legs which include loss of pain and temp as well as the burning symptoms lead me to consider peripheral neuropathy. This would also explain the delay in conduction in your EMG tests bilaterally. If this was from the cord, the EMG would be negative. You don’t mention weakness or imbalance symptoms. The up-going toes could be a residual from your prior cord problems as surgery is designed to prevent further progression but damage that was already done may not improve.

    The neurologist seems to be the way to go. You might need another EMG/NCV as these tests are very operator dependent and the skill of the test giver makes all the difference in the world. There are various vitamin deficiencies that can cause these symptoms as well as disease processes and even alcoholism and various types of infections.

    Please let me know what the conclusion of the neurologist is.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    Your wife by your account has a significant but typical disc herniation of L5-S1 right that is compressing the right S1 root. (See web site for lumbar herniated disc information). This can create excruciating pain as you and your wife are unfortunately well aware of.

    If there is no weakness of the muscles, then this condition can be treated with medication, injections and therapy. If these treatments are ineffective or the patient is in extremis (severe pain and cannot obtain relief in any position) then surgery is required. Do not be apprehensive regarding surgery. 90- 95% of the time, the patient awakens without leg pain and breathes a sigh of relief.

    The one important issue for immediate treatment in my book is whether she has weakness of the gastroc/soleus group of muscles (the calf muscles). The easy way to test these muscles is to have your wife tip toe for about 10-15 feet. It will be painful but have her try to do this action and ignore the pain for a very small instant. Watch her heels as she tip toes. The calf muscles hold the heels off the ground when tip toeing. If she cannot hold the affected heel off the ground on the painful side no matter how hard she tries, she may have weakness of this group of muscles.

    Surgeons may differ on this but most of us feel that weakness of a major motor group is cause for surgery sooner than later as the motor nerve has the best chance for recovery with timely decompression surgery.

    I understand the national health insurance issues in Australia make timely visits to a physician sometimes difficult, so try to contact a surgeon and have a conversation as soon as possible. If your wife has weakness, try and push up the timing of this visit.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    Your physician recommended against physical therapy because of a bad response the first time you sought care so it makes sense that further care from the same therapist might still aggravate the radiculopathy. Therapists are not always similar and some are more talented than others. A different therapist may improve the outcome. Discuss this with your doctor.

    Chiropractors are the same. In the face of nerve irritation from a disc herniation, some chiropractors can improve symptoms and some can aggravate them. It really depends upon the chiropractor. Some chiropractors incorporate massage in their treatment programs and massage typically will not aggravate nerve compression.

    Back pain can occur from a disc herniation which presses onto the posterior annulus but this is not typical. (See the section on back pain in neckandback.com). Back pain normally occurs from discal instability. The typical treatment is a good therapy program. In addition, an epidural steroid injection can be helpful for the back pain and the radiculopathy.

    Hope this helps.

    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.
    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7481

    Were X-rays of your lower back performed? If so, did they reveal a degenerative spondylolysthesis or isthmic spondylolysthesis of the L5-S1 level? See website for more explanation. On the front to back view (the AP or anterior-posterior), was there a significant angulation of L5 on the sacrum? The presence of any of these can indicate the need for an additional fusion of this level to remove the foraminal stenosis.

    Ask your doctor if there is instability of the level. Instability can also lead to a collapse of the foramen and the need for fusion.

    If there is instability, a degenerative spondylolysthesis or isthmic spondylolysthesis of the level, then simple decompressive surgery like you originally had can occasionally cause foraminal stenosis as a side effect of surgery or at least not cure preexisting foraminal stenosis. This is no fault of your surgeon but simply one of the risks of decompressive surgery in the face of instability.

    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.
Viewing 6 posts - 7,387 through 7,392 (of 7,480 total)