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Suggest Treatment For Sciatica In Buttocks And Pain In Leg
Question: Doctor, I am 68. 5'6" 180, and one month ago I developed bad sciatica in both buttocks and pain down left and primarily right leg into the calf. I have taken meloxicam and Tramadol for 1 month....plus ice....and I am still walking on the indoor walking track. . I had a round of steroid pills....They helped a lot but the pain returned but not as bad..... I met with a doctor who ordered an MRI. It said : (quote)
L3-4
There is a minimal concentric disc bulge with a new superimposed small broad based right paracentral disc protrusion that does not cause nerve root impingement. Facet arthropathy is minimal . There is no spinal canal stenosis. No significant neural foraminal stenosis is seen
L4-5.. There is a mild concentric disc bulge with a superimposed small central disc protrusion. There is suggestion of a crescentric band of overlying extruded disc material. This measures 14x3x7 mm and there is indentation of the left ventral aspect of the thecal sac with probable impingement upon the descending left L5 nerve root. The lateral recesses are narrowed and spinal canal stenosis is moderate to severe with contribution from severe bilateral facet arthropathy and moderate ligamentum flavum thickening. Fluid is noted in the facet joints and there are bilateral extraspinal facet synovial cysts inferiorly. There is mild right and mile to moderate left neural foraminal stenosis.
L5-S1--There is minimal concentric disc bulge. Bilateral facet arthropathy is moderate to severe. No spinal canal stenosis is demonstrated. Proximal right neural foraminal stenosis is minimal...
My question to you is this.....The doctor recommended an epidural steroid injection in the lumbar. It was scheduled for September 30... Within the past week, I have really improved. It doesn't hurt me to sit, walk or stand. It primarily hurts when I bend over at the waist..... and it hurts for about 20 minutes when I get up out of bed in the morning. I would like to postpose the injection ( ESI) and wait until IF I get worse or digress. My pain level is good now....Im taking the Meloxicam (7.5 mg) and Tramadol 25 mg (half the regular dose) every day....I avoid bending over and lifting over 10 lbs.What do you think???
L3-4
There is a minimal concentric disc bulge with a new superimposed small broad based right paracentral disc protrusion that does not cause nerve root impingement. Facet arthropathy is minimal . There is no spinal canal stenosis. No significant neural foraminal stenosis is seen
L4-5.. There is a mild concentric disc bulge with a superimposed small central disc protrusion. There is suggestion of a crescentric band of overlying extruded disc material. This measures 14x3x7 mm and there is indentation of the left ventral aspect of the thecal sac with probable impingement upon the descending left L5 nerve root. The lateral recesses are narrowed and spinal canal stenosis is moderate to severe with contribution from severe bilateral facet arthropathy and moderate ligamentum flavum thickening. Fluid is noted in the facet joints and there are bilateral extraspinal facet synovial cysts inferiorly. There is mild right and mile to moderate left neural foraminal stenosis.
L5-S1--There is minimal concentric disc bulge. Bilateral facet arthropathy is moderate to severe. No spinal canal stenosis is demonstrated. Proximal right neural foraminal stenosis is minimal...
My question to you is this.....The doctor recommended an epidural steroid injection in the lumbar. It was scheduled for September 30... Within the past week, I have really improved. It doesn't hurt me to sit, walk or stand. It primarily hurts when I bend over at the waist..... and it hurts for about 20 minutes when I get up out of bed in the morning. I would like to postpose the injection ( ESI) and wait until IF I get worse or digress. My pain level is good now....Im taking the Meloxicam (7.5 mg) and Tramadol 25 mg (half the regular dose) every day....I avoid bending over and lifting over 10 lbs.What do you think???
Brief Answer:
Continue medications and physiotherapy
Detailed Answer:
Hello Dear,
I have gone through your question and MRI reports.
The decision for any intervention depends upon clinical symptomatology and pain.
As you are improving with physiotherapy , medicines and back posture care you may consult the treating neurologist/Neurosurgeon regarding postponement of epidural injections.
My opinion will be the postponement until you face any worsening.
Hope you recover early.
wishing you good health.
Regards
Dr Neeraj XXXXXXX
Neurologist
Continue medications and physiotherapy
Detailed Answer:
Hello Dear,
I have gone through your question and MRI reports.
The decision for any intervention depends upon clinical symptomatology and pain.
As you are improving with physiotherapy , medicines and back posture care you may consult the treating neurologist/Neurosurgeon regarding postponement of epidural injections.
My opinion will be the postponement until you face any worsening.
Hope you recover early.
wishing you good health.
Regards
Dr Neeraj XXXXXXX
Neurologist
Above answer was peer-reviewed by :
Dr. Raju A.T
Doctor, may I follow up
Other than pain treatment, would there be any other reason to do the ESI now. Any other reason to do it....therapudic or otherwise?
Other than pain treatment, would there be any other reason to do the ESI now. Any other reason to do it....therapudic or otherwise?
Brief Answer:
Epidural injections are for pain management in lumbosacral root pain
Detailed Answer:
Hello dear,
The main reason for epidural injections is to reduce pain and some associated inflammation of nerve roots.
The pain if responded can be managed conservatively at present.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Epidural injections are for pain management in lumbosacral root pain
Detailed Answer:
Hello dear,
The main reason for epidural injections is to reduce pain and some associated inflammation of nerve roots.
The pain if responded can be managed conservatively at present.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Above answer was peer-reviewed by :
Dr. Prasad
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