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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9000
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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Customer Question

I finally was able to give you five stars and a TIP of 50% or $19-so they collected $19 now even if I were to cancel which I will not.--back to my sad case--------I have CHRONIC LBP with known cspine and lss stenosis who has had primarily bad receurrent
back pain with left sided sciatica for a long time- with recent severe exacerbation (after lifting minimal weight) with difficulty walking --with NEW finding of increased tone ?early spasticity in hamstrings making it hard to stand up straight and some difficulty
ambulating/I went to see a pretty bad neurologist who did incomplete EMG with left leg ONLY although sx BILATERAL of heaviness in hips and hamstrings .MRI central stenosis moderate L4-5,foraminal stenosis bad on left moderate on right . Pain bad enough I have
missed work- am radiologist in very large clinic with 2 radiologists so this is not good I am VERY leary about getting surgery ,,? is------------at what point do you need surgery if spinal stenosis> Is it correct that if eymptoms due to diffusely bulding L4-5
disc with moderate central stenosis and not to the foraminial stenosis (severe on right ,mod left) that minimally invasive procedure on disc would work--------------but if sx due to the foraminal bony spurs must have regular surgery ?laminectomy etc? CAN YOU
TELL ON EMG IF SX ARE DUE TO DISC OR THE FORAMINAL STENOSIS> How can you tell??
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

No way to tell on EMG if muscle weakness (lower motor neuron loss) is due to neuroforaminal stenosis of lateral recess stenosis due to disc herniation. Alternatively, if your spasticity in your hamstrings are the result of an upper motor neuron lesion from cervical stenosis, then you can see CRD's (complex repetitive discharges) in the hamstring muscles on needle exam which can indicate UMN involvement, or you can do somatosensory evoked potentials (tibial and peroneal stimulation) to determine latencies in the cord. In terms of surgery, it is difficult for me to give you the correct answer, I am not a neurosurgeon.. From cases I have seen, with foraminal stenosis, foraminotomy done endoscopically is tried rather than the laminectomy/fusion or partial corpectomy of removing a part of the disc.

Customer: replied 1 year ago.
I have had laminiplasties C3-C7 for cervical stenosis ,short pedical congenital and acquired with HNPs after accident and never had any F/uDoes the finding on EMG on my Left leg only of - Left Peroneal motor potential was ABSENT and right peroneal motor amplitude reduced with normal conduction velocity
Left tibial motor amplitude was borderline reduced and the right was normalSural sensory amplitude and conduction velocities normal as were poneal sensory amplitudesLeft peroneal F wave absent r and the right was prolongedTIbial F waves normal bialterallyTibial H reflexes were prolonged bilaterallyNeedle EMG on left NO SPONTANEOUS ACTIVITYAs before I am going October 30 to Neurosugron who works with neurologist and PMR doc
so hopefully I will have EMG on the RIGHT leg thenDoe the above imply that I have significant nerve damage from this spinal stenosis and that it may progress so that I cannot walk etc( as I am having some difficulty walking now)My son who is a medical student at University Miami keeps telling me I may have cauda equina syndrome which I thought mean bowel and bladder problems and usually is seen with malignancy-none of which are trueWhat would have you send a patient with longstanding spinal stenosis LSS with recent exacerbation due to minor trauma ) to a neurosurgeon??In other words as long as I can walk is it safe to dealyy getting surgery or is surgery done to prevent further progression>Thanks
Customer: replied 1 year ago.
sorry should be is it safe to dealy surgery 9in general I mean not me) or is it done to prevent further progression ----------I had lots of pain but NEVER any spasticity etc until 6 weeks ago after minor traumaTHANKS!!
Expert:  Dr. Frank replied 1 year ago.

HI. First of all, for reasons no one is completely sure, the absence of peroneal motor latencies may be related to your congenital short pedicles/your cervical laminectomies but more just the way you are. There are congenital neuropathies, Charcot Marie Tooth where you have absent or low amplitude peroneal motor responses, and with that cervical stenosis (congenital) not acquired. With your short pedicle syndrome, do you have other family members with this same issue, have they had emg's of their lower extremities? Secondly, the most important issue I would say from your suboptimal emg is the loss of F waves in the left peroneal and the prolongation in the right, with the tibials being normal. That suggests L4/5 problems either disc disease or neuroforaminal stenosis bilaterally, and at S1 things are improved as the tibials are normal (tibials are S1 and S2) Cauda Equina syndrome is a type of plexopathy where nerves leaving the spinal cord at multiple levels below L2 are compromised while in the spinal canal, usually from multiple lumbar stenosis from disc diseases or central canal stenosis (which you have I believe) The MRI is the qualitative way to determine that issue. Your emg would not support that as the tibial F waves would also be absent. But really a picture serves better in that diagnosis than the emg. Yes you should have saddle shaped numbness along the groin area, and loss of bladder function, sometimes bowel when severe. About surgery to prevent progession, that is done in disc disease. In congenital spinal stenosis, or that due to diffuse osteoarthritis, surgery is palliative in my opinion, so you are delaying progression but not necessarily preventing progession. It is more an individual by individual case, so hard to say from here. Get back to me if I can help.. Good luck to you and keep in touch anytime. Dr Frank

Expert:  Dr. Frank replied 1 year ago.

I am concerned that if you never had spasticity prior to the MVA, maybe the whiplash in the setting of your previous surgery was the issue here. You can ask for somatosensory evoked potentials which are done at the Univ. of Miami (or at least they were when I was in training about 20 years ago). That may help in the diagnosis of your spasticity. you didn't answer about baclofen or tizanidine if you need it, let me know again if I can help. Dr Frank