What are the treatment options for left leg sciatica?

Question

Hi doctor,

I have left leg sciatica. There is no back pain, but there is a referred pain down to the heel. I have recurring flare-ups once every six to eight months. I am currently taking Advil 3200 mg per day and ice. I feel great once the Advil kicks in. I got a selective nerve block on L5-S1 two months ago, and it did nothing for me. I cannot do anything during the period of flare-up. I am 46 years old and in great shape. I had an MRI (Magnetic Resonance Imaging) of my lumbar spine without contrast.

The findings are as follows:

The vertebral bodies are of normal height and marrow signal intensity. Small hemangioma noted within the posterior aspect of L5.
The spinal cord is normal in morphology and signal, and the conus medullaris terminates at L1. L1-L2 and L3-L4, there is neither central canal narrowing nor neural foraminal stenosis.
There is mild facet arthropathy.
The impression was L4-L5 paracentral and posterolateral disc protrusion.
This preferentially narrows the left lower recess and abuts the descending left L5 nerve root. L5-S1 broad-based left posterolateral disc protrusion.
This preferentially narrows the left lower recess and abuts the descending left S1 nerve root.
Mild to moderate central canal narrowing at L3-L4 secondary to a diffusely bulging disc.

I am afraid that surgery (discectomy) will not fix it, as this recurs. What is your opinion, doctor? I was a geriatric speech pathologist (retired), so I know it is difficult to say without seeing the patient and how they present.

Please do your best.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your symptoms. Before we go ahead and discuss the MRI, I would like to know some more clinical details. You said pain in the left leg. I would like to know which aspect of your leg it is. Is it in the inner part, outer part, front, or back of the leg?

The exact location will give us a clue about which nerve root is compressed. Are you able to perform heel walking and toe walking? If you have not done it, please do it now, and let me know if you find it difficult. The above clinical information is very important in sciatica. If we go by radiology alone, I mean MRI alone, then we get an impression that so many nerve roots are compressed, but it is not so in reality.

Your MRI (magnetic resonance imaging) (attachment removed to protect patient identity) shows degenerative changes in your lumbar spine, and the changes are quite significant. The maximum changes are at the L4-L5 and L5-S1 levels. The disc is bulging, and the exiting nerve roots are displaced due to the disc bulge.

The other changes are joint hypertrophy, which is normal with age. About recurrence, let me tell you disc disease is known to come in episodes. But once you get the disc removed surgically, it will not recur at that level. If you do not follow the exercises and postoperative precautions, you may have a recurrence at another level.

About medicines, I am really scared that you are taking a really high dose of Advil (Ibuprofen). The long-term usage of this high dose can create other problems. Please discuss with your doctor.

I hope this helps you.

Thank you.