Patient: I had an EMG and the results are:There is electrodiagnostic evidence of chronic denervation in the right peroneus longus, without acute or ongoing denervation.There is electrodiagnostic evidence of chronic denervation in the right gastrocnemius, without acute or ongoing denervation.Given the change in symptoms (from prior EMG) and decreased activation in the right lower extremity, a central process should be considered.
Symptoms: I have a history of lumbar surgeries, with some new symptoms. I am not looking here for treatment options; I just want help understanding these findings.
Doctor: Hi.Read and understood your concerns.As per the reports you have posted, central process should be considered and th e history of lumbar surgeries, it appears in a nutshell that the corresponding nerves might have been affected at the nerve root before or after the surgery.It says the denervation of both the muscles is chronic (without acute or ongoing meaning that the denervation has already occurred long back and at the moment there is no new one.)You have mentioned in the symptoms: ”I have a history of lumbar surgeries, with some new symptoms. I am not looking here for treatment options; I just want help understanding these findings”.May I please know a few things so that we can discuss further and can help me to assist you more:- Since when Have you got the symptoms- the old and the new?- Was the surgery performed before the symptoms appeared or after to relieve the symptoms?- Please let us know, what was the surgery done.Please give the feedback and more information so that we can discuss further.
Comments / Follow Ups
Patient: I had an artificial disk placed at L4-L5 and fusion at L5-S1 almost 10 years ago, and the first result I listed above is the same as the EMG I had 3 years ago, before the new symptoms appeared. 6 months ago, I started having right hip flexor weakness, right ankle eversion and pain in the front of my right thigh. My neurosurgeon is looking for a cause of these symptoms. The second result (denervation in the right gastrocnemius) is new and was not found on the EMG three years ago. Also, what does “a central process should be considered” mean?
Doctor: May I please know whether fresh MRI of the spine ( if it is allowable/ there is no contraindication due to some metal that a magnet can attract ) done to see if there is any problem with the spinal cord.
Thanks for your follow-up.
“a central process should be considered” means The problem is either in the brain or the spinal cord (most probable). These 2 are part of the CNS (Central Nervous system, anything from these is called peripheral).
The inference says that the process of weakness in the nerves
may be in the spinal cord (most likely as there is a history of surgery) or the brain (brain -less likely as the effects have been more wide).
I hope this clears your doubts, please feel free to ask further relevant queries if you need to or if you feel that there is a gap-of-communication.
Patient: No MRI, because of neurostimulator, but I had a recent CT/myelogram which showed only a mild circumferential disk bulge at L3-L4 and a bone spur at L5-S1. My surgeon said there is nothing surgical showing on the CT/myelogram.
Doctor: Yes, no MRI as I suspected- due to Neurostimulator.
CT Myelography findings noted.
One of the known reason can be some sort of autoimmune response/Idiopathic degeneration.
As you may please know, the nerves are pretty the toughest to have regeneration. It has the lowest regeneration power and heals very slow.
You must be taken some nerve tonics or some other therapy ?
Patient: I am taking considerable amounts of pain medications and am seeing a pain management doctor; have also tried PT and steroid injections, but I really want to find a solution beyond just managing pain. And I am concerned that the nerve damage seems to be getting worse, despite the surgeries. For what it’s worth, I had excruciating pain in both the muscles mentioned in the EMG report when the contrast was injected during the myelogram. The radiologist just said that those nerve roots must be “sensitive.” I’m not sure what that means. That pain subsided as my body processed the contrast.
Try to reduce the pain medication to the most minimum as adaptation will lead to dose increase. The increased pain on infecting the dye indeed indicates that the part of the nerve fibers supplying these muscle got irritated and got settled too. This is what your Radiologist meant by saying that those nerve roots must be “sensitive.”
Steroids should have helped you.
he best alternative as per my carrier goes The person who really knows the Acupressure or acupuncture can help you recover the strength and get control over the pain too. It is up to you now that you find the most experienced expert in Acupressure or puncture. This gives wonderful results in some patients.
Doctor: You may continue rest of the medicines as already must have been prescribed.