MS, spinal stenosis or both?

[Phyllis2010]

I'm in limbo and it's not a good place to be. You've been very helpful and I want to update you. Since my first post, Sjogren's was ruled out and the cancer antigens were normal. Although my PCP suggested a lumbar puncture, the neuro at NYU immediately ordered an EMG study instead which showed a pinched nerve and damaged muscle, and apparently ruled out ALS and myasthenia gravis which have distinctive patterns. Based on the EMG, he ordered an MRI of my lumbar spine. No lesions but it showed multilevel degenerative disease with disk herniations at the T12/L1, L1/2, L3/4 and L4/5 and spinal stenosis at the L3/4 and L4/5. I also had 3 bulging disks.The neuro feels that these findings don't explain my symptoms. But, why wouldn't they? It's a wonder I can stand at all. He has referred me for physical therapy; I guess he feels I don't have a neurological/neuromuscular disease. I know spinal stenosis is a PPMS mimic; however, I also know people with MS can have spinal stenosis. I visited my ENT to rule out vestibular disease and he suggested that I have an MRI of my cervical spine and visit the Balance Program at Rusk Institute. He feels if that also shows stenosis it might explain my gait irregularities. You people are very smart. Does this sound like MS or spinal stenosis or both? Or am I in limbo until something else like optic neuritis or lesions show up? Or, a 60 year old hypochondriac with an MS fixation. A friend is getting the name of a spinal specialist for me to help clarify whether it's spinal stenosis or MS from a different non-neuro perspective.

Here's my previous post: I'm 60 years old. About 6 weeks ago I began to experience intermittent problems with my gait -- listing to the left & dragging my left leg. Sometimes I walk normally, sometimes people ask if I need help. the weekend of the Oscars I began to experience chills, shaking (like the flu without fever) and also increased thirst at night along with nocturia. I had an MRI 2 years ago which was normal. I had another MRI last week which was also normal except for unidentified bright spots which the neuro said were common in people with migraine, also weird vitamin deficiencies. I should mention my labs are beautiful (no thyroid problems, lyme, B12 vitamin deficiency etc). The neuro ruled out MS, Parkinson's, and brain tumor. I'm currently being worked up for Sjogren's Syndrome, vitamin abnormalities, and at my suggestion antibodies suggestive of metastatic cancer. The neuro also wants me to see an inner ear specialist. Since March 10th, the date of my first physician visit, I've lost 10 pounds!!!! My physician feels I have a neuromuscular or neurologic disease, not an autoimmune disease. Does anyone have any helpful insights?

[Phyllis2010]

Thanks Growing2Boy and Quix  this is very helpful. I've had back problems for 40 years and severe sciatica 4 years ago. I now appear to have 2 areas of lumbar spinal stenosis in addition to degenerative disk problems. I know that the disks are definitely compressing/pinching nerves, based on my EMF, and that the nerves in the lumbar spine control the caude equina which affects bowel and bladder function. In fact in certain situations caude equina syndrome can develop necessitating immediate decompressive surgery. Lumbar spinal stenosis is also associated with pins and needles. I'm going to follow Quix's suggestion and request an MRI of my cervical spine using an MS protocol. My ENT feels it's important to have one because my neck may be manipulated in PT and Balance Therapy. The Neuro has advised against decompressive surgery at this point -- he doesn't feel my back problems warrant it, yet. The reason I posted, however, is that he doesn't feel my symptoms can be attributed to my back, which may simply mean he doesn't know much about backs, but it may also mean I shouldn't rule out MS, even though the Neuro has as he's dumping me back to the PCP. I think that before I go for a second Neuro consult, I should see a spinal specialist. And, speaking of back transplants, they are doing some very advanced work at  Cedars Sinai in LA. It's not quite a back transplant but close. Quix, I think you know more about bad backs than you think you do, and you certainly know tons about MS.

[Quixotic1]

Hi, Sarah, thanks for jumping in.

I need to clarify some things.  Problems in the cervical spinal cord can certainly affect the legs.  Afterall, all the nerves to the legs pass thru the cervical cord.  Transection of the cervical cord can lead to quadriplegia.

Degenerative Disc Disease in the cervical spine can also cause a disorder called Cervical Spondolytic Myelopathy.  Because of compression and other trauma on the spinal cord, lesions can form which are primarily ischemic (from lack of blood flow), caused by disruption of the nourishing vessels to the cord.  These lesions can be deeper within the cord and can disrupt muscles in the legs.

Now, you are correct when you state that impingement of the spinal nerves AFTER they leave the spinal cord and the root ganglions affects only the segment of the body that those nerves service.  So peripheral nervous system problems with the legs has to be in the lumbar or sacral spine.

Thanks for your thoughts on PT for the back.  As I have said many times, bad backs are not something I know much about.

Quix

[Growing2Boys]

Hi there,
I am only 41, but I was born with a congenital defect of my spine that was not diagnosed. I have severe degenerative disease, 2 bulging thoracic disks, cervical compression.
I also work as a nurse, so I have a very physical job.

The MRI with contrast can tell them the areas of compression & what nerves are most likely being irritated. For instance,  there is an area of  compression in my neck that has irriated the nerves to my right arm. I don't have feeling in 3 fingers of my right hand.  I'm not a spine expert, but I don't believe the neck can cause gait issues. You can most likely find a chart online showing what areas of the spine go to what parts of the body.
The degenerative disease in my lower back is not causing spinal cord compression, so that can't be the cause of my gait issues. I believe lumbar & thoracic innervate your legs.

I made sure to get a good orthopedic doctor. He communicates with my neurologist. Together they can decide if my current problems are MS or spine related. I agree you should do the same. I wouldn't trust my spine to my neuro guy or my brain to my ortho guy :)

I think PT is for the birds personally once you get a back like ours. They may be able to offer some basic advice on lifting, stretching preventing further injury, but helping? Umm, only a back transplant would help us at this point!

Good luck
Sarah

[HVAC]

Sorry can't read your post trouble with big blocks of print. I will bump it good luck.


Alex