Cervical stenosis: Leg weakness

Posted by candrgonzalez @candrgonzalez, Aug 25, 2019

Hi. I’m 59 years old female with chronic neck pain. I have been diagnosed with cervical stenosis and a bulging disc. I am very concerned because I get leg weakness and loose my balance. Has anyone have this leg problem? I just started seeing a pain management Doctor and he said he is going to treat me with some neck injections.

Hi @candrgonzalez, that must be so frustrating to have leg weaknesses that causes you to lose your balance. How long has this been going on? How frequent do you have leg weakness?

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Hi. This has been going on for 2 months. I have been to my PCP and ER. The have done hesd CT and MRI which were normal. My legs give out everyday – I am using a cane to get around.

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Hello @candrgonzalez. I'd like to invite @jenniferhunter, @billandri, @sandytoes14, and @bernese53 who all discussed having cervical stenosis and may be able to share some of their symptoms and experiences with the diagnosis.

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Thanks

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I was diagnosed with cervical stenosis about three years ago. One of the most important diagnostic tools used to analyze the impact of stenosis is the EMG. It shows the effect of stenosis and/or other problems on the muscles and nerves of the legs, arm, fingers, hands, and so on. An MRI will not necessarily reveal whether or not your leg weakness is caused by your stenosis.

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I will ask my Dr about getting an EMG. Thank you.

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@candrgonzalez I have been where you are now with leg weakness caused by cervical stenosis. I had a ruptured disc and bone spurs compressing my spinal cord at C5C6 and as that got worse, the leg problems increased as well as pain all over my body. I also had muscle spasms that pulled my cervical vertebrae out of the correct lordotic curve, and that increased my leg symptoms and I walked with an uneven gait, like walking with a limp and you can't walk normally if you try. This was something that was missed by every spine surgeon who saw me before I came to Mayo, and none of them thought it was related, but they misunderstand my case and these symptoms. When my physical therapist would realign my spine, I could walk normally again, until the spasms returned which essentially squeezed the spinal cord into a smaller space by shifting the bones. I was also loosing muscle in my arms and shoulders and a lot in back that I didn't notice until I looked in a mirror after my therapist pointed it out. Since my surgery, I got some of that muscle back, but there is still a deficit from what used to be there.

I would caution you about epidural injections in your neck. Doctors like to do that to put off surgery, and the effects are temporary. There are some serious risks too if they inject the wrong place. I had an adverse reaction to an epidural that caused a new paraestheisa pain that sent stabbing electric shocks into my hand and fingers, and if I moved at all, the pain increased. All I could do was get in bed, prop my arm on a pillow and try not to move. It didn't start to improve until about 5 days later, and then I still got stabbing pains, just not as frequently and it took about 6 weeks to stop happening. I had cold sensitivity in that hand for a year and a half. You don't have to do them. I refused to do any more. The injection won't fix anything. You can decide if that is something you want to try or not. The only real fix for cervical stenosis is surgery. If this is affecting your balance, my advice would be to start getting opinions on surgery and get several. Evaluate the doctors as best you can by looking at their training, area of interest, and read their research papers and look at how others in the field regard them. Are they a leader who is teaching at a medical school or teaching lab courses for surgeons who are in practice? There are independent ratings and lists like Becker's Spine where they list 100 spine surgeons to know and that gets updated fairly often. You can find out about current research and studies and who is doing what and where. That isn't foolproof; some of the surgeons who saw me were on that list, but didn't get it right. Learn all you can about this so you will ask good questions when you are at an evaluation. You want to be in a position to make an informed decision when the time is right. It took me 2 years to find a surgeon willing to help me because none wanted to risk their reputation and statistics of their surgical success on me. It was suggested that I could have another problem like MS which wasn't true. I never expected to be dismissed over and over for an obvious problem.

Balance problems also come from misalignment of C1 & C2 and that happened to me. It caused vertigo and I fell over. That is probably what scared Surgeon #5 out of helping me, but it is a real symptom that goes with a cervical spine problem. Skull /spine misalignment can be serious if there is also some instability or slipping of one vertebrae over another. I had 2 mm of movement of this slipping at C5/C6, and maybe some at other levels. If there is instabililty between C1, the "atlas" and the skull, that needs an expert evaluation before anyone tries to treat it. I also have thoracic outlet syndrome that causes tight muscles in my neck and chest, and it starts twisting my vertebrae just a little bit, but that is enough to cause bad headaches and nausea or dizziness.

