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Old 08-25-2012, 03:24 PM   #1
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at my wit's end... please help

I posted two months ago reporting new-onset hyperreflexia (in the knees), as well as gait unsteadiness and subjective leg "tension" (that wasn't really affecting my walking speed) for three weeks.

Prior to that time I had never had any trace of leg problems.

Since that time, my symptoms have evolved. Now I have significant muscle atrophy in both thighs, as well as in the left calf. The atrophy happened so quickly that I can't even pinpoint when it happened...one day I just woke up and noticed my runner's legs were just gone...my quads were skin and bones.
My legs are weak, mainly in the quads, and the left leg is significantly weaker than the right.
My quad muscles are stiff--I can actually feel one of the quad muscles (the rectus femoris, I think) as a hard rock under my skin along the entire length of the muscle whenever I extend the leg or work the muscle.
The stiffness has slowed down my walking speed. It also makes flexibility, turning, jumping, and moving around in general more difficult.
I have bouts (6-7 days at a time) of leg heaviness. The legs feel like lead. It is usually worst when I try to get out and run errands, or after a "big" (for these days) workout (run/bike).

I have also developed weakness in both hands, left greater than right. When I sit down for an extended period of time, my right arm starts to feel heavy.

I have mild numbness on the right side of my body, from the chest down.

I don't have MS. I've been seeing a neurologist, and besides the discs at C5/C6 and C6/C7, there's nothing wrong with me. The discs don't appear on imaging (5 cervical MRI's now?) to be compressing the spinal cord. There are a few things I did in May that I am EXTREMELY concerned could have caused injury to the spine without causing any structural changes on imaging--I wore a heavy lead suit (like what xray techs wear) for 7-8 hours one day; those things weigh 10 pounds. I also started PT, which, as crazy as it sounds, I worry may have caused damage due to a lot of aggressive soft tissue work/hard neck massage. Also, one time, while driving (I was the passenger), we came to a very sudden stop, although it was nothing similar to whiplash.

I know I'm not supposed to ask for a diagnosis here, and that's not really my intention. I am just wondering if anyone can shed light on whether my course of symptoms sounds familiar. For a long time I was convinced I was developing myelopathy, but everything seems to have developed so quickly and to have gotten severe so fast...especially the muscle atrophy in the legs.

I'm not really sure that wearing lead or starting PT (or the driving) could have affected the spinal cord so severely, causing such severe symptoms. Does anyone know??

I'm on my fifth week off work and have lost nearly all hope for recovery. I haven't improved much, if at all, since the symptoms developed. I'm 30 years old.

Below is an MRI report for reference. This was performed after all the injuries I described.

Findings:

The C2-C3 intervertebral disc space displays normal disc height. Facet joints and uncovertebral joints as well as ligamentum flavum are without prominence.

C3-C4 intervertebral disc space displaying 2-3 mm annular disc bulge causing effacement of the anterior thecal sac. Facet joints and uncovertebral joints display no significant hypertrophic changes, the ligamentum flavum is without prominence. Mild central and mild bilateral neural foraminal stenosis is identified at this level. AP canal diameter is 10 mm.

The C4-C5 intervertebral disc space displays normal disc signal and height. Facet joints display degenerative changes. There is hypertrophy of the left uncovertebral joint. There is mild central canal stenosis with mild right and moderate to marked left neural foraminal stenosis present at this level. No significant change during flexion or extension is noted.

The C5-C6 intervertebral disc space displays a 3.5 mm midline herniated nucleus pulposus. This causes contour abnormality of the anterior surface of the cervical spine. AP canal diameter is 8 mm. There are hypertrophic changes of the uncovertebral joint right greater than left. Ligamentum flavum is without prominence. Facet joints display degenerative changes. There is moderate central canal stenosis with mild to moderate right neural foraminal stenosis and mild left neural foraminal stenosis identified at this level. Flexion and extension views display no significant change in the disc herniation or canal stenosis.

The C6-C7 intervertebral disc space displays a 2-3 mm annular disc bulge causing effacement of the anterior thecal sac. Facet joints and uncovertebral joints display degenerative changes, the ligamentum flavum is without prominence. Mild central and mild bilateral neural foraminal stenosis is identified at this level. No significant change with flexion extension views are noted.

