Neuropathy from lumbar stenosis?

Jennifer... have you checked into microsurgery? I had lumbar work done and rather than going with the fushion, a microsurgeon did some work on my stenosis and pinched nerve. It turned out rather well. Did not do alot for my neuropathy, but it did help strengthen my left leg which was the main point of the surgery. Go small before you go big is now my philosophy to back work. My back is a mess!

I had left leg and buttock pain caused by a pinched nerve in l4 and 5. Went to a specialist in microsurgery vs going with a fushion. He is Vanderbilt's microsurgery guy. My left leg and buttock are pain free and my muscle strength in that side is much better and becoming stronger. It unfortunately did nothing for my neuropathy.
His name is Gordocki...hope my spelling is correct.

I had spinal stenosis. Neurosurgery was done at L4 and 5 and two years later, L 3 and 4. The numbness was there before the surgery and still remains. NS says it depends how long the nerve was squeezed.

I also have fusions at those levels. Numbness just gets worse. Have no calf strength; unable to stand on toes for years,
Wish I’d never had back surgery!!!

I had the numbness before the two surgeries. Other symptoms went away.

I have been reading the evolving thread on neuropathy and lumbar stenosis with particular interest. I have idiopathic sensory-motor PN, giving me terrible balance and difficulty walking, even the shortest distances. In March 2022, I was diagnosed with cervical stenosis (“critical stenosis centrally at C4-C5, C5-C6 without cord signal change”: my neurosurgeon’s note). I had had no cervical-area symptoms then; I had been looking for an answer to my lower-body PN. That I had cervical stenosis came as a surprise. The neurosurgeon offered cervical surgery but cautioned that even a positive outcome might have no effect on my bad balance and walking difficulty. We decided on –– and are continuing with –– a wait-and-see approach to my cervical stenosis. Reading about others’ experiences with PN and lumbar surgeries has me wondering if any of you have ever had cervical stenosis surgery, only to be pleasantly surprised to find that it helped reduce or even eliminate your lower-body PN symptoms.

@ray666 I think you are in a situation where it is hard to know what problem is causing your symptoms or if it may be a combination of things. Cervical stenosis does cause problems like balance issues, dizziness and vertigo, lower body pain and actually pain anywhere in the body, weakness in legs, uneven gait and problems with incontinence or normal emptying of the bladder or bowel and many surgeons miss that connection. That is the problem I had in finding a surgeon to help me, because they didn't understand that connection until I found this described in medical literature and came to Mayo. Have you thought about the possibility that the cervical stenosis may be the cause of the neuropathy? It also may not be. How did this develop? Was there a spine injury like a whiplash? Did a spine injury happen before the lower body pain began?

The surgeon doesn't know for sure, so he can't make any promises, but that's OK. My surgeon didn't promise to cure my pain either, but cervical spinal cord decompression did solve the problem. The big clue I had was that I had an epidural injection that stopped all the pain I had all over my body temporarily, and then it slowly came back as that wore off over a few weeks, but there were 5 or 6 totally pain free days. I also had a lot of details on how this developed for me over a few years. I knew the all over body pain was connected to my cervical stenosis even though there is no diagnostic test for this. My fusion at C5/C6 did solve all of the pain I was experiencing which proved that it was generated by spinal cord compression.

My other question is about the about the wait and see approach. Will the neuropathy obscure worsening of the symptoms that are coming from the spine? If these are separate problems, neuropathy could prevent the normal warnings that would come from pain if there were no peripheral neuropathy. When damage shows up on an MRI, it may not be reversible with surgery. Surgery can prevent something from getting worse and it can also leave you in more pain than before surgery. It is a big decision and you need to know from your surgeon an accurate assessment of your condition. Surgeons cannot tell you exactly when permanent nerve damage will occur if the spine is not decompressed. What if there is no change in symptoms, but the MRI imaging starts to show nerve damage within the spinal cord? Would that be the indicator to proceed with decompression? Is that really worth waiting for? For a patient who does not have dignosed idopathic neuropathy, waiting for damage to occur just doesn't make sense. I know in my case, an earlier intervention gave me the best chance to not have lingering nerve pain after surgery. That is the result I have with a very successful recovery. I also had surgery with out hardware, and I know from a later experience with a fractured ankle, that metals inside my body were causing additional pain, so that was a good choice on my part and my surgeon made that solution available to me.

