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Diagnosed with sciatic nerve compression. MRI scan of lumbar done. What does the report suggest?

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Orthopaedic Surgeon
Practicing since : 1994
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I need help reading an MRI
Hi, I recently had a baby, XXXXXXX 5th 2012, a csection had been scheduled later that day as my previous baby had to be delivered csection for failure to descend, however the baby came early that morning, and i delivered him was not a long labor, 2 hours at most. i pushed while on my back, and did have my legs in stirrups, not sure how long. After the anesthesia/epidural wore off, I no longer could lift my foot, foot drop. I was seen by a neurologist and physical therapist while still at the hospital, both stated my prognosis was good, nuerologist suspected it was "sciatic nerve compression" and asked to see me in 4 weeks for follow up. since then I have had an MRI/lumbar without contrast completed, the findings which I am inquiring about are the following:

L4-5: Normal sagittal plane alignment with 2.5mm AP dimension broad based disc herniation. More focal left posterolateral disc herniation of 3 mm in AP dimension with abutment of the extraforaminal left L4 nerve root. No significant foraminal stenosis. Small bilateral facet joint effusions.

L5-S1: Normal sagittal alignment. 2.5 mm in AP dimension broad based disc bulge with abutment of the S1 nerve roots in the lateral recesses. No significant foraminal stenosis. No abnormalities identified along the course lumbosacral plexus on the sagittal images.

Lastly, I saw two nuerologists who conducted two separate EMGs. The first reported abnormal study, the electro physiological findings are most consistent with a subacute left l5 lumbosacral radiculopathy. No evidence was found for plexopathy, peripheral nueropathy, or peroneal entrapment at the fibular head. he suggested back surgery.
The second neurologist stated it was a compression at the peroneal nerve and did not recommend surgery.

I have seen improvement in the use of my leg since I left the hospital. The numbness has decreased somewhat, I can lift my toes, point my toes down, outward, and slightly inward. I can bear weight on the ankle, climb stairs. Please tell me that this condition will go away on its own. Im really nervous, and I wont see the orthopedic for followup for another couple of weeks.
Posted Fri, 3 Aug 2012 in Bones, Muscles and Joints
Answered by Dr. Praveen Tayal 31 minutes later
Thanks for posting your query.
Your MRI findings are suggestive of a lumbosacral radiculopathy causing the symptoms. Surgery is not the first line treatment and is not immediately needed.
Medicines are the first line treatment along with physiotherapy. If the patient responds well with medicines then physiotherapy helps in preventing further progression of the problem. Surgery is kept as a last resort to improve the quality of life of the patient. Most of the times complete recovery takes 5-6 months.
The main treatment of such problem is bed rest along with pain killers and methylcobalamin supplements. You can get these prescribed from your orthopedician.
Doing regular physiotherapy will help in decompression of the nerve. Epidural steroid injections have been used if oral pain killers are not very effective. Discuss with your orthopedician and an appropriate treatment can be planned depending on the response to medical drugs.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Dr. Praveen Tayal.
Above answer was peer-reviewed by
Follow-up: Diagnosed with sciatic nerve compression. MRI scan of lumbar done. What does the report suggest? 52 minutes later
Dr. Tayal,
I thank you for your response. Above you stated "further progression of the problem". Does this mean that without surgery , I won't be able to fully recover? I have seen improvement since the day I left the hospital. However I am very worried of permanent nerve damage. Thank you again for your time.
Answered by Dr. Praveen Tayal 7 hours later
Thanks for writing again.
You can have a complete recovery without the surgery also. Timely and regular physiotherapy stops any further deterioration and helps in improvement. There is no permanent nerve damage involved.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Above answer was peer-reviewed by
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