Track your symptoms on a body diagram, and draw where you have pain or other symptoms, what you were doing at the time (because it can be different when your spine changes position) and date. You will know how fast your symptoms are changing. I wish I had come to Mayo first because that is where I found the true expertise in a surgeon who understood my symptoms and was willing to help. I found medical literature about cases like mine, and contacted a surgeon at Mayo with that and described how my symptoms were similar. One of the predictors was the epidural shot I had that had taken all the pre-existing pain away temporarily and that was common with the patients in the literature. By the time I had surgery, I could bend my neck and send an electric shock down my body because of spinal cord compression.

I was lucky when I contacted Mayo. I got an appointment a month later due to a cancellation, but I had been told it might be a 3 month wait. I'd seen enough surgeons and knew enough by that time, so I knew that I was getting good answers to my questions, and I had very successful surgery at Mayo and I've had a great recovery. All of this can cause permanent damage to the spinal cord, and that happens to patients who wait too long. That being said, I understand the fear that goes with this, and you will need to trust the surgeon you choose with your life, so choose wisely. I think I'm lucky that none of the previous surgeons would help, because I had the best of the best at Mayo, and I had excellent results. I wasted a lot of time waiting weeks for appointments, then weeks to discuss with a doctor, then weeks for something else, and on it went for 6 months while I just got worse and after all that a denial for help. At Mayo they efficiently refer you to other specialists as a team approach and they get this testing done in a few days. I had an offer of surgical help at my first appointment with the Mayo surgeon as opposed to no answers after over 2 years somewhere else. I was able to get scheduled for surgery within a couple weeks of my evaluation at Mayo and I'm doing great.

Here are some links, the medical literature I spoke about and my patient story. Let me know if you have any questions. I would be happy to answer.
https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/
Excerpts from "Cervical cord compression presenting with sciatica-like leg pain" from the European Spine Journal
http://europepmc.org/articles/PMC3111492/reload=0
"Funicular leg pain is a rare presentation of cervical cord compression."

"Leg pain or sciatica is a rare ‘false localizing’ presentation of cervical cord compression and there has been only a few cases described in literature [1–5]. The term sciatica has often been associated with disorders of the lumbar spine and pelvis, and we often tend to overlook other parts of the spine in the search for its cause. We report two cases of cervical cord compression, which presented with sciatica-like leg pain. Each case is unique and different from one another in their presentation and concurrent spinal lesions. We hope that the discussion of these cases and the accompanying literature review will make us more aware of this uncommon presentation of leg pain in cervical cord compression."

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@candrgonzalez

I will ask my Dr about getting an EMG. Thank you.

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@candrgonzalez Most spine surgeons want to order their own EMGs, so that is a better place to start with a spine specialist or you may find yourself doing that test again. Mayo does theirs a little differently too, so I had to redo the nerve conduction and EMG studies when I came there. They are kind of painful and not my favorite thing to do getting electric shocks and stuck with needles. I wrote another post with a lot of specifics, so check that for information.

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@jenniferhunter

@candrgonzalez I have been where you are now with leg weakness caused by cervical stenosis. I had a ruptured disc and bone spurs compressing my spinal cord at C5C6 and as that got worse, the leg problems increased as well as pain all over my body. I also had muscle spasms that pulled my cervical vertebrae out of the correct lordotic curve, and that increased my leg symptoms and I walked with an uneven gait, like walking with a limp and you can't walk normally if you try. This was something that was missed by every spine surgeon who saw me before I came to Mayo, and none of them thought it was related, but they misunderstand my case and these symptoms. When my physical therapist would realign my spine, I could walk normally again, until the spasms returned which essentially squeezed the spinal cord into a smaller space by shifting the bones. I was also loosing muscle in my arms and shoulders and a lot in back that I didn't notice until I looked in a mirror after my therapist pointed it out. Since my surgery, I got some of that muscle back, but there is still a deficit from what used to be there.

