Calf weakness/atrophy -L5/S1 radiculpathy due with no pain
Apologies for my long Introduction inquiry!
Hello all. I am new to the forum (actually, new to the Mayo groups). I have been dealing with chronic and progressive L5-S1 mixed deficits over the last 8 years in the right leg. It all began after I experienced acute and severe back pain after an airplane flight. When I returned back home 3 days later, I had an acute ~25% loss of strength in the right calf with no radiating pain or paresthesia. I have had 3 EMGS over the years. Last year, EMG of the right leg showed L5-S1 nerve root abnormalities. My neurosurgeon has been hesitant to perform surgery, as pain there is no radiating pain down the leg, nor back pain. This Spring, on a repeat EMG (different provider), this was discovered again and diagnosed as a mononeuropathy. Over this year, the weakness and calf muscle atrophy has worsened. During the EMG this Spring the neurologist was also concerned about a more generalized issue possibly superimposed on the L5/S1, so she tested the left leg. The left leg was found to have a mild polyneuropathy. Over the last 2 years, I have begun to develop some weakness in the left calf, with no atrophy nor pain. The official diagnosis was that both distal legs are being affected to varying degrees , L5/S1 nerve root. I had planned on consulting with my neurosurgeon this Summer/ Fall as now I am beginning to get worried: I don't further progression. Bunch of issues roadblocked me mid-summer from carrying out that plan. Very long story, but I tripped and partially re-tore my right quad tendon, had to have surgery, and then developed an infection in the right knee requiring 2 more surgeries. I am currently 6 weeks post op the last surgery.
This right leg has taken a beating. Not only the calf weakness and atrophy, but also the quad tendon tears. The patella was also removed as well due to the infection and severe patellofemoral arthritis. Over the last year, the patella was causing me such severe pain that I had been favoring that leg (right) anyway. Therefore, there have been 2 reasons for favoring the right leg: severe patellar pain and the calf weakness. I have intact right foot dorsiflexion(moderately strong) and ventroflexion ( weak). The fact the right leg has been basically immobilized since July has caused further weakness. I was only PWB on the right leg for 3 weeks before the infection occurred, which was at the surgery site from the July partial quad tendon tear. Both legs have strong quadriceps. I was once an elite level bodybuilder, and I am still quite muscular and built ( ~ 300 lbs).
Anyone else have a similar issue?? L5/S1 mixed deficits with no radiating pain, back nor leg?
Sidenote: I do have multi-level lumbar disc degeneration, stenosis, and facet involvement; however, it has been stable (MRI) for 2 years now. I did have an acute right sided L3-L4 disc herniation 10/21 that happened randomly when I simply turned over in bed. This resulted in severe sciatica symptoms (back and right leg) I had a right-side LFD (Laminectomy, fasciectomy, discectomy) which corrected that issue 100%.
I feel like both the neurologists and my neurosurgeon as 'confused' as to what to do next. At this Springs' EMG, there was discussion about a potential genetic disease overlapping, however, there is no family history of any genetic neuro disease. She then recanted this differential after I reminded her of the initial acuteness of loss of right calf strength after a severe back pain episode after a airplane flight.
I appreciate any input or advice. I feel the neurologic issues are related to the back. A 4-level lumbar fusion was discussed earlier this year as a possible surgical approach; however, my neurosurgeon did not seem on board or confident that this was necessary. They really do not want to cut if there is no pain with weakness.