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What causes numbness in lower back and leg with history of lumbar fusion?

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Posted on Thu, 28 May 2015
Question: I am 3 yrs post Lumbar Fusion L2-5. I have had previous cervical fusions- both anterior and posterior, Since 2001, first cerv fusion- I have had numbness from mid chest to bottom of feet. The subsequent fusions have not relieved the numbness or pain. Pain is in lower back.
Recently, I noticed that the numbness in left leg is slightly increased. I saw my surgeon and he did MRI's of cervical and lumbosacral. He states all looks ok except I have one collapsed disck at L1, He is recommending he go in and remove the old hardware and redo the fusion from say T10 to S1. This is a very tough surgery and takes a long time to recuperate. If I choose not to- could I become unable to walk?
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Answered by Dr. Olsi Taka (34 minutes later)
Brief Answer:
Risks is present but decision depends on clinical and imaging evaluation.

Detailed Answer:
I read your question carefully and I understand your concern. Yours is obviously a complicated case with advanced spinal changes and procedures at many levels. Decisions at this stage are complex and at times it is more a case of choosing the minor evil.

One is at a risk of becoming unable to walk when there is compression of of the spinal cord or of the nerve roots coming out of it. In theory any collapsed disc carries a potential of protruding in the spinal canal and compressing the spinal cord and if not intervened in time cause walking disability. That doesn't mean every collapsed disc must be intervened, surgery is reserved to cases when there is such compression.

So since your neurosurgeon has stated that other levels look fine and the issue is this collapsed disc, you should discuss with him whether that is causing any compression of the spinal cord or nerve root at this level which corresponds to the numbness you have been feeling. If that is the case then he could be right in saying that further advancement could render you unable to walk, if it isn't then I would be reluctant to go to such extensive surgery since he states that the rest looks ok.

I remain at your disposal for further questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (2 hours later)
Thank you for your quick reply. I have been thinking that since 98% of the numbness in my legs, hands and fingers has been there since 2001, there is no concern for immediate surgery. The increase I am noticing in my left leg may be related to other issues. This brings up a couple more questions:
1. Do changes in temperature affect cord compression? I notice in past 2 yrs or so that I simply cannot tolerate heat. I feel like I cannot move or walk far. There is some difference noted in cold weather but not as pronounced. ( I live in Ohio where there are big changes in seasons).
2. Does having this injury cause me to tire easier? I get so exhausted from activity.
I am pretty active but it seems it takes twice as much energy to do housework or laundry.
I realize I have damage to C- spine as well as lumbar but I really work hard to stay active.
Thanks again
doctor
Answered by Dr. Olsi Taka (17 minutes later)
Brief Answer:
Read below.

Detailed Answer:
Thank you for the follow-up.

Do changes in temperature affect cord compression.... they do not affect cord compression itself, but if there is a degree of impairment of the nerve fibers traversing the cord it can enhance the symptoms. It does not mean there is extra damage, with removal of the heat source should return to previous level, but the impaired partially functioning fibers under changes in temperature function even less efficiently. It's a phenomena more known in multiple sclerosis patients but can occur in other type of nerve damage as well.

Regarding the second question, I do not know what degree of damage to the cord there was previously (I mean cervical cord as well), but if there was cord compression it is common for it to leave some degree of residual damage resulting in muscle weakness and spasticity. It is great that you stay active and you should continue so (it may be thanks to that that you preserve mobility), but as I said some damage may be left and with age the capacity to compensate diminishes somewhat.
Of course fatigue can be a symptom of many other conditions, so that is assuming that test have been had to exclude some other common causes of fatigue like blood count for anemia, glucose, liver and kidney function tests, electrolytes, Vitamin B12, thyroid function, evaluation of cardiac function.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

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Practicing since :2004

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What causes numbness in lower back and leg with history of lumbar fusion?

Brief Answer: Risks is present but decision depends on clinical and imaging evaluation. Detailed Answer: I read your question carefully and I understand your concern. Yours is obviously a complicated case with advanced spinal changes and procedures at many levels. Decisions at this stage are complex and at times it is more a case of choosing the minor evil. One is at a risk of becoming unable to walk when there is compression of of the spinal cord or of the nerve roots coming out of it. In theory any collapsed disc carries a potential of protruding in the spinal canal and compressing the spinal cord and if not intervened in time cause walking disability. That doesn't mean every collapsed disc must be intervened, surgery is reserved to cases when there is such compression. So since your neurosurgeon has stated that other levels look fine and the issue is this collapsed disc, you should discuss with him whether that is causing any compression of the spinal cord or nerve root at this level which corresponds to the numbness you have been feeling. If that is the case then he could be right in saying that further advancement could render you unable to walk, if it isn't then I would be reluctant to go to such extensive surgery since he states that the rest looks ok. I remain at your disposal for further questions.