Cervical disks and heaviness and numbness in legs

@rico2 We have communicated in your first discussion which was this one.
https://connect.mayoclinic.org/discussion/acdf-56-and-pinched-nerves-leg-weakness/
You are correct in that cervical stenosis with cord compression can cause problems with weakness and heaviness in the legs. It can also be caused by problems elsewhere in the spine. Since you are in physical therapy, you can ask your PT. It is easy for them to assess if your cervical spine is out of alignment if they have you lay on your back and feel if the spineous processes are lined up . It may be that symptoms increase if the alignment is off due to a muscle spasm or slipping of vertebrae that increases pressure on the spinal cord. If your PT is able to realign the cervical spine and it relieves the symptoms, that would be evidence that the cervical spine is causing or at least contributing to the leg issues.

I had leg issues from cervical canal stenosis that caused me to walk with a limp and uneven gait. Like I described, my symptoms could get better if my PT realigned my spine, and the issues returned when a muscle spasm moved the vertebrae again. Of course, my spine surgery that fused C5/C6 resolved all of it.

Will you be following up with your spine specialist after a period of PT? Has PT helped?

I had c5c6 ACDF surgery due to cervical spondylitic myelopathy which is spinal cord compression/injury (also have DDD/spinal stenosis). You should see your orthopedic spine specialist asap and get an updated MRI to see if something has changed and is now compressing your spinal cord again (especially after fall and after PT). Myelopathy can cause permanent injury. The heaviness in your legs sounds like cervical spinal cord (can also cause weakness in arms/hands where you drop things or have difficulty writing). I also have lumbar spinal stenosis/DDD/sciatica and have pain, numbness, weakness in hips, buttocks, legs and feet plus balance issues. My stenosis is congenital since birth and desk job 30+ years hasn’t helped. I am considering lumbar surgery since I am having difficulty walking, using stairs, standing, sitting, etc.

@rico2 I would not advise any manipulation of the cervical spine until you get an updated MRI (not sure when you had your last). You don’t know what is pressing on your spinal cord/nerve roots (vertebrae, disc, bone spur, etc.) so manipulating your neck or thinking PT will help resolve this may delay you getting testing to see if your spinal cord is being injured.

@dlydailyhope Perhaps my answer needs more context. My PT was not doing spinal manipulation; she was just feeling with her hands to feel if the spinal processes were aligned. She was doing myofascial release to release the muscular tension and muscle spasms. She also did neuro-stimulation on nerve roots to block pain signals. Because the muscles can pull the vertebrae out of alignment during a muscle spasm, releasing that with her hands allows them to return to a more normal alignment. Her work was similar to massage of the muscles. The doctor did MR imaging and my PT required that before working on my neck. It is important to rule out spinal instability because that can be serious and lead to spinal cord damage and PT would not be advised.

With the degree of cervical canal stenosis that I had, it had not caused visible damage to my spinal cord on imaging, but I did have intermittent symptoms when my neck was out of alignment and was more straight with the loss of the lordotic curve. My PT was able to get the lordotic curve back except where the collapsed C5/C6 disc was and this relieved some pain symptoms because it took pressure off by getting closer to normal alignment. If I had instability, she would not be doing PT, and I would have been ushered to surgery. Actually, it was the opposite, I was trying to get a surgical fix, and no surgeon would help because I had pain symptoms all over my body that they did not understand. My therapist was buying me some time and slowing the progression of symptoms before surgery. It actually took 2 years of PT and surgical consultations before I had an offer for surgical help. In my answer to @rico2 , I presumed that the surgeon would have done imaging before writing orders for PT.

My PT advised against chiropractic type manipulations. If PT is making symptoms worse, the surgeon should be told about it. I know there are patients where MR imaging would be different in a laying down position vs sitting or standing because of vertebrae shifting. My spine had not advanced that far, and PT did help temporarily until the next muscle spasm. PT prevented further damage, and insured the success of my decompression spine surgery. Every case is different, so what worked for me may not be the answer for someone else. I was trying to explain the connection between aggravation of symptoms and physical alignment changes that provided evidence that cervical cord compression was causing the problems and body wide pain. I was amazed that 5 surgeons missed that connection, didn't understand why, and wouldn't help. That was what brought me to Mayo to a surgeon who did understand this phenomenon called funicular pain. My PT had a doctorate and she was a great source of knowledge about spine surgery and rehab after spine surgery.

My neurosurgeon wants MRI of back and neck as he is thinking it’s lower back where I had surgery in 1996. What I keep thinking is the leg weakness and heavy legs did not show up until I started PT for the right arm tingling and weakness so I am thinking it is related to my ACDF and the 3/4 bulging into my spinal cord and then PT probably aligned things like they should be but aggravated nerves. PT definitely has helped taking pain level in neck from 7 to 4 but the bad side is that I have to drive 80 miles round trip to do PT. Even though my car rides very well all the little bumps feel like I fell into the Grand Canyon. My neurosurgeon has said he will probably want to do ACDF on 3/4 but I’m hesitant of another surgery. I’m kind of lost on what I should do for this but I have to do something as I’m afraid to walk as sometimes my legs don’t do what I think they should do. Seeing others going through this and seeing how they are coping with it helps too.

@rico2 I was in a position of surgeons questioning where my symptoms were coming from and not recognizing that the sciatic pain and pain elsewhere in my body was only being generated by spinal cord compression in my neck at the C5/C6 level. I am sharing with you the medical literature that I found that changed my spine journey. These articles talk about a phenomenon called "funicular pain" or "tract pain" and there is no diagnostic test to prove that it is happening except than when you have surgery and decompress the spinal cord, it resolves the pain.

