This topic contains 5 replies, has 2 voices, and was last updated by Christopher Stepien July 13, 2018 at 8:52 pm.
July 6, 2018 at 9:41 am #5384
47 year old female
Bilateral lower leg and foot numbness and “feels like sand is on toes and feet”
Patient would also complain of a quick sharp jolt in back with bad movement.
Provocative was stretching the back and sitting.
Palliative is nothing once it is flared up.
Patient does a lot of sitting and driving at work.
All level one tests were 100% with the exception of QLF was 60% and
SLR was 90 degrees with numbness increasing at end range on the right and 83 degrees with numbness increasing at end range on the left. SLPF brought on bilateral stretch in calves and increased tingling in toes.
Diagnosis at this point was a central disc protrusion with adhesion in the paraspinal muscles.
Since then I have seen the patient 6 times, QLF has gone to 80%. Numbness is becoming more and more pronounced and constant.
I ordered an MRI and there is a central disc protrusion at L5-S1 with annular tear. This disc is impinging on the right nerve root sleeve.
My question is can a central protrusion at this level account for bilateral numbness from the knee down?July 9, 2018 at 8:41 am #5386
Search “lumbar spine nerve roots” and look at a picture from PA of the Lumbar spine. Notice, in order for the nerve roots to leave their level, they need to be spaced more laterally (i.e. Pick L3). For the nerve roots to leave lower on the spine, they need to be placed more medially where a central disc.
Search “lumbar dermatomes”. Specifically, S1 and S2 nerve roots is consistent with posterior thigh, posterior leg, and some of posterior foot (along with L5).
So, YES.July 9, 2018 at 4:52 pm #5387
Seth Schultz, DCParticipant
What are the exact locations of numbness and the sand sx? Is the entire lower leg involved or just the posterior lower leg? Same thing with the foot. Is it the entire foot or specific areas?July 9, 2018 at 8:29 pm #5388
Keith Puri, DCParticipant
I believe Chris is referring to the traversing nerve roots versus the exiting nerve roots. If you reference the pic below, in theory, a central disc protrusion could abut/impinge/compress the exiting L5 nerve root and the traversing S1/S2 nerve roots. However, if this was the case I would believe a disc pathology large enough to compress the bilateral traversing and/or exiting nerve roots would produce more pronounced nerve retraction signs on physical exam (positive SLR between 40-60 degrees with the reproduction of known complaints). As Seth mentioned specifically what is the distribution pattern of her numbness? Something sounds off.
Given her case history and ID level exam findings I suggest looking up the spine into the cervical region and/or brain. Cervical cord compression or MS?? If you didn’t check for a positive Hoffman’s sign or clonus I would do so on her next appt. I could be completely off-base but as Dr. Brady reminds me frequently; smaller adhesion smaller MSK problem. For a lumbar disc to cause the above scenario that would be a big MSK problem, but the ID findings appear less suggestive of that.July 12, 2018 at 1:12 pm #5389
Seth Schultz, DCParticipant
Any updates with the case Andrew?July 13, 2018 at 8:52 pm #5390
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