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Results of NCV/EMG
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Results of NCV/EMG

I have just received a copy of my testing done due the loss of sensation, burning cramping pain of both legs and feet, and bowel and bladder incontinence.  
The test says,
1. bilateral chronic radiculopathy L5-S1, new or ongoing denervation of the L5 nerve left myotome,
2. The pattern of weakness in the lower limbs suggests an upper motor lesion.
The doctors report says, Cauda Equina Syndrome and upper motor neuron lesion.
Does this mean there are two different problems going on.  I suffered a central disc prolapse which caused mass effect on the L5-S1 nerves bilaterally, I had a disectomy and fusion with instrumentation (TLIF) but that was seven months too late, and I now have alot of pain and weakness, have to use a wheelchair for distance.
The doctor that did this test told me that sometimes a fall such as mine (on my buttocks) can cause damage higher up in the cord and this does not show up for some time.  He was alittle evasive when pressed further and told me to speak to my neurologist about it, but my neurologist said he didn't know what he was talking about.
Whatever is going on is progressing and it is quite frightening and any insight would be appreciated.
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Avatar_n_tn
Without knowing your case in more detail, I cannot be specific in your individial case

EMG can be a subjective test and is even more difficult to interpret. The appearance of the EMG in an upper motor neuron lesion (ie in the spinal cord) can also be seen with poor activation of the muscle during the test from whatever reason eg pain. There does seem to be evidence of pinched nerves at L5-S1, especially the L5 root - this would be expected to give sensory loss over the medial lower leg and upper foot, and weakness of foot flexors and eversion.

If your spine is now stable after surgery, furhter damage should not occur, which is the aim of surgery. Surgery though does not necessarily reverse previous damage from a disc prolapse at that level. The  spinal cord ends above that level but fibers innervating the lower legs and bladder pass through there.

If the EMG is accurate, then further imaging higher up the spine may be indicated. If it is just poor effortm your exam localized to the area of prolapse

Good luck
5 Comments
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Avatar_n_tn
Cranky,

Can you please tell me if the EMG hurt? I have been putting mine off for some time now. I am in enough pain on a daily basis that I do not look forward to adding more pain to it. Mine will be done on both legs and arms.
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Avatar_n_tn
I have constant burning cramping pain in both legs and feet so if it were for the fact I have very little touch sensation left in my legs and feet I wouldn't even notice.
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Avatar_n_tn
Dear Racquel Morris,
  if you are in constant pain, EGM will be nothing compared.
I have had 4 in the last 6 months and now I go to them like a blood test. No pain compared to the REAL PAIN!
Have the test done as soon as possible, if you have any damage it is better it is solved and if you haven't you have peace of mind. By waiting it won't get better and if you have nerves affected or pinched, they won't recuperate and they could cause permanent damage.
Good luck and get well soon,
       ea5cng
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Avatar_n_tn
Than you for your response,
My biggest questions were not answered though, they were,

Are there two seperate neurological events happening in my spine?
Could they have been precipated by a single spinal injury?
Could an undelying condition have been aggravated by a single injury to the spine?
Everything that has happened to my spine in the last eighteen months stim from an injury which produced Cauda Equina Syndrome and foot drop.

I was referred to UCSD Neurology for confirmation of the tests done by my personal Neuro, so subjective findings don't apply in this case as they are consistant between doctors.
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