Back pain, leg pain, numbness, tingling, itching. Should I expect symptoms to worsen post epidural steroid injections?

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Posted on Fri, 29 Jun 2012 in Brain and Spine
Question: I have been treated for lower back pain for the last year and received treatments including facet injections, trigger point injections, RF nerve ablations all along L3-S1. I was most recently diagnosed (2+ months ago) with a herniated disc S1/L5 after a CT scan was ordered as my pain was only getting worse and started to have nerve issues.. Recent treatment included epidural steroid injections and just finished the third round last Wednesday which took place over a 4 week span. 5 weeks ago I had an nerve study done which was positive for nerve damage.
I have had lower back pain and severe leg pain, burning, XXXXXXX ache, numb/tingling, itching sensations in my left leg, buttock, and pelvic region for several weeks. My concern is that yesterday the nerve pain/symptoms and lower back pain has gotten significantly worse and my current medications are not covering the pain. I have noticed extensive weakness and the numb feeling in both my legs vs. only the left leg. Should I expect my symptoms to get worst 4 days post injection or should I have some pain improvement by now. I am not sure what the next step should be and my biggest concern is the nerve damage/pain and want to avoid long term damage to the nerves. I'm not sure if it's time to move from my spine specialist to a neurologist and if the damage to my nerves is reversible. I am desperate to have pain relief but afraid of the potential risk of surgery. What is a reasonable amount of time to wait?
doctor
Answered by Dr. Shiva Kumar R 2 hours later
Hello,

Thanks for the query.

From the description it looks like you are suffering from slip disc in the back with compression of the spinal nerves exiting the spine.

Epidural steroid injections would be of benefit to reduce the pain and would act as early as 24-48 hours of the injections. If the pain does not respond to the medications and epidural injections, possibility of the nerve compression is high and required immediate nerve decompression to avoid further damage and worsening of symptoms.

Magnetic resonance Imaging (MRI) is superior to Computed Tomography (CT) scan for the compression of the spinal nerves due to slip disc. So I personally feel to avoid further nerve damage, surgical possibility needs consideration.

So I personally recommend you to XXXXXXX a Neurologist for a good physical examination and consultation followed by MRI of the Lumbo Sacral spine. If confirmed, possibility of decompression would be the ideal option of treatment in you.

Let me know if I have missed out any other concern in your question.

Yet again, I duly appreciate your query to me, I do hope that you have found something useful to help you and I shall be glad to answer any further apprehensions.

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Shiva Kumar R 1 hour later
Dr. XXXXXXX
Thank you for your response. I appreciate your recomendation to see a neurologist. My follow up question is: since I have a pacemaker I am unable to have a MRI. Would the prior CT scan and the EMG/NCS results be enough to determine if surgery is the reasonable next step or should I have/request any other testing? I was not able to have a complete EMG/NCS due to the pacemaker but was told by the technician that there was sufficient data to confirm nerve involvement. Would you advise having an additional CT scan done?
doctor
Answered by Dr. Shiva Kumar R 4 hours later
Hello,
Thanks for the query.
I understand your concern.

Since we would be unable to do a magnetic resonance imaging scan (MRI scan), good clinical examination along with a computerised tomography scan (CT scan) and electroneuromyography (ENMG) is sufficient to confirm the diagnosis and proceed with the surgical option. I advise you to have a repeat scan done before you proceed for the surgery after consulting your neurologist.

Take Care,

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist
Above answer was peer-reviewed by : Dr. Aparna Kohli
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Dr. Shiva Kumar R

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Practicing since :2001

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