Hi Ray -
My decompression and fusion of L2 to pelvis was in early 2021 after 3 years of epidural injections which worked for a few days and became less and less effective over time. I had very bad stenosis (along with arthritis and spondelosisthesis ) and already had neuropathy in my feet for about 20 years. The result of the spinal surgery (done at the U of Iowa Hospitals) was amazing, as far as the stenosis and other spinal issues were concerned. But there has been no improvement to my imbalance and gait issues, which have become worse, likely at least in part because I fell and had to have a partial hip replacement in Apr.-May of the same year. You can identify your stenosis, right? For me, prior to surgery, the pain during standing/walking was severe, and the minute I sat down it disappeared completely. I had only to give it a few minutes' rest and could get up and resume, only to have the pain return and have to sit down. If I had to do it over, I would definitely get that spinal surgery done with the same surgeon (or at Mayo if I had a way to get there) but I would not fall again and break my hip!!🙄
Hope you have a great weekend!

Good morning, Jennifer (@jenniferhunter)

Thank you for such a careful reply! I have tried going over all of the points you make with equal care.

I believe it is so true for many of us with idiopathic PN, and especially those of us with additional conditions, either related or unrelated, to know which therapies may help relieve some if not all of our symptoms. That's undoubtedly the conundrum I'm facing with my PN and cervical stenosis. You do refer to pain throughout your post. Here's where we encounter one of my situation's oddities, the source of considerable frustration when I speak with my clinicians, notably when I'm presenting for the first time: I have no pain. I have neither pain that I can associate with my stenosis nor pain linked to my PN. I only learned that I have cervical stenosis due to the MRI my neurologist's MA sent me to get in an attempt to decode my balance and gait issues. That led to my being referred to the neurosurgeon who further diagnosed my cervical malformity, offered surgery, but at the same time called my condition "borderline" and, as I had no cervical symptoms (at least none of the typical symptoms that might cry for urgent cervical surgery), we take a wait-and-see approach. I got that diagnosis a little under two years ago, and I've still no pain that I (as a person who has no pretensions of being a doctor) think of as stenosis-related pain; no dizziness or vertigo-like symptoms, either. An EMG a year ago pinpointed (bad pun!) sensation-loss in my feet. Even that sensation loss – if it hadn't been for the EMG – is yet another condition of which I might not be aware if it hadn't been for the EMG. I tell my clinicians: "It's a weirdness. I've no pain, but my balance is poor, my walking is wonky, and I don't know why." I should add that I've not been injured. One curious note: a brain MRI, which was otherwise A-Okay, did reveal my having been a heavy drinker, although my drinking days ended more than 30 years ago and I've had nothing alcoholic since. You ask toward the end of your wonderful message, regarding the wait-and-see approach, "Will the neuropathy obscure worsening of the symptoms that are coming from the spine?" That is a question weighing heavily on my mind. Should I get a fresh cervical MRI and return to meet with the neurosurgeon? I trust he'll not pressure me into surgery. He'll expect me to consider seriously what he has to tell me, but he'll also expect me to make that surgery decision. That the decision is ultimately mine? Therein lies the crux of my conundrum.

Again, Jennifer, thank you a millionfold for your thought-provoking reply!

Ray (@ray666)

Good morning, bjk3 (@bjk3)

Yes, falling and breaking a hip is never a good idea! 🙂

If you'll allow me, I'll make this a short reply. You'll see I just now posted a rather lengthy reply to Jennifer, and now I'm afraid I need to get started on a project that's due later today. Your saying that your spine surgery did not help with your balance and gait is precisely what my neurosurgeon warned, but it is still on my mind: Maybe I should get that cervical surgery done anyway? Surgery's a big deal, making the deciding tough.

I wish you a fantastic weekend!
Ray (@ray666)