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re: Multiple level thoracic HNP

  I am 44 and was injured 2 years ago at work when a pt wrapped her arm around my back and went limp.  I was supporting her full upper body weight.  I had such severe pain I had to stand up at that point.  That was 12/6/95.  After numerous diagnostics with a myelogram/CT being the last test, I was found to have 7 thoracic HNP's from T3-4 down to T10-11.  There is moderate to severe cord deformity at 2 levels.  T7-8 has a mod-severe deformity from a central herniation and T10-11 has a moderate cord deformity from a lt sided herniated.  Both are 5mm in size according to the CT. The other HNP's vary from righty to left. I have little pain at present but I have difficulty walking especially wih increased activity.  The more I walk the heavier my legs get.  I tend to walk like a prancing horse to keep my knees from hyperextending.  My legs slam the ground when I go down a hill.  The tops of both my feet are numb to temperature.  I cannot separate my toes on my right foot.  I cannot lift my rt leg off the floor from a lying position.  With my lt leg by the 3rd lift, I can't get it off the floor from a lying position.  I had an IME end of January and the neurologist said my gait problem is due to a conversion reaction.  Since this was a work injury, (I am an RN in OB) my previous employer fired me and cut off my medical care as of 11/96.  I am not asking for diagnosis, just some reassurance that this could be caused from the multi-HNP's not from my head.  If it is in my head then I need to do something because I cannot walk like this forever.  It is exhausting.  Thank you for your help.
This is a tough question.
You probably won't get a satisfactory answer in this forum, because the full assessment requires a face-to-face interview, detailed neurologic exam, and careful review of all the imaging studies.
However, it is possible to have gait disturbance as a result of spinal cord injury. The thoracic spine is not commonly involved in degenerative changes or disc herniations - the most common sites are cervical and lumbar, as you probably know. It is quite conceivable that your symptoms could arise from damage to the spinal cord (myelopathy).
Without the full clinical picture, it is impossible to state whether your problems stem from a work injury. Matters such as yours are very complicated, because of so many possible conflicts of interest.
You are welcome to seek a second opinion here at Cleveland Clinic. There is a spine center associated with the departments of neurology and neurosurgery. An experienced clinician can proceed with the relevant evaluation.
I hope this helps. Good luck. CCF MD mdf.

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