I would caution you about epidural injections in your neck. Doctors like to do that to put off surgery, and the effects are temporary. There are some serious risks too if they inject the wrong place. I had an adverse reaction to an epidural that caused a new paraestheisa pain that sent stabbing electric shocks into my hand and fingers, and if I moved at all, the pain increased. All I could do was get in bed, prop my arm on a pillow and try not to move. It didn't start to improve until about 5 days later, and then I still got stabbing pains, just not as frequently and it took about 6 weeks to stop happening. I had cold sensitivity in that hand for a year and a half. You don't have to do them. I refused to do any more. The injection won't fix anything. You can decide if that is something you want to try or not. The only real fix for cervical stenosis is surgery. If this is affecting your balance, my advice would be to start getting opinions on surgery and get several. Evaluate the doctors as best you can by looking at their training, area of interest, and read their research papers and look at how others in the field regard them. Are they a leader who is teaching at a medical school or teaching lab courses for surgeons who are in practice? There are independent ratings and lists like Becker's Spine where they list 100 spine surgeons to know and that gets updated fairly often. You can find out about current research and studies and who is doing what and where. That isn't foolproof; some of the surgeons who saw me were on that list, but didn't get it right. Learn all you can about this so you will ask good questions when you are at an evaluation. You want to be in a position to make an informed decision when the time is right. It took me 2 years to find a surgeon willing to help me because none wanted to risk their reputation and statistics of their surgical success on me. It was suggested that I could have another problem like MS which wasn't true. I never expected to be dismissed over and over for an obvious problem.

Balance problems also come from misalignment of C1 & C2 and that happened to me. It caused vertigo and I fell over. That is probably what scared Surgeon #5 out of helping me, but it is a real symptom that goes with a cervical spine problem. Skull /spine misalignment can be serious if there is also some instability or slipping of one vertebrae over another. I had 2 mm of movement of this slipping at C5/C6, and maybe some at other levels. If there is instabililty between C1, the "atlas" and the skull, that needs an expert evaluation before anyone tries to treat it. I also have thoracic outlet syndrome that causes tight muscles in my neck and chest, and it starts twisting my vertebrae just a little bit, but that is enough to cause bad headaches and nausea or dizziness.

Track your symptoms on a body diagram, and draw where you have pain or other symptoms, what you were doing at the time (because it can be different when your spine changes position) and date. You will know how fast your symptoms are changing. I wish I had come to Mayo first because that is where I found the true expertise in a surgeon who understood my symptoms and was willing to help. I found medical literature about cases like mine, and contacted a surgeon at Mayo with that and described how my symptoms were similar. One of the predictors was the epidural shot I had that had taken all the pre-existing pain away temporarily and that was common with the patients in the literature. By the time I had surgery, I could bend my neck and send an electric shock down my body because of spinal cord compression.

I was lucky when I contacted Mayo. I got an appointment a month later due to a cancellation, but I had been told it might be a 3 month wait. I'd seen enough surgeons and knew enough by that time, so I knew that I was getting good answers to my questions, and I had very successful surgery at Mayo and I've had a great recovery. All of this can cause permanent damage to the spinal cord, and that happens to patients who wait too long. That being said, I understand the fear that goes with this, and you will need to trust the surgeon you choose with your life, so choose wisely. I think I'm lucky that none of the previous surgeons would help, because I had the best of the best at Mayo, and I had excellent results. I wasted a lot of time waiting weeks for appointments, then weeks to discuss with a doctor, then weeks for something else, and on it went for 6 months while I just got worse and after all that a denial for help. At Mayo they efficiently refer you to other specialists as a team approach and they get this testing done in a few days. I had an offer of surgical help at my first appointment with the Mayo surgeon as opposed to no answers after over 2 years somewhere else. I was able to get scheduled for surgery within a couple weeks of my evaluation at Mayo and I'm doing great.

Here are some links, the medical literature I spoke about and my patient story. Let me know if you have any questions. I would be happy to answer.
https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/
Excerpts from "Cervical cord compression presenting with sciatica-like leg pain" from the European Spine Journal
http://europepmc.org/articles/PMC3111492/reload=0
"Funicular leg pain is a rare presentation of cervical cord compression."

"Leg pain or sciatica is a rare ‘false localizing’ presentation of cervical cord compression and there has been only a few cases described in literature [1–5]. The term sciatica has often been associated with disorders of the lumbar spine and pelvis, and we often tend to overlook other parts of the spine in the search for its cause. We report two cases of cervical cord compression, which presented with sciatica-like leg pain. Each case is unique and different from one another in their presentation and concurrent spinal lesions. We hope that the discussion of these cases and the accompanying literature review will make us more aware of this uncommon presentation of leg pain in cervical cord compression."

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Thank you so much for the information. I'm glad your doing well. After reading your information I realized that our symptoms are very similar. I have noticed some loss of muscle and I do get some pretty bad headaches. I also feel like I don't know how to walk. I have not told my Dr about my muscles because I really did not realized it until I read your note. Thank you so much. I'm going to call Mayo ASAP. I hope they take my insurance. Best wishes.

