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Have pain of sciatica and the pins and needles sensation. Is this related to the mild nerve impingement?

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Orthopaedic Surgeon
Practicing since : 1994
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My MRI May 24, 2012 showed herniated disc at L4, impingement on L4 nerve, and bulge at L5. I have had sciatica in left leg, pins/needles in left plantar heel, and 5 days ago started having sciatica to right buttocks. I also have pain to left and right groin area. As well as weakness in left leg, intense lower back pain, sexual dysfunction, left foot drop since May, and coccyx pain that started about one month ago. Saw the orthopedic surgeon XXXXXXX 11th, ordered ESI, that was done in September, seemed to aggitate symptoms for 10 days and brought no relief. Saw surgeon again Sept. 17th, ordered PT for core strengthening exercises and an EMG. I am in the middle of PT, and EMG is scheduled for next Wednesday, Oct. 17th. My PT believes I need surgery. I have to agree. This injury is a result of a work related injury on January 16, 2012. My fear is permanent nerve damage. Question: how long can I have nerve impingement before permanent damage occurs? My surgeon says the MRI does not match the symptoms I am describing, why?
Posted Thu, 1 Nov 2012 in Bones, Muscles and Joints
Answered by Dr. Praveen Tayal 5 hours later
Thanks for posting your query.
The pain of sciatica and the pins and needles sensation can be related to the mild nerve impingement that you are having at the level of L4.
The weakness in the leg, sexual dysfunction and foot drop cannot be explained by mild nerve impingement at L4. The level of affection of nerve at L5-S1 is more likely. Further investigations like EMG are needed to find out the exact cause and site of nerve compression before deciding for surgery.
Taking a second opinion from a neurologist will be helpful. You can continue with the physiotherapy till then and see if it helps with some improvement.
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.
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