Could L5/S1 disc protrusion cause weakness in legs AND arms?

April 2, 2016 4:55 PM

I've been having issues with weak and rubbery legs, numbness in my feet, hands and face, and my feet flushing very red when I stand. (Previous comment with more detail about my history. I've been taking Lexapro since then and the anxiety has improved.) My spinal MRI came back with the note, "Left L5-S1 disc protrusion possibly traversing left S1 nerve roots." My research suggests an L5-S1 problem could explain my rubbery legs and foot numbness, but could it explain the arm weakness and numbness in my face, hands and feet?

The neurologist added the note that I showed "normal wear and tear arthritis." I have a nerve conduction test coming, and I think they're waiting for those results before they diagnose anything. In the meantime I'm left with this leg and arm weakness that varies quite a bit (from barely there to nearly disabling) from hour to hour, and numbness that also varies and jumps around in my face and extremities.

I know YANMD, but I'm trying to figure out how much this L5/S1 thing might be responsible for. The "normal wear and tear" thing makes me suspect my neurologist will say it's a rather minor problem, maybe that she'll say it's borderline I have a problem at all. Or maybe she'll say it explains everything and I need emergency surgery. I guess I'll find out.

I have scoliosis and every three years or so I throw my back out. A few months ago I threw it out in a way that felt different, so the pain throbbed down the back of my legs. That sounds like classic sciatica, which would fit this L5/S1 business. But that pain got 100% better after 10 days or so, and since then I've had little to no back or leg pain. But a few weeks ago I was hit with the sudden rubbery legs for an hour or so, it got better, then came back about a week later and has been with me ever since.

Obviously I'll take whatever I can get in terms of armchair diagnoses, likely treatments and outcomes, hope, etc. But my real question is: If we assume this L5-S1 issue is causing me symptoms, how much might it explain? Could this all be from that, or would it be more likely I've got a bunch of unrelated things happening?

posted by Ursula Hitler to Health & Fitness (13 answers total)

IANAD but I read a ton of back and neck injury medical records for my job. Your lumbar disc protrusion could cause leg and foot symptoms, but not symptoms in your arms or face. Arm and hand symptoms can be a result of a cervical spine injury, but not lumbar.
posted by amro at 5:02 PM on April 2, 2016

I had surgery for a lumbar disk that was causing extreme pain and numbness in my right leg and about a year later I had numbness in my right arm but my surgeon said that they were totally unrelated except for the fact that my entire back is over fifty years old. I managed to cure the issue with my right arm with physical therapy and exercise in a few months.
posted by octothorpe at 5:12 PM on April 2, 2016

Response by poster: It does seem unlikely it could all be one deal. But whatever this is, it all sure feels connected. It all tends to get better and worse at the same time. They said my cervical/skull MRIs looked clear, and saw no sign of stenosis anywhere.
posted by Ursula Hitler at 5:19 PM on April 2, 2016

i'm sorry you're going through this. there are TONS of people with weird disc anomalies that they don't know about because they never cause them trouble. IANAD but i have seen lots of people try to explain their pain with an MRI showing disc bulges etc. Just remember that correlation is not causation.
Sensory nerves in your body that are affected present as a zinging sensation (that sciatica back-of-the-leg feeling you had was almost definitely nerve-related, possibly because of a disc bulge, possibly for an unrelated reason) but not this other stuff, definitely not because of L5-S1 disc bulge.
your symptoms SOUND at least partially vascular (muscle weakness when walking is often a lack of blood to the muscles, the legs often also feel very heavy and sluggish), but the blood vessels could even be in vasospasm (contracted, not letting much blood through, turning your extremities white and then flushed with blood, it can be painful). I wonder what the patches of numbness look like. obviously a doctor who you could see in real life is better than internet strangers, but you sound like you have seen several doctors. if you feel like googling Raynaud's disease, that might give you some pictures to compare against what is going on in your own body. Raynaud's is an auto-immune thing; the more stressed (or cold) you are, often, the worse it is. Does it change with temperatures or stress? (worse in cold or extreme temperatures, or when things are going particularly badly, in a general sense?)
i don't think there's a scientific test for vasomotricity but i would be glad to be wrong, and i certainly don't know everything there is to know about Raynaud's but google around and see if it's worth talking to your doctor about. Good luck!
posted by andreapandrea at 6:24 PM on April 2, 2016

No, lumbar and sacral protrusions cannot affect your hands or face. Yes, they could affect your legs and feet.

MRIs don't always pick up on back issues that are causing pain and numbness.

NOT offering this as a diagnosis, but you mention you are taking Lexapro. For some people, Lexapro has quick-onset withdrawal symptoms (quick as in, they can show up if you are a few hours late taking your meds) that include sporadic face and hand tingling.
posted by moira at 6:29 PM on April 2, 2016

don't know if this helps, but when i went to a doctor with various strange problems in hands and feet, i tried to understand the mri report (which mentioned some disc problem) and completely missed the important detail. so be careful about picking and choosing which details you focus on (especially if you're older - my doctor often pauses then says, oh, but you're old, that's normal....). i've since had regular mris that report piles of terrible sounding but irrelevant stuff. likely your doctor was looking for some specific problem.
posted by andrewcooke at 6:47 PM on April 2, 2016 [1 favorite]

Response by poster: Don't mean to threadsit, but:

My feet turn red/purple when I stand (or sit, with my feet down) but the color returns to normal when I put them up or walk. There is a swollen, sunburn-y feeling occasionally, but they never turn pale. Temperature doesn't seem to have any effect. Sometimes my arms seem a bit red maybe, but I can't say for sure if that correlates with the numbness.

