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Cervical stenosis: Leg weakness
Spine Health | Last Active: May 31 2:01pm | Replies (83)Comment receiving replies
Please forgive me if this isn’t the place to ask this. I wasn’t sure if I should start my own post or reply to this one.
I am a 55 yr. old male with lumbar, thoracic and cervical issues. I had a microdiscectomy at L3 in 2010 and a few years later had L4 done also in 2015. I had neck issues off and on during these early years also but we were trying to focus on what was most important so we started with lumbar. Shortly after the L4 discectomy I ended up getting C4-C6 fused to alleviate the neck issues.
Things were OK for a while but soon started again as the adjacent cervical levels began to show signs of failing. I’ve been to PT and ended up with pain mgt and have done cortisone shots for L5-S1 issues and also in the neck followed by radio frequency ablation in June of this year. The ablation worked well for about 4 months but then wore off and I am back to daily headaches and neck pain. Two different neuro surgeons recommended another fusion, one at the level above the previous fusion and the my current doc recommends fusing the level above AND below the prior fusion so as to avoid having to go back in a year or two from now since the MRI indicates issues starting below now also.
Currently my symptoms are:
1. Occipital headaches – daily
2. Pain when turning my head left or right beyond minimal movements. i.e -. Turning when backing out of a parking spot or trying took over my shoulder at something.
3. Numbness and tingling in mostly the left hand but sometimes also the right.
4. Diminished dexterity, also mostly in the left hand, and am dropping/fumbling things often when I’ve been pretty sure handed all my life prior to this.
5. Numbness and itching that can’t be satisfied by any amount of scratching in my left toe that has started spreading to top of my foot and outside of my ankle.
6. 4 falls in the last 6 months or so, however, I am not entirely sure if it is from balance or just my left leg/foot not working properly, or maybe both.
7. Lastly, I have had an itchy/numb spot about the size of a grapefruit just inside of and beneath my right should blade. Again, no amount of scratching ever seems to alleviate it.
8. Along with the numb spot near my shoulder blade, I am now getting a crampy pain right in between my shoulder blades. Especially after yard work, house work or exercise.
9. I am not sure if this is even related to the spine issue but I’ve tentatively been diagnosed with chronic gastritis (probably from years of the USAF prescribing ibuprofen for every ache and pain. Vitamin M they called it. 😊) which leads to nausea or may just be tied to the headaches. They have reluctantly diagnosed me with IBS-C and a pancreas that is apparently becoming inefficient leading to dietary supplements.
Pain mgt wanted updated MRI’s of my lumbar and thoracic levels so I had those done and although, there were arthritic findings, the lumber was mostly unchanged with the exception of a Tarlov cyst or two at the sacral level. One of which may be on the S2 nerve but my current neuro is not worried about it. The thoracic MRI showed arthritis, mild disk height loss at nearly all levels and also a few hemangiomas that the doc wasn’t worried about either as they are normally incidental findings and the largest was about the size of a butter bean or pea.
The numbness in the left foot, daily headaches, falls and dexterity issues are concerning for me and I am trying to wrap my head around what to do next. My current neuro wants an updated cervical MRI done and I follow up with him in 2 weeks. From talking with him about the options I get the distinct feeling that he thinks it may be time for that surgery now. I’ve put it off for about a year or two hoping the “conservative” treatments might help.
Could the cervical issues be causing the other issues I am experiencing? This whole time I have been focused on trying to “separate” the issues into what level would be the most likely cause but it seems they are thinking this may be all stemming from the neck. (minus the GI issues, that is just my brain half wondering if they may be related since the GI docs can’t find much definitively wrong.
Sorry for the very long post but thanks in advance for any info/advice you can lend, it is greatly appreciated!
Replies to "Please forgive me if this isn’t the place to ask this. I wasn’t sure if I..."
@rdflash0788 Hello and welcome! Joining an existing discussion that covers similar questions is a good idea because participating members get notifications of your input. Thank you for your very detailed description of your symptoms. You bring up some great questions.
The symptoms you describe are consistent with cervical spine issues. Surgeons often get focused on what conditions are related to particular levels, and those relate to the specific nerves that exit the spine between vertebrae at the nerve roots. The other type of problem can be spinal cord compression, and it's harder to pin that down specifically as to where symptoms will occur. The 4 mm of listhesis essentially makes the spinal canal smaller when it slides out of alignment. That is a lot of movement. The spinal cord needs to move inside the fluid in the canal when you change your body position or bend your neck or turn your head, and that can make the spinal cord either contact the hard "walls" of the canal or cause some spinal cord compression. That can affect any body parts below that level.
Some of the other issues that can cause similar or overlapping symptoms can also be attributed to a condition like thoracic outlet syndrome. This is something that I have (TOS) along with being a cervical spine surgery patient. TOS causes compression of nerves that travel to the arms in several places in the neck and shoulder area, and if your spine issues were caused by an injury such as a whiplash, there could have been injury to muscles that can cause TOS in addition.
The biggest issue might be the instability at C3/C4 causing the vertebrae slipping and it poses a risk for spinal cord injury. That is something to ask your surgeon about. It may be why they are recommending surgery. My experience is kind of unique in that I had a collapsed C5/C6 disc with bone spurs causing spinal cord compression with 2mm of retrolisthesis (backward slipping). I did not have issues at the nerve roots. My case was confusing to several surgeons because of the somewhat unpredictable nature of where the pain symptoms would be, and they changed location when I changed body positions. I was also working with a physical therapist who would realign my spine resolving symptoms temporarily until it slipped out of alignment again. I had pain go everywhere and also into my legs and feet. I had dizziness and vertigo. The reason that was happening was because my vertebrae were spontaneously rotating with muscle spasms which stretches the vertebral arteries inside the sides of the vertebrae that are part of the blood supply to the brain. All I had to do was look upward at birds flying, and that kinked the stretched arteries causing extreme dizziness and I lost my balance. It also caused intermittent issues emptying the bladder which is a symptom of pressure on the spinal cord.
I found this medical literature with a case similar to mine, and that led to getting help from a surgeon and a C5/C6 fusion that solved all the issues by freeing the spinal cord. I know you have concerns about how many levels would need future surgery. The longer the fused area that you have, the greater the stress above and below that fusion that could lead to more surgery. It sound like you have some tough decisions to make. Getting multiple surgical opinions is probably a good idea because you cannot undo a surgery once it's done. I had 6 opinions. Most missed the diagnosis of why I had my set of symptoms, and one got it right. He got the job.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111492/
What are your questions now that you have some more information?
Are you connected to the Veterans administration? Could this all be service related? I don’t know where you are but the V A in Minnesota is absolutely the best!
Do not neglet Tarlov cysts as not being a cause of some of your lower extremity symptoms. It is a widely held, unfortunate fallacy of the medical community that they are always asymptomatic. I have had symptomatic cysts for over 10 years, and S2 level can cause leg, foot pain, urinary issues and more. Leaks of CSF fluid can occur from these "cysts", which are basically ballooned out weakened areas of the nerves...leading to dizziness and vertigo due to unstable CSF pressure. It sounds like you have many other issues though, so there could be multiple contributing factors. Hope you get the best care you can. I know how it is dealing with chronic pain for so long!
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Oh and I forgot that I my last cervical MRI showed a 4mm anterolisthesis at the level just above my fusion.