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Neurology (Expert Forum)
leg pain
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leg pain
by bklk, May 23, 2003 12:00AM
Following L5 S1 dis replacement I still have bilatral leg symptoms to toes. Had post op mri-artifact but no gross abnormality in canal or foramina at level of op and no other levels have ANY degeneration. Same goes for emg-unremarkable and meylo/ct, unremarkable.
I have a stenosis type of effect where sitting is tolerated and walking even 10-15 minutes flares legs.
I'm a mess and can't return to career like this. No tests show stenosing.
Are there dynamic tests, mri, emg, that may reveil more?
Could you think of a scenario where the movement of the artificial disc is irritant to nerves. I have no previous surgery and disc was installed anterior so scar isn't teathering nerves?
I have mri of pelvis that shows anomolus vessels on sciatic nerve in sciatic notch. Could these teather the sciatic nerve now that disc space is taller and has movement?
thanks for your thoughts
I have a stenosis type of effect where sitting is tolerated and walking even 10-15 minutes flares legs.
I'm a mess and can't return to career like this. No tests show stenosing.
Are there dynamic tests, mri, emg, that may reveil more?
Could you think of a scenario where the movement of the artificial disc is irritant to nerves. I have no previous surgery and disc was installed anterior so scar isn't teathering nerves?
I have mri of pelvis that shows anomolus vessels on sciatic nerve in sciatic notch. Could these teather the sciatic nerve now that disc space is taller and has movement?
thanks for your thoughts
Doctor's Answer
by CCF-Neuro-M.D.-JT, May 28, 2003 12:00AM
As I have never seen your MRIs or personally examined you, I cannot make an accurate medical opinion specific to your case. What I can say is that unfortunately, depending on how extensive the disc problem was and how long it was left untreated, neurological symptoms especially burning type pains do not necessarily resolve or even improve with surgery. Sometimes all that can be done is to prevent further nerve damage. If you're still feeling like there's something going on and the MRI is normal, an EMG may be able to help document ongoing nerve damage. Another consideration is to look for other causes of leg pain such as vascular disease. More info is needed on type of symptoms and your demographics, but if you're older with cardiac risk factors then insufficient blood supply to the legs is a possibility rather than neurologic causes.
As for nerve irritation with hardware, it depends on whether or not everything is intact. Certainly we have seen screws/pins come loose or push on nerves but I don't think I;ve ever seen an artifical disc that was completely in place just irritate nerves without a true allergic/inflammatory reaction (you would know it, it wouldn't just be the same symptoms pre-op)
Finally, unless the sciatic abnormality is present on both sides and actually large enough to push on the nerves, then it's unlikely that the symptoms you report are due to the blood vessels.
If you're still in pain and it's seriously debilitating your life, take your MRI to a spine neurosurgeon at an academic center to see if there's anything that can be done for you. Drs. Benzel, Kalfas, and Whitfield are excellent spine surgeons here at the clinic. Good luck.
As for nerve irritation with hardware, it depends on whether or not everything is intact. Certainly we have seen screws/pins come loose or push on nerves but I don't think I;ve ever seen an artifical disc that was completely in place just irritate nerves without a true allergic/inflammatory reaction (you would know it, it wouldn't just be the same symptoms pre-op)
Finally, unless the sciatic abnormality is present on both sides and actually large enough to push on the nerves, then it's unlikely that the symptoms you report are due to the blood vessels.
If you're still in pain and it's seriously debilitating your life, take your MRI to a spine neurosurgeon at an academic center to see if there's anything that can be done for you. Drs. Benzel, Kalfas, and Whitfield are excellent spine surgeons here at the clinic. Good luck.
Member Comments (4)
by Anbe, May 27, 2003 12:00AM
My mom had the same symptom. Neurosurgeon couldn't find anything. It turned out to be peripheral vascular disease. She didn't find out what it was for two years. Finally had to have urgent surgery. You should ask for a doppler study.
by PRP, May 27, 2003 12:00AM
I am sure there are plenty of things this could be. I have many similar symptoms and can tell you that I had a Doppler because that's one of the things they were looking at and it came back ok. But, it is worth bringing up to your doctor. Walking may set off my legs at that time, although generally I feel more like I suffer later, if that helps any.
by jools, May 27, 2003 12:00AM
To: bklk
have you investigated if your symptoms could be Cauda Equina Syndrome? It is said to be very rare but I am in the CESSG, Cauda Equina Syndrome Support Group, and this group is growing by the day sadly.
