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HomeAnswersNeurologyneuaropathic pivdI am suffering from disc herniation and sciatica. What to do?

What does herniation and extrusion of the inferior disc on the MRI suggest?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Hitesh Kumar

Medically reviewed by

iCliniq medical review team

Published At April 28, 2023
Reviewed AtOctober 12, 2023

Patient's Query

Hi doctor,

I am a 65-year-old female. My height is five feet and eight inches and I weigh 150 lbs. My MRI result shows a small left central broad-based disc herniation and inferior extrusion. I have pain in the sciatic nerve (hip to the knee). If I sit too long it hurts. I have had this feeling for a few months. I have pre-existing high blood pressure, and I take Losartan 50 mg daily.

Thank you.

Answered by Dr. Hitesh Kumar

Hi,

Welcome to icliniq.com.

I would like to know some details about your symptoms:

1. Since when you started to have this pain?

2. Do you also have lower back pain?

3. The pain which you mentioned from hip to knee is on the front side of the thigh or the back side of the thigh?

4. Apart from sitting, does this pain occur in other positions like standing, walking, bending forward, turning in bed, coughing or sneezing, or something else?

5. How is your sleep pattern, do you get sleepy quickly after lying in bed? Do you have frequent awakenings in sleep? Does this pain disturb your sleep?

6. Are you taking any medicine for this? If yes, please tell medicine names, their dose, and timings.

7. What type of pain do you feel stretching, current sensation, heaviness, burning, pins and needle sensation, or something else?

Investigations to be done are

1. Serum vitamin D3.

2. Serum vitamin B12.

3. T3, T4, TSH (Thyroid-stimulating hormone) test.

Preventive measures are

1. Use of lumbar belt.

2. Avoid forward bending and weight lifting.

3. Physiotherapy for lower back (only under the guidance of the physiotherapist).

Regarding follow up revert to the above-mentioned information for better understanding and further judgment.

Thank you.

Patient's Query

Hi doctor,

Thank you for your answer.

The pain started a few months back. Sometimes I have lower back pain usually on the back side of the thigh. I cannot stretch all the way down as I used to. It is hard to fall asleep. When I am sleeping the pain does not bother me because I use a pillow underneath my knees. The pain feels sometimes feels like a needle sensation or burning sensation.

Thank you.

Answered by Dr. Hitesh Kumar

Hi,

Welcome back to icliniq.com.

As per your description, there is likely possibility of this pain be radicular pain from lumbar PIVD (prolapsed intervertebral disk).

Investigations to be done is

1. Serum vitamin D3.

2. Serum vitamin B12.

3. T3, T4, TSH (thyroid stimulated hormone) test.

4. Nerve conduction study bilateral lower limbs.

Differential diagnosis is PIVD L4-L5, L5-S1 with Lumbar radicular pain.Treatment plan includes medications: Gabapentin or Pregabalin, Nortriptyline, and muscle relaxants like Tolperisone or Eprisone may be effective for pain relief along with physiotherapy of the lower back. For an exact prescription, I would suggest you to meet your doctor. Also, one needs to consult a neurosurgeon or spine surgeon to have a look at MRI images for decisions regarding any need for surgical procedures in the spine or not.

Preventive measures to be taken are

1. Use of lumbar belt.

2. Avoid forward bending and weight lifting.

3. Physiotherapy lower back - only under the guidance of a physiotherapist.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Hitesh Kumar
Dr. Hitesh Kumar

Neurology

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