They can do an epidural spinal injection, and if that takes away the pain (temporarily), it suggests that it may be funicular pain (as stated in one of these articles). I had that experience in that an epidural injection in my neck took away all the pain, all the sciatic pian and all the body pain. Pain started comping back slowly on the 6th day after the injection, and it was back to pre -injection pain levels at about 6 weeks which is how long it takes for the body to metabolize the steroid that was injected. My surgeon could not guarantee that my C5/C6 ACDF surgery would cure this pain, but I knew that it would. I had paid attention from the very start, and my first indication of any pain being generated by my neck was when I turned my head, I got a pain in my ankle, and when I looked straight forward, the pain went away. It was reproducible and this was before the condition had advanced, so I absolutely knew my neck was causing sciatic pain. Your experience with an increase in symptoms with physical therapy is similar to mine. One of these articles relates to issues at C3.

I also experienced leg weakness and walking with an uneven gait or limp, and there was nothing I could do to walk normally. My spinal cord compression was at beginning stages and early enough that when my PT realigned my neck, I walked normally again, and my bladder functioned normally again until the next spasm. I was having trouble emptying my bladder when the muscle spasms straightened my neck and caused the vertebrae to put more pressure on the spinal cord. This was another clue that the cervical spine was causing these issues.

You might share this literature with your surgeon. Be careful in how you present them because you don't want to sound like you are telling the surgeon how to do his job. When I approached a surgeon at Mayo for care, I sent this first article with my request and wrote a letter about my symptoms, and I posed it as a question asking if my case was like this case in literature. That lets the surgeon be the expert and answer your intelligent question. The problem I had was that 5 surgeons missed this and missed the diagnosis, gave a wrong answer, and no one would help me bring this up because I, the patient, would be pointing out a mistake. It's best to ask this before the surgeon gives you and absolute answer about where he thinks the pain is coming from.

Ultimately, you'll need to decide if you want to proceed with surgery and listen to your gut feeling about your body. Your PT may have some valuable input. You may have issues in multiple places that generate pain and confuse getting a clear diagnosis because of overlapping symptoms. With your prior spine surgeries, that introduces a bit more complexity.

You may want to discuss this with @upstatephil because he had both cervical spinal stenosis and a lumbar spine issue and had surgeries on both. He reached a point where his legs were giving out under him and decided to go forward with surgery. He'll probably join this discussion since I mentioned him.

After reading this literature, what questions would you ask your surgeon? Do you have thoughts about surgery? I know that can be a hard decision to make when you have no guarantee that it will improve your condition. You may have some of your own insights that could be clues to a future surgical outcome.

Eur Spine J. 2011 Jul; 20(Suppl 2): 217–221.
Cervical cord compression presenting with sciatica-like leg pain
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111492/
J Neurol Surg Rep. 2013 Dec; 74(2): 101–104.
Cervical Spinal Canal Stenosis and Central Disc Herniation C3/4 in a Man with Primary Complaint of Thigh Pain
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3836946/
BMC Musculoskelet Disord
. 2020 May 14;21(1):302.
Funicular pain: a case report of intermittent claudication induced by cervical cord compression
https://pubmed.ncbi.nlm.nih.gov/32410709/
Spine (Phila Pa 1976)
. 1999 Jun 15;24(12):1265-7.
Sciatica caused by cervical and thoracic spinal cord compression
https://pubmed.ncbi.nlm.nih.gov/10382257/

@rico2 and @jenniferhunter - Glad to help in any way. Let me know what questions I can weigh in on...

I had L-S fusion of L-4,5 & S-1 in May of 2023 for bilateral sciatica. Post op my pain was gone but I was left with no sensation in my right foot & unstable gait.

I had cervical & thoracic MRI which showed cervical compression from C-3 through 7. I had ACDF two weeks ago & have no residual back pain or numbness in the right foot.

The funicular explanation certainly applied to my situation.

Good luck!

@coachdavid That's wonderful to hear! That is a lot of validation for problem solving and figuring out just where the trouble spots are in the spine. I was surprised how many surgeons missed this with me, but it's 8 years later now, and hopefully more surgeons are aware of this condition. Thanks for the update! I hope your recovery is going well. Get lots of rest.

Jennifer

I do have weakness in arms and hands. I also have trigger thumb in both thumbs although right is extremely bad and extremely painful. This did not show up until the weakness and tingling showed up in both arms again right being the worst by far. I drop things even though I’m concentrating on holding on to them.
I also have lumbar disks that are compressed and 2 that are herniated and I also have sciatica in both legs along with pain in hips. Stenosis is all along lumbar region. I was also told I have two vertebrae that have turned a little which I never knew they could.
I have told my neurosurgeon that I can turn or tilt head and will have burning to very sharp pain going down legs and into my toes and toes are also numb. I have broke 4 toes from getting up in middle of night and hitting things and since I can’t feel them I don’t know how bad I hurt toes until they swell and turn colors - fixed this by putting shoes on every time I get up. She kind of played that off as back problems and not cervical.
Her opinion is full fusion of neck with disk replacements and as far as lumbar it is basically the same recommendation.
The Army was tough on my body and I carry the battle scars from it. But I am shocked my only options are tying my spine up so tight I can’t turn or bend down.
Sorry for long rant - sometimes it helps to rant.