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Suggest treatment for radiating pain in lower limb

Answered by
Dr. Vaibhav Gandhi

Orthopaedic Surgeon

Practicing since :1998

Answered : 5165 Questions

Posted on Wed, 13 Aug 2014 in Back Pain
Question: Hi Dr,
I am 26 year old female, who has been experiencing pain for about five months now. In feb 2014, I had a kidney stone in my left kidney- which did not pass normally and I had to get a surgery to get it removed (cystoscopy with ureteroscopy with stent placement).10 days after my surgery (2 days after stent removal)- I started having pain in my buttock (on left side) and my left leg. At that point, any more kidney stones were ruled out- and dr told me i might have a pinched nerve in my back. So i went to see a orthopedist- who did an MRI and told me I have a bulge in my disc L4-L5 and L5-S1- 2mm each. Dr said that it might be pinching on my sciatic nerve causing the symptoms. He told me it should get better overtime with physical therapy and movement. But 5 months later I am still suffering with pain- I experience aches and pain in legs all the time- i cant walk much, my legs feels like i have walked miles even after i go for short walk inside the house.

About 1.5 month after initial pain, one night i started feeling pain in my right leg too. So for no new reason- i started having pain, burning and tingling sensation in both of my legs. Over the last month, I have also noticed stiffness in neck and pain in arms occasionally too.

One thing that I did notice which dr could not provide any explanation for is that- pain either occurs in my arms or legs in one time- if it is happening in my arms- it doesn't happen in my back, if it happens in my legs- it doesn't happens in my arms- seems like pain travels between my legs, back, arms, and neck- but mostly the trouble is in my legs.

So presently my pain is mostly in my buttock and legs- left leg being worse and constant tingling under the foot. I had all kinds of blood tests- with most tests negative except EBV and tested positive for mononucleosis in april.
From my symptoms- I am confused what I might it a possible neuropathy from mononucleosis? Is it sciatica? or is it back issue causing problem? is it pinched nerve possibly caused by my surgery? or fibromyalgia- I get a different answer from every Dr- so i am confused.
I have done 5 months of PT, tried chiropractor, acupunture, nothing helped.
Tried neurontin- had allergic reaction to it. Tried cymbalta and lyrica- didnt help.
Now taking elavil-which help very slightly.
Can you give me some advice- what I need to do? or what could help me?
Answered by Dr. Vaibhav Gandhi 42 minutes later
Brief Answer:
Lower limb pain can be due to sciatica.

Detailed Answer:

I have studied your case and reports.

Lower limb pain can be due to sciatica.
Your MRI says foraminal protrusion causes bilateral neural foraminal stenosis which leads to compression of exiting nerve root which later on supply both lower limb [leg].Due to compression of this nerve root there is radiating pain in your leg.

Medication like methylcobalamine with neurotropic like elavil which you are taking will reduce pain

I will advise to check your vit B12 and vit D3 level.

Epidural steroid shot will help you.
Cause for your upper limb pain can be due to neuropathy.
You may need to do EMG –NCV nerve conduction study if required after clinical examination.
Pinched nerve may not be related to your surgery.

You also need to work on how you are suffering from so many problems at early age
What is your body weight? What are your food habits?

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Take care.
Dr Vaibhav
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
Follow up: Dr. Vaibhav Gandhi 9 hours later

thanks for your reply.

following up on my question.

Before all this happened- I was very active person, also eating healthy.

I weigh 117 lbs and i am 5'2" tall.

I used to exercise 3-4 days a week.

I did had one epidural shot in april 2014- which didn't help much.

My vitamin b12 level was in 500's- I am taking supplements for b12

My vitamin D levels were fine- 31.4

what would be my options at this point? since i have been suffering from this for 5-6 months without relief? - would surgery be an option? or I should try something else first?
Answered by Dr. Vaibhav Gandhi 8 hours later
Brief Answer:
Explained below

Detailed Answer:

Thats good that your B12 and Vit D are with in normal range.

I will advise local lumbar root block under c arm guidance before going for surgery.

Also spine extension exercises will help.
Many of my patients get relief by yoga pranayama and XXXXXXX XXXXXXX so you can also due that.

If no relief then you can go for surgery.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.


Dr Vaibhav
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Vaibhav Gandhi 1 hour later
just to follow up on your reply!

is lumbar root block same as epidural shot? I had an epidural shot in april- at two levels L4-L5 and L5-S1- i did not had immediate relief- but overtime the pain in my leg turned from sharp shooting pains to achy pain.

Should i opt for another epidural? My physician currently keeps on sending me to physical therapy- and has not given me option of surgery

currently my legs feel more achy all the time- like I have done intense workout and it feels like that all the time.

I have tried yoga generally- but i can ask my yoga instructor particularly about these exercises.

If I do opt for surgery- what kind of surgery would it be? would it involve taking out disk bulge? spinal fusion? I would like least complicated way?

Is surgery something I should opt for since i have suffered from these pains for almost 6 months.

Answered by Dr. Vaibhav Gandhi 46 minutes later
Brief Answer:
Explained below

Detailed Answer:
Hi again,

Epidural shot is different from lumbar root block.

You can take another shot consulting your doctor.As per your statements previous shot might be lumbar root block.

You can ask your yoga instructor to focus on spine extension exercises.

You may not require spinal fusion only fenestration laminectomy with discectomy will help along with foraminotomy will help.This may not involve much complication.

But keep in mind spine surgery is major surgery and be aware of complication before opting that.

Decision for surgery is taken after clinical examination and patients response to treatment.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.If you find this answer helpful you can rate at end of discussion.

Take care.
Dr Vaibhav Gandhi
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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