EMG Results and Epirdural Shot question

@soccer1477 Are you planning on seeking opinions from other surgeons? It sounds like you don't have any clear answers right now for the cause of the polyradiculopathy.

Spinal epidural injections usually only provide temporary relief. When I had one as a diagnostic procedure, I had only 5 days of being pain free, and after that pain started coming back and building back to where it had been and by a month later, it was all back. Often they are used as a a diagnostic because they reduce inflammation a little bit and it may tell a surgeon what could be improved by a surgical procedure.

nemo1, you wisely keep insisting on a dx. Without the testing we investigate on our own and can't anything out. The doctor suggesting the spinal tap may have had a differential diagnosis of some type of demylineating process. If you are retrieving medical records, asking for the "doctor's notes" might reveal their thinking.
The MRI would show greatly thickened nerve roots with CIPD. A friend was diagnosed several years ago and has been helped by Hizentra. The link can locate the closest diagnostitian. There is also a video outlining the path to diagnosis. https://www.gbs-cidp.org/support/centers-of-excellence/?utm_source=google&utm_medium=cpc&gclid=Cj0KCQiAnrOtBhDIARIsAFsSe50ia-0YfTWHAZXpZbI3RifeGwrUHCC2k2CT9VeNPQhRKm_fUxIhgeEaAvG3EALw_wcB

@nemo1 Yes it does, i have lots of pain growing from Hamstrinig to tibialis and peroneus, it even hurst with contact, surgeons have said no surgery but the pain just gets worst, started in one leg and now is on the other leg, same pain path and muscles, wish there was something clear they could do for us rather than all these test and PT and medicines that really do not help to heal us.
Thank you for replaying and hope it goes better for us

Hello @jenniferhunter Yes, i have seen 3 surgeons, two orthopedics and one neurosurgeon, one orthopedic believes my issues are coming from my neck due to a disc herniated 4 mm, but the neuro and 2nd ortho said no surgeries is needed, as they don't see how surgery would fix anything they see on my MRIs, the ortho said it could be Piriformis syndrome but did not confirm 🙁 the neurosurgeon said, go do the epidurals and if the pain continues we can see what we can do to alleviate the inflammation there, so again, are you saying yes or no on surgery, i don't know he wasn't clear.
None of the doctors the 3 surgeons, muscular neurologist, or pain management have been able to explain polyradiculopathy cause, but like neuro said, most be coming from S1 L4 and L5 based on the EMG findings.
I'm very confused with the MRI as i read there is a Herniated disc (see below) but the doctors are not paying much attention to it, this is my 2nd MRI:
"L3-L4: Disc height loss is seen with a diffuse annular disc bulge which impinges upon the ventral surface of the thecal sac and is superimposed upon facet hypertrophy. Mild spinal canal stenosis is seen. There is mild to moderate bilateral neural foraminal stenosis identified.
"L4-L5: A broad-based central disc protrusion type hemiation impinges upon the ventral surface of the thecal sac.
The spinal canal is patent. Moderate bilateral neural foraminal stenosis is seen.
"L5-S1: A broad-based central disc protrusion type hemiation remains subligamentous. The spinal canal is patent.
Mild to moderate bilateral neural foraminal stenosis is seen"

nemo1, you wisely keep insisting on a dx. Without the testing we investigate on our own and can't anything out. The doctor suggesting the spinal tap may have had a differential diagnosis of some type of demylineating process. If you are retrieving medical records, asking for the "doctor's notes" might reveal their thinking.
The MRI would show greatly thickened nerve roots with CIPD. A friend was diagnosed several years ago and has been helped by Hizentra. The link can locate the closest diagnostitian. There is also a video outlining the path to diagnosis. https://www.gbs-cidp.org/support/centers-of-excellence/?utm_source=google&utm_medium=cpc&gclid=Cj0KCQiAnrOtBhDIARIsAFsSe50ia-0YfTWHAZXpZbI3RifeGwrUHCC2k2CT9VeNPQhRKm_fUxIhgeEaAvG3EALw_wcB

