Suggest treatment for degenerative spine disease and neuropathy in legs

Posted on Tue, 9 Jun 2015 in Brain and Spine
Question: I have mild chronic sinusitis. I have diffuse cervical disc desiccation without disc narrowing and diffuse cervical facet arthropathy. Then in the thoracic spine T8 I have a 11 mm hemangioma and T9-10 and T11-12 central disc protrusions and thoracic foraminal narrowing related to facet hypertrophy. then in the lumbar grade 1 anterolisthesis of L4 on L5 on the basis of facet hypertrophy. there is loss of disc T2 hyperintensity at several levels indicating desiccation. Conus terminates approximately L1-2 appears normal in signal intensity and morphology. There are Tarlov cysts at S2. I have had so many symptoms as well as having nerve conduction tests done showing neuropathy in legs, feet and in arms. So, what does all this ?
Answered by Dr. Erion Spaho 45 minutes later
Brief Answer:
Risks of worsening of symptoms.

Detailed Answer:
Welcome to HCM.

I have read carefully your query and understand your concerns.

First, discs dedication together with fascet joints hypertrophy indicates that there is degenative spine disease.

This is result of aging process and repetitive loading forces on spine.

Degenative spine disease can lead to more serious spine conditions such herniated disc disease ( protrusion, extrusion of disc material with compressing effects on nerves) and instability.

Since there is instability ( listhesis) at L4-L5, it means there is advanced spine condition or the instability stage of degenative spine disease.

Hemangiomas are considered benign lesions of vertebrae and there is no need for Hemangiomas treatment as far as they don't have compressive effects on neural structures.

Tarlov cysts are nerve cysts that may or may not cause symptoms.

If Tarlov cysts are symptomatic, their content could be evaluated by imaging guide.

Neuropathy could be result of nerves compression, or other conditions such Diabetes, vitamins B deficiency, etc.

All these findings indicate that your spine is damaged at several levels by degenative disease and there is serious risk of progressive worsening of symptoms by herniated disc and instability.

The treatment should be guided by your symptoms ( distribution, pain quality, walking, working, sensory changes, urinary function involvement) and neurological damages after careful neurologic examination.

Treatment modalities include avoiding weightlifting, loosing body weight, exercises to strengthen spine muscles, NSAID drugs, steroids, physical therapy with the aim of joint load reduction.

If these measures fail to improve your symptoms, decompressive or stabilization surgery is indicated.

Hope this helps. If you have further questions or clarifications, feel free to ask, if not, you can close the conversation and rate the answer.

Wishing you good health.

Above answer was peer-reviewed by : Dr. Raju A.T
Follow up: Dr. Erion Spaho 18 hours later
I'm not diebetic. I had my right kidney removed when I was 23 due to it never functioned properly didn't know that until then. I've had lots of blood work done and it's come back fine. I am using a CPAP machine at night and wake up during the night coughing and having to spit alot. My tongue sticks to the roof of my mouth as well. I had a CVA/TIA in 2012. I have tingling and then sometimes numbness in stomach/abdomen area down my back. When sitting butt and vaginal area goes tingly then goes numb legs tingling then numb especially when riding in car or just sitting. Sometimes my vision gets black spots then my face and tongue tingle then arm and hand tingly then numb. During the night my neck, chest, shoulders and upper back bother me alot. When laying on right side my hip has pain so i have to change positions alot. When getting up and down and walking my right hip, lower back and right buttocks hurt. As the day goes on my neck bothers me a lot. I have a lot of popping and snapping in my ears. I have vocal cord dysfunction as well. Wondering if all can be from spine?

Also, suffer from constipation and have been using miralax and metamucil for 3 yrs. Don't always empty bladder all the way and have to go back and pee again. I have myoclinical activity at night take keppra for.
Answered by Dr. Erion Spaho 3 hours later
Brief Answer:
Dynamic x-rays needed to evaluate instability of spine.

Detailed Answer:
Welcome back and thanks for the clarifications.

Not all your symptoms are related to degenative spine disease.

Symptoms related to face, vision and vocal cords dysfunction are related to brain (it's lower part) most probably by damages caused by CVA, seizures may be related to it as well.

Symptoms localized to trunk, arms, legs and vaginal area are related to degenative spine disease.

Constipation and urinary disfunction could be related mostly to spinal stenosis, or listhesis.

Worsening of symptoms by sitting means there is instability of spine.

I wonder if the listhesis you referred is seen by dynamic x-rays or by MRI.

If you didn't have dynamic x-rays ( flexed and extended position) of cervical and lumbar spine, you need this examination because this is the best way to evaluate instability of spine and the grade.

Symptoms localized at hip may be related to spine disease, or may be related to hip degenative disease too. (arthritis)

Hope this helped. Best regards.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
Follow up: Dr. Erion Spaho 51 minutes later
I also suffer muscle loss and always feel fatiqued and tired as well. I have an appt. on Friday and would like some ideas for questions to ask. I really want to get to the bottom of this so I can feel like myself again.
Answered by Dr. Erion Spaho 2 hours later
Brief Answer:
Read below.

Detailed Answer:
Hi again there.

Questions and clarifications to ask should be divided into two categories:

1. Questions about your brain-related symptoms: ( Is the localization of CVA causing my snoring, vision problems, cords disfunction? are there any subtle brain damages, small vessels damage by high blood pressure for example, that may justify my symptoms? what about treatment possiblities?)

2. Questions about your degenative spine disease: ( is there any moderate to severe on my nerves that corresponds to pain and tingling distribution? is there serious instability? if not sure, makes sense of having done dynamic x-rays of my spine?
is muscles wasting related to nerves compression? is there arthritis of the spine? about treatment ( conservative vs. surgery) which one fits better to this case?

Treatment should be guided by symptoms and neurologic findings correlated to imaging findings.

Hope I helped you. Best regards and good health.

Above answer was peer-reviewed by : Dr. Yogesh D
Answered by
Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3795 Questions


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