Thigh weakness/foot drop after spine surgery

Which specialist was able to diagnose your problem? I’ve seen my PCP, neurosurgeon, and ortho and they can’t. I’m scheduled with a neurologist in June.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a slowly developing autoimmune disorder in which the body's immune system attacks the myelin that insulates and protects your body's nerves.

I think you left out the "demyelinating" part unless CIPD is something else.

I have foot drop on the right which developed suddenly along with severe right radicular leg pain. An MRI showed that I had severe spinal stenosis. Given the sudden onset neurological changes in the context of severe spinal stenosis that explained the foot drop ---not.

Fortunately, an EMG/NCS was done to "delineate the damage." The results EMG/NCS showed diffuse peripheral neuropathy involving my arms and legs. Neuropathy of the peroneal nerve caused the foot drop.

I still have severe lumbar spinal stenosis. Nobody could explain why I have peripheral neuropathy so it was called idiopathic. I do have autoimmune problems so I suspected CIDP might be the cause except the foot drop happened suddenly.

Hello,
I think we have different issues although my foot drop does seem to come from the Peroneal nerve. Is anyone suggesting surgery for the spinal stenonis?

Do you still have your foot drop? I had no idea what it was. I only knew I was tripping and slapping when I walked. I did mix up the acryomen. I have CIDP. My NCT/EMG didn't show any spinal stenosis causing my foot drop. Further studies were done after I had another radiculopathy episode, outside my spine again, it eventually led to my diagnosis of CIDP. I had significant conduction delays on my testing. That's only what I can remember off the top of my head. I had to have a sural nerve biopsy that left that area completely numb. Did you have a biopsy? I sure that must have been really alarming for you.

Further testing showed a remitting course of demyelination with remyelination as the nerves repaired themselves. Mine only affects my long motor nerves/fibers. I didn't have any sensory symptoms nor do I remember it being very painful outside of the muscles reacting to not being able to lift my arm. I simply could not lift it just like with the foot drop. Both resolved on their own. I just remember it being such a whirlwind of testing and that's probably close to 8 years ago. Now I just do annual testing. No treatment. I know my balance has now been affected-my neurologist noted that first. I can't do a toe-heel test because I just fall over. He told me he doesn't think I'll end up in a wheelchair and I hold on to that. This is why I don't think what I am experiencing is related to CIDP. I'm not feeling weak in my legs, it is more of a hot burning, deepness of pain mainly in my upper thigh on one side where my hip and butt hurt. How have you been dealing with your stenosis? Have they told you you need surgery? How much does it affect your daily activities? Every time I've see an MRI of my own that says "severe" I've had to have surgery because it's impinging on my cord and causing the thecal sac to narrow. That's been limited only to cervical. Do you have degenerative disc disease? I do-it's just a fancy word for arthritis. I developed OA nodules in my fingers in my 30's. I also have scoliosis from that. I appreciate your comments.

@sb4ca
Everything you have written about sounds like an autoimmune problem to me. Do you see a rheumatologist?

@gabriellec
An orthopedic surgeon and a confirming second opinion from a neurosurgeon diagnosed my severe lumbar spinal stenosis and a need for surgery. The spinal stenosis was reported on the MRI results and was very easy to see on the MRI imaging.

A lumbar fusion surgery is recommended but still pending until I decide what I want to do. Both surgeons said surgery may relieve some of the back pain but probably won't help the foot drop. I'm not the best surgical candidate so pain was going to be the "deciding factor" for when to do surgery. A neurosurgeon last year said I should have surgery sooner rather than later. The foot drop happened five years ago so "no chance of it improving."

The neurologist who originally interpreted the EMG/NCS results diagnosed the peripheral neuropathy but didn't know what caused the problem with my nerves. It is still "idiopathic" so the cause is unknown. The neurologist can't say for sure that it is CIDP but peripheral neuropathy can be autoimmune related.

The rheumatologist that I see for my autoimmune conditions says inflammatory arthritis may have caused the severe arthritic changes seen in my spine which led to the lumbar spinal stenosis. There is a lot of damage to my spine but I have never had any trauma to my spine. I had chronic back pain caused by inflammation. I took prednisone for the inflammation but prednisone doesn't prevent the damage that the chronic inflammation causes.

I now take a biologic medication for my autoimmune problems. The inflammation has stopped so I don't have too much pain anymore. The damage to my spine is permanent. I feel like the peripheral neuropathy is improving. Maybe the foot drop has improved but it is still a problem.

It was all very confusing when the foot drop happened. The pain was the worst part and it happened rather suddenly. The pain radiated from my back all the way to my ankle. Leg weakness made me drag one leg when I walked. The pain and leg weakness mostly stopped when I took a large dose of prednisone. I noticed that I had right foot drop after the pain stopped.

This is what happened after the acute onset of pain in 2016:
MRI results:
Indication: Radicular right leg pain with right foot drop, leg
weakness and loss of patellar reflex

Comparison: None

A level by level analysis is as follows:
T12-L1: There is no significant disc disease or stenosis.
L1-L2: Large posterior disc osteophyte complex and mild bilateral
facet hypertrophy causing moderate canal narrowing. Mild bilateral
neural foraminal narrowing.
L2-L3: There is no significant disc disease or stenosis. Mild
bilateral facet hypertrophy.
L3-L4: There is no significant disc disease or stenosis. Mild
bilateral facet hypertrophy.
L4-L5: Mild broad-based disc bulge and severe bilateral facet and
ligamentum flavum hypertrophy causing severe canal stenosis. Mild left
and severe right neuroforaminal narrowing.
L5-S1: There is no significant disc disease or stenosis.

RESULTS REVIEWED:
MRI reveals significant femoral stenosis at L4-5, with degenerative spondylolisthesis at that level.

ASSESSMENT:
Degenerative spondylolisthesis with severe foraminal stenosis. At this point, I discussed potential surgery, which would be decompression with fusion at L4-5. Discussed there would be no guarantee his nerve function would return; however, it would be more likely to return with surgery. In addition, I would like to obtain an EMG to help further characterize the amount of nerve damage present.

2 WEEKS LATER:
Staff Physician Comments
Return patient follows up for EMG results. He has right foot drop, which is consistent with some intrinsic neuropathy and peroneal nerve compression. He has known severe stenosis at L4-L5, with radiating right hip pain. I have indicated him for an L4-L5 decompression and fusion at some date in the future. The patient will continue nonoperative treatment and return to clinic when he feels like his symptoms are significant enough where he would like to proceed with surgical intervention.
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This all happened in 2016. I still don't think my symptoms are so significant that I want surgery. The foot drop didn't improve that much. The spinal stenosis got worse. Surgery is still pending. The surgeon said it isn't about the pain anymore and the foot drop won't get better.

@jenniferhunter

Thank-you for your concern. I still haven't had surgery and I'm not planning to do surgery. I "reluctantly agreed" to do surgery awhile ago. A synovial cyst formed and my symptoms deteriorated. I was "penciled in" for surgery last year but I wanted to wait to see if things would improve.

We discussed the issue of falling. I didn't think I needed anything to help me keep my balance. My primary care doctor was skeptical. She escorted me to the physical therapy deartment and told the physical therapist that I needed a rollator. I tried to tell her that I never fall. She said the rollator was to keep me mobile. I didn't like the rollator at first for walking but I loved it when I could sit down.

I'm glad I waited to have surgery because my symptoms improved. When another MRI was done prior to surgery the synovial cyst was smaller. The neurosurgeon agreed there was more canal space so things didn't get any worse. We mutually agreed that I could wait until I was ready to do surgery. The neurosurgeon said my gait was still functional.