Does Lumbar Spinal Stenosis Cause Symptoms Of Sciatica?

Posted on Fri, 27 Nov 2015

Question: I have symptoms of sciatica which are believed to be caused by
Lower lumbar spinal stenosis (congenitive). However, at first sign of symptoms I developed twitching in my left calf (also same side as sciatica). Went to neuro. Had lower lumbar mri and brain mri. Lumbar mri showed stenosis and brain all normal. Neuro exam normal. Emg showed +fib on median nerve suggestive of carpal tunnel right arm and normal left leg. Nerve conduction normal.

Now I have twitching almost constant in left leg and sporadically all over. I saw spine dr. And he said I have hypeflexia in both knees and clonus in right foot.

Now I am really scared about what is going on. My left leg feels weak and I have a dent in my left calf. My left calf is smaller also than my right.

I fear ALS. I'm so scared. Dr is looking for possible cervical stenosis and ordered an MRI.

Advice? I am 34/female with young babies and so scared this is not good.

Answered by Dr. Dr. Erion Spaho (1 hour later)

Brief Answer:
Upper cervical spine stenosis most likely than ALS.

Detailed Answer:
Hello and thanks for using HCM.

I have read your question and understand your concerns.

There are two factors that make ALS unlikely to be the diagnosis:

1. Your age, ( ALS is a very rare condition in people under 40 years old )

2. nerve conduction study and EMG (hallmark findings in the electrodiagnosis of ALS are normal sensory nerve conduction studies and abnormal motor nerve conduction studies)

Brisk reflexes could be a finding in ALS too, but since there is evidence for lower spinal cord stenosis, there might be upper spine stenosis too.

Difference between two calf group muscles could be explained by sciatica, it is a common finding in prolonged period of nerve compression.

In my opinion, upper spinal cord (thoracic and spinal cord) compression or lesion is the most probable diagnosis.

I suggest you to discuss with your treating Doctor about having done thoracic spine MRI too.

Hope you found the answer helpful.

Let me know if I can assist you further.

Take care.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Erion Spaho (1 hour later)

Thank you for your response.

I don't do waiting well. I feel very nervous and uneasy about the twitching.

Add to that normal reflexes in at all neuro visits in January and XXXXXXX and then this new finding of hypeflexia with clonus. Really scared me.

His diagnosis for MRI request was spondylosis with myopethy cervical region

Do you think the EMG and NCS I had on January 15, 2015 that was normal is sufficient to rule out ALS?

I was twitching in the leg they did the Emg on when they did it but normal reflex per neuro at time.

Do you think if the twitching and reflex response was ALS that is happening now; the EMG would have picked it up in January?

Ty

Answered by Dr. Dr. Erion Spaho (10 hours later)

Brief Answer:
There is no single test to exclude/confirm ALS.

Detailed Answer:
Welcome back and thanks for being on follow up.

EMG and nerve conduction study findings are diagnostic keys against ALS, the same your age.

There is no single criteria to diagnose or exclude ALS.

At this moment, looking all the concerns you report, it is my personal opinion that spinal cord stenosis is the most likely diagnosis.

Again, tests are needed to confirm that.

Hope I've been of help.

Take care.

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Sonia Raina