Question
QUESTION: I have this needles and pins feeling that started in my left foot and leg 7 weeks ago.Since the feeling has gone over to the right leg and foot and the numb, needles, electric shock varies day to day.....I have been for a MR and they indicated moderate pressure.....however the neuro surgeon said polineuritis....what a word! He said the feeling might stay forever but i disagree....I have recently had cranial therapy but with little improvement...Over the weekend some friends suggested i go to a chiro, what can you recommend or suggest.....please it is a ....feeling!!

ANSWER: Thank you for your question. I don't have enough information regarding the MRI findings to draw any specific conclusions regarding your symptoms; I would need to know more about the body region studied (for example, lumbar spine, brain, or cervical spine) and the exact verbatim findings of the study.

Polyneuritis is general term to describe inflammation and irritation of several branches of nerves simultaneously, rather than a specific disease process or disorder.

I regret that I cannot offer you a diagnosis over the Internet, but in general, spinal manipulation (although probably not cranial manipulation) may be of benefit only if there is a structural problem that could be related to your physical symptoms (for example, a lumbar disc herniation encroaching on a spinal nerve root which supplies the lower extremity). Part of the decision-making process involved in using spinal manipulation would be to determine if your symptoms worsen or improve with specific movements (for example, pain/symptoms worse with forward bending of the trunk, better with backward extension of the spine), and physical examination of the spine and pelvis itself to determine if there is tenderness or reproduction of symptoms by touch, if there are any deficits in your muscle strength in the legs or abnormal reflexes of the knees and ankles, or if there are any sensory abnormalities in the lower extremities.

Beyond MRI evaluation, additional neurological testing may include electrodiagnostic testing, such as electromyography (EMG) or nerve conduction velocity (NCV), which can help pin-point a specific nerve problem. These tests are usually performed by a neurologist.

Depending upon a patient's symptoms, a more invasive test might include obtaining a sample of cerebrospinal fluid from the spine to evaluate for proteins or bacteria, to rule out infection. Similarly, a blood chemistry panel might be obtained to rule out infection or generalized inflammation.  





---------- FOLLOW-UP ----------

QUESTION: Doc,
The mri findings.
L3L4 - There is stenosis of both of both intervertebral foramens but no obvious pressure on existing nerve roots.Partial loss of signal in the lower thoracic region with moderate disc space narrowing.
T12-L1 - mild pressure on thecal sac
L4L5 - High signal in posterior aspect of the disc. Disc prolapse moderate pressure on the thecal sac,consider tear in the annulus fibrosis.
EMG and NCV by the neurologist with no problems, sample cbs fluid was done no problem,full blood scan no problems or infections. The neurologist did a thorough clinical examination before the tests with no problems. I told him that due to my skin feeling dead it sometimes feel strange to do a some movement but not creating freedom of walk strecth flex or cycling...
I think the neurologist based his Polyneuritis on the findings. Although he might put the diagnosis as that there is no antibiotics or medicine for it he said.
What i do find is that in certain positions the 'dead' feeling feels a bit 'lighter' easiest description.....The burning sensation in my feet has mildly started to disappear in the fifth week but remains noticeable! The front part of both legs are numb with the calves only sometimes numb and sometimes fine. The dead feeling and numbness varies in height almost every day and the highest it went was into my thy but not scrotum or backside. It sometimes appear like a 'strap' around my stomach and disappears leaving a numb sensation in the center of my stomach just above my navel....the strap/belt disappears but the numbness remains...
My feet was swollen till the fourth week and gently started decreasing and remains slight with the bottom of my feet sometimes being 'very white' and feeling dry!
I am 44 yrs old active off-road motorbike and mountain bike rider, the neurologist said that i should continue my riding and let my body tell me when to stop....i have decreased the riding from 70km per week to 30km. No motorbike riding sine i detected my problem.....Friends say i should rest for three months, but i find that hard as i have NO pain and i will be 'rotten' from doing nothing, others say my problem will only disappear after 8 months...thats very hard to understand....
I somehow think that my problem is definitely related to my disks or a nerve stuck somewhere...what can i do to search or eliminate certain problems?Is there any medication that can help?Can a Chiropractor assist or help me?  
Oh forgot...I am from South Africa and live 400km away from Pretoria where all the 'experts' are based. My medical aid has been stretched to its limit by al the test and doctors with no solution or improvement...please assist and i appreciate any help or relief to try whilst hoping to recover....

Thanx doc.

Answer
It appears that the symptoms you are experiencing at the level of the navel as well as in the legs are related to compression of the thecal sac (the outer covering of the spinal cord). The T12-L1 level would refer symptoms to the belly-button area; the lower lumbar segments (L3-L5) would refer symptoms to the thighs, legs, and feet.

One group of authors explains this point this way: "Since the nerve root supply to the lower extremities and genitoperineal regions travels in very close apposition within the thecal sac, external compression such as that occurring with lumbar canal stenosis is manifested by dysfunction in multiple root distributions. For example, pain and other sensory deficits may occur in several lumbar and/or sacral dermatomal territories, as well as weakness in the various muscle groups supplied by these nerve roots" (Reference: Alvarez J, Russell H. Lumbar Spine Stenosis: A Common Cause of Back and Leg Pain. Am Fam Physician. 1998 Apr 15;57(8):1825-1834).

Another author states:  "... the clinical expectation that greater thecal sac compression may result in more severe (neurological) symptoms" (Sokolowski M et al. Postoperative lumbar epidural hematoma: does size really matter? Spine 2008. 33;(1):114-119).

We generally recommend lumbar epidural spinal injections for patients with disc herniations that cause significant symptoms (usually pain) who have not responded to an aggressive course of non-surgical care (chiropractic, physiotherapy, home exercises, anti-inflammtory and pain medications), but are not severe enough to warrant surgery. The injection of a steroid reduces inflammation, which causes pain, allowing the person to more easily engage in physical rehabilitation.

One method of self-treatment that you might try is the Australian physiotherapist Robin McKenzie's method of spinal extension. This technique essentially involves repetitive backwards-bending exercises (if a few backwards bending maneuvers are tolerable and do not create a worsening of symptoms). The idea behind this maneuver is that by locking the facet joints of the lumbar spine, the disc herniation is pushed forward from its displaced backwards-position. Over time, the person feels a gradual relief of leg symptoms as the pain focuses in the spine; gradually, the spinal pain disappears. This phenomenon is called centralization.

McKenzie wrote a short workbook for patients explaining this technique called "Treat Your Own Back", which is available from many Internet suppliers. It is important to remember that this technique is not a cure-all for everyone with back symptoms, but it is generally effective for many back pain sufferers.

I would also recommend being extremely observant for loss of muscle mass in the legs and feet (a problem called atrophy, a sign of nerve degeneration), numbness in the groin and inner thighs on both sides (called saddle paresthesia), dragging of the foot (drop foot), or loss of control of bowel and bladder function. These can be symptoms of cauda equina syndrome, severe compression of the nerve endings at the base of the spinal cord, which is a medical emergency and which generally requires emergency neurosurgery.

I hope this helps to answer your question. I wish you the best of luck and hope you experience a successful recovery.