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@candrgonzalez

Thank you so much for the information. I'm glad your doing well. After reading your information I realized that our symptoms are very similar. I have noticed some loss of muscle and I do get some pretty bad headaches. I also feel like I don't know how to walk. I have not told my Dr about my muscles because I really did not realized it until I read your note. Thank you so much. I'm going to call Mayo ASAP. I hope they take my insurance. Best wishes.

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@candrgonzalez Here is a page where you can check what insurance is accepted at each Mayo campus. Dr. Fogelson is in Rochester, MN, and you can request him if you wish. I highly recommend him. He's s a great surgeon and all around nice guy which helps when you are the patient who is worried. He is a neurosurgeon and also has orthopedic spine training. He is one of Mayo's best and highly respected. His nurses are also very kind and supportive. https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/accepted-insurance/contracted-health-plans

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@candrgonzalez I have balance problems and use a cane most of the time. Jenniferhunter has given you a good amount of information and area's to look into. I have been evaluated by many neurosurgeons and Doctors of Osteopathy. All say surgery will not help with pain and could increase it. Heck no! In the past 11 years I have had facet injections, nerve blocks,epidurals in my C Spine and lumbar spine. Most of the time I have gotten relief. I am VERY peculiar on who I let inject near my spine.In my opinion, fluoroscopy is necessary when injecting near the spine.I research pain management physicians that are recommended by my insurance company. Primarily, I find that doctors specializing in anesthesiology are the most compassionate and competent pain management Check out Google and Health Grades for researching.

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Hi Jen. Do you have balance problems due to cervical stenosis? Do you do okay sometimes with your balance? or is your balance always off? Thank you.

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@candrgonzalez

Hi Jen. Do you have balance problems due to cervical stenosis? Do you do okay sometimes with your balance? or is your balance always off? Thank you.

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@candrgonzalez I do have balance problems, not all the time, it comes and goes. No doctor has ever said it was because of cervical stenosis. My husbands balance is much worse than mine, he has it nearly all the time. Sounds like we need to question our Doctor. Thank you.

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Hi. The Pain Management I went to see says that my legs problem is from Cervical Stenosis but I am not sure.

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@candrgonzalez

Hi. The Pain Management I went to see says that my legs problem is from Cervical Stenosis but I am not sure.

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@candrgonzalez You owe in to yourself to get an evaluation from a spine specialist and MRI imaging that shows the current condition of your spine. Doubt can be a very loud voice inside your head and fear is right there with it, but don't let them decide your future because they don't know what they are doing. I was pretty scared when I saw the first spine surgeon and saw my imaging and I knew then that I would need surgery at some point even though he said it didn't look that bad. I also knew how my symptoms related to this because I paid attention as it all developed over a few years and it continued to get worse until I had surgery. It can be shocking to get this kind of news and a spine problem can sneak up on you. With stenosis, if another injury like a whiplash were to happen, you are at a greater risk for injury and paralysis. The pain I had all over my body from spinal cord compression is called funicular pain. There is no diagnostic test or proof that can be done prior to decompression surgery for it, but the evidence is that spinal decompression cured all that pain for me. I knew that would be true for me and it was. A surgeon can't give you a guarantee that their procedure will relieve pain, and the goal is to prevent further damage. I was a patient who was scared of major surgery, but I knew I didn't want a wheelchair in my future along with problems with bowel or bladder control. If that starts to happen, it becomes an emergency situation to try to save your spinal cord function. Your neck is the connection of everything in your body and all that can be damaged from cord compression. Spine surgery did not hurt as much as I though it would, and I chose not to take pain medicine and I could manage just fine. I was careful and rested a lot and was in a neck brace for 3 months by my own choice because I didn't want hardware and foreign materials attached to my spine and it was done with just a bone graft. A lot of surgeons may not offer that choice, but my Mayo surgeon did that for me and I healed beautifully. I did everything I could to prepare myself health wise and emotionally and it all worked and I conquered my fears and changed my life. You will need to advocate for yourself and make educated choices. It is best to take control of this now while you have time to be evaluated and can find out about what your options are, and to chose the doctor you trust instead of who ever is assigned if this becomes an emergency situation. I think your pain management doctor's opinion about your legs is correct.

Here is some literature about another case that talks about leg pain and muscle loss in the arms and shoulders.
http://europepmc.org/articles/PMC3836946

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