[MelodyL]

This is his 3rd in about 7 years. Alan thinks his PN between his toes is caused by something going on with his back (but he doesn't have any significant back pain). For instance, he's never held his back or lower area and went "oh my aching back". NEVER!!

Okay, here we go!!

It says "FINAL REPORT"

Reason for Exam
LS RADICULOPATHY

MRI study of the lumbar spine without contrast.

I'll skip all the stuff and get to the end.

Impression:

Multilevel degenerative disc disease resulting in stenosis of the spinal canal and neural foramina.
More pronounced stenosis of the spinal canal it is seen at L3-L4 and L4-L5, without evidence for compression on the roots of the cauda equina.

Severe narrowing of the neural foramina is seen in on the right at L5-S1. Moderate to severe narrowing is seen on the left at L5-S1 and bilaterally at L4-L5.

His neuro said she wants him to bring in his other films on Monday so she can compare everything. We have them all ready to go.

I asked him "what did she say about the MRI?" and he says 'well, she said my back was VERY BAD". He doesn't like to ask questions.

Anybody see anything on this impression that yells out 'THIS IS WHAT IS CAUSING ALAN'S PN BETWEEN HIS TOES"

thanks much

Melody

[lynxgal]

Hi Melody,

I did a quick search on Lumbar Spinal Stenosis....talks alot about pain being in the back, bottom and legs....didn't see any mention of toes though. Wish I could be more help!

(hugs) to you and Alan

Kelly

[Kathi49]

Melody,

I have issues with the L4/L5 and S1 and will say it refers pain all the way down to my little toe. Now, my husband had a Selective Nerve Root injection two days ago at L5/S1 I believe. Although it could have been L4/L5; I forgot to ask his doc. He said he felt all of his toes just zapped! If you go to Chirogeek's website, he has some dermatome charts that show how those levels refer pain in various populations. It's worth a look-see.

[Colin Street]

I had spinal stenosis with no pain in back at all, but lots in legs - diffuse neuropathic pain rather than located in any particular area. Not degenerative disease, but discs and bone spurs etc pressing on spinal cord. The pain in legs is because the part of spinal cord affected is that which serves the legs. Had operation which was of limited benefit because spinal cord had given way, so permanent damage (softening). So what appears to be peripheral neuropathy can in fact be due to malfunction of central system.

[glenntaj]

--in that it's entirely possible Alan has two things contributing to his lower pain: both autoimmune AND spinal compression issues, through the double crush hypothesis. His autoimmuinty may have comprimised his nerves enough that additional pressure on them, such as from bone spurring or disc pressure in the spine, may be enough to produce symptoms, whereas either alone might not, or at least not enough for him to notice much.

It does sound from this report that he has sufficient degenerative changes in the lumbosacral area to possibly pressure the nerve roots--those are the first peripheral nerves outside the spinal cord, and they connect with the cord in the neural foramina (spaces). (This is where the word radiculopathy comes from, by the way--radic means "root" in Latin, and a problem with nerve roots is a radiculopathy.) Normally, the nerve roots occupy about 25-35% of the foraminal space, but if that space is narrowed, by bone spur gwoth in the spine or by disc herniation, the nerve roots can be compressed and cause neural symptoms, and this can happen even without the more "normal" pain of backache--the muscles in the area may not be affected, but depending on what nerve root and what part of the root is pressed, one can get neural symptoms anywhere within that dermatome (body area that the nerve eventually serves).

It is good that they want to compare these films to previous ones. Almost everybody beyond a certain age (which Alan is certainly beyond ) shows some sort of arthritic deterioration of the spine--our spines were simply not designed to bear the loading they do for so many years. However, placement is everything--there are people with ugly MRI's that have no symptoms, and people with only slightly abnormal MRI's that have a LOT of symptoms, It all depends on just where that bend, spur, herniation, etc. is and does it impinge on anything.

I have an ongoing cervical spine radiculopathy, for example, secondary to a right side trapezius muscle tear two and a half years ago, which brought a bone spur close to the foramen--it's at the C6/C7 level and impinges on the right foramen sufficiently to cause numbness/tingling down my right arm medial nerve and into my thumb/forefinger/third finger. The symptoms vary in severity and I do a lot of stretching, occassional traction, etc. to try to keep it from closing the opening up more. What I can say is that in my case the symptoms from this, while definitely neural, are very different in kind from those I get from my original small fiber neuropathy--burning pain is not invovled. I do think it's likely that the original comprimise to my nerves, though, has led to more symptoms from the nerve root pressure than someone else might have otherwise gotten.

Alan's MRI might certainly explain why the neurologic chiropractic helped his symptoms-it relieved pressure on the roots to a certain extent. It remains to be seen, through comparison of the MRI's, if the spaces have narrowed and the pressure increased over the years since that occurred.

[MelodyL]

Want to know what amazes me? That I understand most of what you wrote. And Alan's neuro (yesterday), told him "you have autoimmune stuff going on and OTHER stuff". I don't know how she worded it but that's the jist of what she said.

Alan seems to think that the pain between the two toes on his left foot, and the two toes on his right foot, well he believes that this pain (there is no buttock pain, there is no leg pain, no calf pain, NO OTHER PAIN. Just the burning, buzzing and tingling between the toes. He has said "I know this comes from my back because when Dr Theirl does his thing, I feel great".

So I have no idea if he's right or wrong, but he's determined to FIND SOMEONE who will do some minimally invasive procedure on his back, TO UNPINGE THE COMPRESSION and he feels this will stop the toe pain stuff that's going on.

I asked him last night "did you ask your neuro if this warrants an operation?" and he said "That's the first thing I asked her" and I said "so what did she say".

She said "don't know yet, I have to see the other Films".

Then he took a nap and I said 'do you want a massage?" and he said "oh yeah". So I did my thing, (I've been doing this for years and he loves it, and his Dr. Theirl told me to keep doing this". I just massage his shoulders, his back, his spine, his thighs, his legs, I take my elbow and I dig it in his spine and I go up and down his back. He goes "Oh my god, all my pain is going away, all the pain in the toes goes away when you do this".

So obviously I'm doing SOMETHING. I guess we jus wish there was a doctor, who would put him on table, take some micro tool, go into his spine and say "AHA, here's the little bugger that pressing on those nerves and once we make them loose Alan's buzzing in his toes will go away".

After 20 years of this, I really don't think this is going to happen, but I'm not telling him this. We'll continue the IVIG, the massages, ..he goes back to Dr. Theirl in January.

I guess he'll do the best he can do. He rarely complains. And the worst of all this was way back 7 years ago when he had to go on Fentanyl. Whatever Dr. Theirl did for him way back then, well it got him off of that patch.

Alan did feel better when he went to the gym. Now we just have to get him motivated to do this. He was a different person went he went to the gym. But in the cold weather it's not so easy.

Thanks Glenn. and all who responded.

Hope you are all having a nice day.

Melody