I started taking the Lexapro just recently, after all this started.

I think you guys have basically answered my main question, and it's unlikely to be the L5/S1 causing all these problems. My guess is there's something up with my blood flow making my system go haywire, and the L5/S1 thing is just the MRI catching a problem that caused sciatic pain recently but probably isn't causing this sudden weakness in my arms and legs now. I had an echo recently and that apparently came back OK (they didn't give me details) and I'm waiting on Holter monitor results.
posted by Ursula Hitler at 7:13 PM on April 2, 2016

I have had fusions of both the lumbar spine and the cervical spine. IANAD. The arm and leg symptoms are unrelated. L5-S1 is a very likely cause of your leg pain and numbness. The arm can be any number of things including a disk issue in the cervical spine or a pinched nerve. I found terrific relief with my fusions/surgery, but I am not qualified to recommend it to you or for you. If you were me, I would have an MRI of the cervical spine to see if anything can be ruled out or in. Are you in the normal range for your height and weight? Overweight can cause all sorts of stress on your spine and can probably affect a lot of your systems. I know for me, when I lost 50 pounds, many of my spine issues were either mitigated or relieved.
posted by AugustWest at 8:22 PM on April 2, 2016

I've thought for a while now that a CSF leak could be at the root of many of your symptoms, yet since a crash sank a raft of my bookmarks a couple of years ago, I haven't had useful pages to point to.

But Googling "csf leak pots" just now, a very interesting UK site popped up, and there are a few items from their symptom page which remind me of things you've said about yourself here, and that I remember from past questions:

CSF leaks, which normally lead to Intracranial Hypotension (loss of CSF pressure and volume in the cranium), can result in a wide range of symptoms; some are primary symptoms, some secondary. Many of the symptoms can be debilitating and have a significant impact on the sufferer’s quality of life and ability to work.

Typically, a variety of symptoms will be experienced by suffers and few people will experience identical symptoms. It is rare that only one symptom will be present, although not unheard of. There can be a slight difference between the range, combination and severity of symptoms experienced by spinal and cranial leakers.

...

Facial

Facial numbness
...

Back, Neck & Limbs

Neck pain and stiffness
Back pain (area-specific and general)
Tingling sensations and spams in the spine, back, arms and sometimes legs

Other Symptoms

Rapid heartbeat, particularly when sitting or standing
Nausea and, in extreme cases, sickness
...

Cranial Leak-specific

Fluid discharge from ears, nose and to back of throat
...

A key characteristic of most of the above symptoms is that they are generally orthostatic. That is to say that they occur principally when standing, but are significantly relieved, sometimes even relieved in their entirely, when lying down.

Symptoms may present themselves immediately upon sitting or standing, or increase gradually over a period of time. A common pattern with many CSF leak sufferers, particularly those with a small or intermittent leak, is that symptoms may only become noticeable or severe later in the day.

Many CSF leak symptoms are common characteristics of other headache disorders, such as migraine, acute sinusitis, severe tension headache and post-traumatic headache. Research shows that these similarities routinely result in the misdiagnosis of a CSF leak.

The orthostatic characteristic is, however, a key indicator of a CSF leak and whenever this is present, a CSF leak should not be ruled out. Due to the perceived rarity of this condition and the lack of diagnosis experience in GP surgeries and A&E wards, it may be necessary for those experiencing CSF leak symptoms to specifically raise it as a possibility with their GP or emergency medicine practitioner.

I haven't had a chance to look for support for this on the CSF Leak site, but I think anxiety is another key feature of CSF leaks because CSF is under slight pressure in your brain and spinal cord, that pressure seems to be maintained by a slightly higher level of dissolved CO₂ in CSF, but when there's a leak it would be helpful to reduce that pressure to reduce the volume of the leak and to give any lesions a better chance to seal themselves, and anxiety serves this end because anxious breathing reduces CO₂ in the blood and, in turn, the CSF.

And I don't know whether this applies to you at all, but CSF leaks are much more common among people with any kind of hypermobility than among the general population.
posted by jamjam at 10:06 PM on April 2, 2016

Have you had your B12 levels checked?
posted by fshgrl at 11:14 PM on April 2, 2016

I think someone mentioned this above - but disc protrusions are not necessarily the cause of any of your problems. Most people above a certain age have disc protrusions, and it's a convenient thing to find and blame for your symptoms, but may not be the cause of even the leg symptoms at all. Especially if you're getting the arm and leg symptoms at the same time.
posted by amro at 4:52 AM on April 3, 2016

Have you ever been tested for Ehlers Danlos Syndrome? There's some overlap with POTS, and a significant overlap with anxiety disorders, especially panic (see this post and discussion on the Blue, and comments). EDS can have neuro symptoms, including peripheral neuropathy. EDS is one of those things many doctors are not going to be interested in looking at, though, be warned :/

My feet turn red/purple when I stand (or sit, with my feet down) but the color returns to normal when I put them up or walk.

I still think the tamsulosin is doing something funky, maybe aggravating existing POTS-related problems. (so much NAD, obviously.)
posted by cotton dress sock at 6:10 PM on April 3, 2016

Response by poster: Whew, I was away for a day and you folks gave me a lot to think about. One of the frustrations in all this is that there are many, MANY possible illnesses to ask my doctors about. At this point I don't know what my neurologist or cardiologist are thinking. They've gone quiet while we wait for the EMG/nerve conduction test.

I can say that while I've had bad headaches over the years, it's been a while since they were a big problem. I also don't have hypermobile joints, or saggy skin. I am wondering about adjusting my meds, just to see if that helps.
posted by Ursula Hitler at 7:14 PM on April 3, 2016