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  • confusing the diagnoses??

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    Old 12-09-2014, 06:36 PM   #1
    barbglrrt
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    Unhappy confusing the diagnoses??

    Hello, Im 51 yrs old and have a bit of a complicated medical history. In 1087 I had a slip and fall. began having leg and back pain that progressively worstened. I was eventually diagnosed with Sponylolisthesis and had my L 3/4/5 fused. during my recovery i was diagnosed with having FSHD (Fascio-Scapulo_Humeral-Dystrophy) Over the years my legs have progressively weakened, i have bilateral foot drop, numbness of feet/legs,pain in feet/legs, urinary issues (urgency) my balance and gait is bad. My Symptoms have been mostly blamed on my FSHD. I recently had an MRI of my Lumbar spine. One of the descriptions reads.."Bilateral Cystic densities greater on the right at L5-S1 may be related to PERINEURAL TARLOV CYST"..I looked this up and many of my symptoms coincide with symptoms of PTC. I also have been plagued with headaches. daily..several times a day. I have Migraines also, but these are just annoying headaches..not Migraines. Do you think some of my issues with my legs and the headaches could be attributed to this new "possible" diagnosis?? Is it worth investigating. I must also tell you my L5-S1 has "autofused" itself sometime in the past 20 years. Thank you for your input

     
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    Old 12-14-2014, 07:51 AM   #2
    teteri66
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    Re: confusing the diagnoses??

    Welcome to the board. I just saw your post. I am sorry no one responded. I can only assume you are not seeing a spine specialist on a regular basis. While I do not see any reason for the headache unless you also have cervical spine issues, there is an extremely good chance the symptoms are caused by nerve compression in the lower lumbar spine.

    When there is pain that radiates out from the spine it is often due to a compression or irritation of a spinal nerve. The nerve is affected at the source but the pain can appear anywhere along the pathway of the nerve. You can look up a "dermatome map" and see which nerve innervates which area of the body.

    There are two main areas where spinal nerve compression occurs. One is in the central canal and the other is in the neuroforamen. The foramina is an opening that is located at each disc level that allows a spinal nerve to exit the spine and go out to a particular area of the body. When there is something that obstructs this space, there is less room for the nerve. Depending on the extent of the obstruction, the result can be minimal or it can lead to loss of function of a particular area of the body.

    When this happens it is important to go in to surgically decompress the nerve to minimize damage to it. Sometimes less invasive treatments can work. It all depends on the reason for the nerve compression.

    Sometimes there is tissue that enlarges and usurps space that would otherwise be needed for the nerve to function normally. A disc herniation would be an example of this...or an enlargement of a facet joint, or something like a cyst or tumor would also have the same effect.

    In the case of the perineural cyst, it is a bit like a water balloon. It is a sac that is fed by fluid from the central spinal canal. When it becomes large enough to take up space, it can start to press on a spinal nerve...which results in the same symptoms as any other source of nerve compression.

    It is important that you make an appointment with a fellowship-trained orthopedic spine surgeon or a neurosurgeon who only treat neck and back problems. I think you probably need a new MRI to see what is going on...and an expert diagnosis and plan of treatment to arrest further degeneration.

     
    Old 12-15-2014, 09:05 PM   #3
    barbglrrt
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    Re: confusing the diagnoses??

    Quote:
    Originally Posted by teteri66 View Post
    Welcome to the board. I just saw your post. I am sorry no one responded. I can only assume you are not seeing a spine specialist on a regular basis. While I do not see any reason for the headache unless you also have cervical spine issues, there is an extremely good chance the symptoms are caused by nerve compression in the lower lumbar spine.

    When there is pain that radiates out from the spine it is often due to a compression or irritation of a spinal nerve. The nerve is affected at the source but the pain can appear anywhere along the pathway of the nerve. You can look up a "dermatome map" and see which nerve innervates which area of the body.

    There are two main areas where spinal nerve compression occurs. One is in the central canal and the other is in the neuroforamen. The foramina is an opening that is located at each disc level that allows a spinal nerve to exit the spine and go out to a particular area of the body. When there is something that obstructs this space, there is less room for the nerve. Depending on the extent of the obstruction, the result can be minimal or it can lead to loss of function of a particular area of the body.

    When this happens it is important to go in to surgically decompress the nerve to minimize damage to it. Sometimes less invasive treatments can work. It all depends on the reason for the nerve compression.

    Sometimes there is tissue that enlarges and usurps space that would otherwise be needed for the nerve to function normally. A disc herniation would be an example of this...or an enlargement of a facet joint, or something like a cyst or tumor would also have the same effect.

    In the case of the perineural cyst, it is a bit like a water balloon. It is a sac that is fed by fluid from the central spinal canal. When it becomes large enough to take up space, it can start to press on a spinal nerve...which results in the same symptoms as any other source of nerve compression.

    It is important that you make an appointment with a fellowship-trained orthopedic spine surgeon or a neurosurgeon who only treat neck and back problems. I think you probably need a new MRI to see what is going on...and an expert diagnosis and plan of treatment to arrest further degeneration.

     
    Old 12-15-2014, 09:10 PM   #4
    barbglrrt
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    Re: confusing the diagnoses??

    thank you. These results have shown up in a new MRI. The Cyst is at the L-5/S-1 level that has been fused. My family dr says Nobody will touch this, as the vertebra are fused together and he says there is no way to "drain" the cyst. Not sure if my insurance will cover seeing a surgeon. and at what size must the cyst be for intervention to be considered? thank you for your help and any tips on research or a specialized spinal clinic that may see me...

     
    Old 12-16-2014, 11:55 AM   #5
    teteri66
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    Re: confusing the diagnoses??

    I don't believe the cyst is the only reason you should see a spine specialist. With the foot drop and urinary issues, you should be under the care of a spine specialist because there is the potential for far greater nerve damage if the nerves are left in a compressed state. Just because there is fusion at one level, other issues can still develop in the surrounding areas. Also since you say L5-S1 fused naturally, it may be trapping a spinal nerve or at least irritating a nerve in some way.

    I know of a very good surgeon not too far from you...Dr. Richard Easton. He is in the Troy area, in Rochester Hills. There is also a very good spine clinic at Beaumont and I think their spine docs see people in a variety of locations.

    My PCP was a brilliant doctor but I wasted a year in pain because he felt he knew as much as the spine doc and could treat me. Your issues are sufficiently complex that I think you should see a spine specialist.

    Last edited by teteri66; 12-16-2014 at 11:58 AM.

     
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