|06-23-2011, 09:35 PM||#1|
Peripheral Neuropathy, Spinal Stenosis, and Surgery?
It looks like it has been a while since someone posted about treatment of lumbar spinal issues, so I'm going to open a new thread. I'm looking to build up a good set of options for my situation. That certainly was the case with resolution of my shoulder issue last winter, which turned out very well.
I've been experiencing bilateral peripheral neuropathy in both feet, which has been going on for more than two years. It manifests itself by numbness and tingling, but no pain (the "stocking syndrome"). Unfortunately the area experiencing sensation loss has been steadily increasing, moving up the lower leg now. It has gotten to the point I have to check the bottoms of my feet occasionally to make sure I haven't cut or otherwise damaged parts I cannot feel. Movement and/or loading do not seem to relieve or exaggerate the symptoms; I can deadlift, squat without pain, have pretty good flexibility (bend at hips reaching hands past feet, can do a full bridge without discomfort).
When I first noticed the symptoms, my regular doctor suspected that my being pre-diabetic was the cause (this was at the end of a stressful time period where I was sedentary and inactive, and had just started dieting and CF). He had me visit a neurologist, who did an EMG and nerve conduction studies. He found conduction velocities decreased in either leg by about 30%, and that motor nerves were also affected (there's a lot of random muscle activation indicating a disconnect from the peripheral nerves in the calf). The sensation areas affected appear to be correlated to the L4 and L5 nerve roots. But he didn't identify a specific cause, didn't rule out the diabetes angle, and after seeing bloodwork thought there was a possibility of some form of heavy metal toxicity, so he sent me to another Dr to do a full assay. Subsequent blood work (and 24hr urine collection) showed the earlier suggestion about metal toxicity to be false, so again no firm diagnosis. At this point I dropped it as the refrain was "it must be the blood sugar".
Started CF, fixed diet, lost 50+ pounds, got blood numbers in good shape including sugar over the next year, without any relief from the neuropathy symptoms.
This winter, while rehabbing shoulder surgery I spent some time on my indoor bike trainer, and for the first time found that sitting on the saddle (one I had used for 20+ years) caused the tingling to noticeably increase. Ahhha! Maybe some kind of impingement.
Talked to my regular DO again about it, and he agreed it was worth requesting an MRI, which I had last month (no contrast). Brings me finally to the point of this post.
Got the results back today. Findings:
On L3-L4, L4-L5, and L5-S1: Broad based annular subligamentous disk bulge combines with [advanced on L4-L5] ligamentum flavum and facet hypertrophy to result in [L3-L4 mild, L4-L5 moderately severe] spinal stenosis. Biaxillary recess narrowing, left greater than right. [L4-L5 The disk bulge is eccentric to the left and it fills the lower portion of the neural foramen, and there could be impingement upon the foraminal left L4 nerve root]. [Other milder observations omitted]
Impression: L4-L5 spondylosis, resulting in moderately severe spinal stenosis. Left-greater-than-right biaxillary recess stenosis, which could affect either or both L5 nerve roots as they attempt to exit from the thecal sac. The disk bulge is eccentric to the left posterolateral region, an d there could be impingement upon the foraminal left L4 nerve root. [Other mild findings omitted]
So today I get a referral to a neurosurgeon for a consult.
Reading the earlier threads, Mike Mallory called it criminal to do surgery just for bulging disks, but does that assessment fit my profile with stenosis? I did ask the DO about the DRX9000 protocol, and he wasn't enthusiastic, mostly because there are only two providers here and both require up-front payment for a full treatment ($5k), without any way to tell if it will help. I've never used chiropratic, so I have no idea what they can do. From my one-evening searches on stenosis, particularly in the foraminal area, I don't see how manipulation could open up the constriction on the nerves. But I'd love to hear if some of the folks here who have had something similar, or are in the PT/rehab field can show me a non-surgical path to try (without laying out five grand!).
What's maddening is that this is not a debilitating condition because it's not painful, but it is encumbering activities such as running and jumping because I just can't get feedback on when the feet touch the ground. Balance still works (well, as well as it ever had, which wasn't very "athletic"), and there seems to be sufficient strength. So from that perspective the need for surgery is diminished.
My stats: 56y/m/74"/210lb.
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