The C7-T1 intervertebral disc space displays normal disc height. Facet joints and uncovertebral joints as well as ligamentum flavum are without prominence.

The vertebral bodies display abnormal alignment. There is reversed lordosis. No decrease in vertebral body height is identified. No endplate irregularity is noted. Minimal osteophyte formation is noted at the C5-C6 and C7 levels. The arch of C1 displays normal relationship to the dens of C2. Cerebellar tonsils display no evidence of ectopia.

The spinal cord is without syrinx, demyelinating disease or myelomalacia. Motion artifact is present on some sequences which limits evaluation.

Impression:

C5-C6 intervertebral disc space with a midline 3.5 mm herniated nucleus pulposus with facet hypertrophic degenerative changes and uncovertebral joint hypertrophic changes. Moderate central, mild to moderate right and mild left neural foraminal stenosis is identified at this level. Disc displays similar appearance on flexion and extension views.

C4-C5 intervertebral disc space with hypertrophic left uncovertebral joint with mild central, mild right and moderate to marked left neural foraminal stenosis identified at this level. The appearance is stable on flexion and extension views.

C3-C4 intervertebral disc space with a 2-3 mm annular disc bulge with mild central and mild bilateral neural foraminal stenosis. Facet joints and uncovertebral joints display degenerative changes. No significant change during flexion and extension positioning is noted.

The spinal cord displays no altered signal intensity. There is however contour abnormality anterior surface secondary to the disc herniation at the C5-C6 level.

No evidence of a Chiari I malformation.

 
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Old 08-25-2012, 05:04 PM   #2
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Re: at my wit's end... please help

Did you take my suggestion to have a different radiologist look at the MRI? Not that I think there's a problem, as the one who did your report seems conscientious.

I thought Barry Berkowitz in Van Nuys did a good job on mine.

 
Old 08-26-2012, 01:25 PM   #3
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Re: at my wit's end... please help

Who ordered the MRI? Was it an orthopedic surgeon or a Neurosurgeon? I suggest that you sit down with the ordering doctor to discuss. If you are treating with an orthopedist or neurosurgeon are they specifically trained in spine related issues? If you arent treating with one of the above then you should be. I am not sure it's a matter of another radiolgoist point of view its now the doctor to decide what treatment is in order?

You mentioned mild to moderate foraminal stenosis in the findings. To me this may be a cause of some concern. I had foraminal stenosis in the neck in 1995and that required surgery. I don't recall if it was mild; moderate or severe, I don't have a copy of the report in front of me at the moment.

I suggest talking to the proper doctor. and if you don't have one then you need to see one soon!!!

 
Old 08-27-2012, 05:57 PM   #4
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Re: at my wit's end... please help

Thanks to you both for responding. I did run my MRIs by a few more spine surgeons as well as a radiologist, and nobody sees any cord compression, at least nothing significant enough to explain the severity of my symptoms.

But my symptoms and signs localize the problem exactly to my left cervical spine, where the discs are. I have hyperreflexia with clonus in the left knee. The right knee sometimes jumps but it's not nearly as severe or consistent.

I just got the results of a recent lumbar puncture back, and I had high protein and albumin (and some oligoclonal bands, as seen in MS) in my CSF. This seems to be a sign that some kind of injury to the spinal cord did occur...whether by compression or inflammation, I don't know. Has anyone out there with myelopathy due to spinal cord compression had LPs done? What abnormalities were found, if any?

I'm seeing a new spine surgeon Wednesday. I have seen a couple already, and they've just been scratching their heads. In the meantime my symptoms have been getting worse/more limiting and I am terrified.

At this point I'm considering surgery just to see what happens...acdf vs. artificial disc vs. laminoplasty...I'll see what the surgeon says on Wednesday, but I feel that action needs to be taken stat. If I end up having permanent damage from this I will be devastated, but I know it's a risk given the symptoms developed three months ago.

Last edited by cspinehelp; 08-27-2012 at 05:59 PM.

 
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