@soccer1477 My case was also really confusing to the surgeons, 5 of them before I came to Mayo. I did have one spinal epidural injection done as a diagnostic in my neck, and it relieved all my pain everywhere, legs included temporarily. The surgeon at the time didn't understand why that could be, so he dismissed the results. This is because he didn't understand the funicular pain phenomenon that caused pain all over my body and it was generated in my neck by stenosis with a disc osteophyte complex that was pressing 5 mm into the spinal canal causing a bit of spinal cord compression. I hear many patients talking of similar situations in having leg pain with a cervical stenosis problem and their surgeons don't know what's wrong. If surgeons can't pin point and understand the cause of the problem, they are unlikely to help. You are getting varied opinions and I did too. They have to look for the differential diagnosis of what else could be wrong because they can't afford to be wrong and make a mistake with surgery.

If you try an epidural injection, it may give you more information, but only you can make that call. Having an epidural in my neck that also helped leg pain was a predictor of funicular pain, but there is no diagnostic test to prove the existence of funicular pain except when decompression surgery fixes it. You also have stenosis at the nerve roots, so that confuses where the pain is coming from. It can come from both places or either of them, the nerve roots or the spinal cord if it is getting touched or compressed.

The Piriformis Syndrome also mimicks a spine problem because of creating similar pain. You may want to read about these kinds of problems at this link:
https://mskneurology.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/
Jennifer

@soccer1477 My case was also really confusing to the surgeons, 5 of them before I came to Mayo. I did have one spinal epidural injection done as a diagnostic in my neck, and it relieved all my pain everywhere, legs included temporarily. The surgeon at the time didn't understand why that could be, so he dismissed the results. This is because he didn't understand the funicular pain phenomenon that caused pain all over my body and it was generated in my neck by stenosis with a disc osteophyte complex that was pressing 5 mm into the spinal canal causing a bit of spinal cord compression. I hear many patients talking of similar situations in having leg pain with a cervical stenosis problem and their surgeons don't know what's wrong. If surgeons can't pin point and understand the cause of the problem, they are unlikely to help. You are getting varied opinions and I did too. They have to look for the differential diagnosis of what else could be wrong because they can't afford to be wrong and make a mistake with surgery.

If you try an epidural injection, it may give you more information, but only you can make that call. Having an epidural in my neck that also helped leg pain was a predictor of funicular pain, but there is no diagnostic test to prove the existence of funicular pain except when decompression surgery fixes it. You also have stenosis at the nerve roots, so that confuses where the pain is coming from. It can come from both places or either of them, the nerve roots or the spinal cord if it is getting touched or compressed.

The Piriformis Syndrome also mimicks a spine problem because of creating similar pain. You may want to read about these kinds of problems at this link:
https://mskneurology.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/
Jennifer

Hello @jenniferhunter quick question, did you also have fasciculations in your legs or around your body? Thanks,

nemo1, I didn't have you figured for CIPD because of the MRI. I suspect it's those discs. Not only can the compress the nerve root, but they lessen the space in the facets--those little joints at the side of each vertebra where the pain nerves exit. Where pain management wanted you to have radiofrequency.
I wasn't thinking sciatica either, interesting that the injection was effective.
https://www.spine-health.com/conditions/sciatica/causes-piriformis-syndrome

@soccer1477 Yes, I did have spontaneous jumping muscles inside on my thigh and calf on one leg. That was being caused by spinal cord compression in my neck. The first symptom I had when it all started was my ankle hurt like something was biting me and that was only when I turned my head. When I looked forward again; it stopped. I know that was caused by the bone spurs raking across my spinal cord.

You may want to ask your providers if they can assist with some pain management to get you through a trip to Mayo since you wouldn’t be doing the driving.

Is there a surgeon you have in mind at Mayo?