Patient has had an extensive work up for polyneuropathy including a nerve biopsy, without a diagnoisis emerging.Nerve conduction data apparently showed axonal neuropathy and the biopsy showed axonal loss without inflammation or vasculopathy.Lumbar MRI shows rather severe, but not catastrophic canal stenosis at L1-2 and L2-3.The usual and some unusual--- lab stidies were normal.He does not decribe claudication like symptoms.Only minor loss of appreciation of pin in the 5th fingers bilaterally.Thigh strength and bulk appear to be normal but there is abvious atrophy and weakness of the anterior tibial muscles and both calves.Kness jerks are present, ankle jerks absent,plantar absent.Sensory loss to temperture and vibration in a stocking pattern.
Impression: To 1st neurologist did not think that the lumbar stenosis was severe enough to account for the patients findings.I think we all have seen with this degree of stenosis who have no disability, so I understand his caution on this point.
I am never the less inclined to attribute his Syndrome to lumbar stenosis.The normal hand function is a point against polyneuropthy, as are the preserved knee jerks.Certainly lumbar stenosis can account for the nerve conduction and biopsy results, via Wallerian degneration of nerve fibers.I referred the paitent to a spine surgeon for consideration of surgery.The decision will be difficult. It almost seems that the two Neurosurgeons aren't on the same page.
I had talked to the spine surgeon and the surgery would take about 3hrs and he doesn't think it would help.