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Posted in: Back pain.

New here - but not to spinal problems

Started by jill915 on 01/13/2011 12:58am

I am a 45 y/o femal who has had my share of cervical spine issues and am s/p C4-C7 ACDF w/ instrumentation, as well as having undergone an occipital neuromodulator implanted into the occipital nerves for continued debilitating nerve pain. 2-1/2 months ago I underwent a total knee replacement which has had several complications leaving me unable to lift or bend my leg.

EMG/NCS showed femoral nerve damage (probably from the tourniquet that was applied during my TKR and which explains my inability to bend or lift my leg), but while doing the test on my leg, the doctor said it showed something in my back and he had me roll over to test my lumbar spine. Below are the abbreviated results from the EMG/NCS. Based on these findings, my knee has taken a "backseat" and I was referred for an immediate CT scan (cannot have an MRI due to the implant). My knee surgeon did not go over the results of the CT scan with me, and instead has referred me to a spine specialist, whom I see on Friday for the results.

I should also mention that during my TKR, I was catheterized and had spinal anesthesia. Since that time my urinary stream has been just a "trickle". At first I was told that my bladder was probably just in shock from the catheter... but now they aren't so certain.

Do the findings from my EMG below mean anything to anyone? I'm one of those people that likes to know or at least have a feeling of what I might be in for. I will have more answers on Friday, but the quickness of all the tests and appointments has me a bit concerned. Whatever happens... happens. Like I said, I'm one of those people who just likes to know so that I can wrap my head around things and go forward. I know I will get more results on Friday, but any thoughts about this test would be appreciated. Thanks in advance.

EMG/NCS Findings:

1. Abnormal Study.

2. Likely left femoral neuropathy proximal to the motor branch of the iliopsoas; with approx 50% motor axon loss to the vastus medialis, prognosis for functional recovery good if instigating lesion is removed.

There is electrophysiological evidence of a left-sided femoral mononeuropathy as shown by the abnormalities on needle EMG of the left iliopsoas, vastus medialis which is clouded by the abnormalities throughout the rest of the left lower limb and in the right as below.

3. Possible left and possibly right L5 or S1 radiculopathy, plexopathy, cannot rule out left lumbosacral panplexopathy.

There are diffuse abnormalities on needle EMG throughout the left lower limb w/ sparing of paraspinals. A panplexopathy cannot be excluded in this situation. However, there is an alternative more likely explanation for the proximal left lower limb symptoms as above. The remainder may be explained by an L5 or S1 radiculopathy or plexopathy. Abnormalities were seen in the tibialis anterior on the right side and there may be a similar but lesser process on the right.

Clinical Impression: Test shows what is likely a left femoral neuropathy with approx 50% motor axon loss to the vastus medialis. If this is related to a one-trauma the prognosis is good. Recovery usually takes place at 1 inch per month as a very rough estimate, and recovery could therefore take a year or even longer. There was no current evidence of axonal sprouting or regrowth.

There are diffuse abnormalities thruout the left lower limb and even some on the right. This may be due to a bilateral L5 or S1 radiculopathy, though a panplexopathy on the left cannot be excluded. Imaging of the lumbosacral spine and pelvis should be considered.

Thanks again.


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