Left Sciatica

In this video Dr. Castanet will show you the lumbar MRI findings of a rheumatologist he treated for left-sided sciatica 6 years ago. This doctor has done fine for 6 years and had a recent recurrence, so he is returning for treatment.

This MRI scan looks reasonably good for a 78-year-old man. He has two disc problems, and a modest spondylolisthesis of L5 on S1. He tells me that he probably aggravated his problem by lifting his grandchild last weekend. Will I get new lumbar spine imaging of his spine before I treat him? No. The MRI from 6 years ago tells me about his general anatomy. Sure, he may have had some appreciable progression of his degenerative changes, but that is not certain, even after 6 years. And he does have one “red flag” risk factor, i.e. his age, which makes it more possible that his pain is arising from a malignant cause. But neck and back problems are usually benign, and, since his complaint seems to be the same as before, I will treat him without new imaing. But he must improve quickly to affirm this is just a benign recurrence of his left sciatica, or I will refer him for a new MRI scan.

Left sciatica

His two disc problems are relatively mild. He does have a slight extrusion at L4-5, which you will see. I will also point out his multifidus muscle atrophy, which is common in chronic low back pain, and also a common senescent feature, even when one does back strengthening exercises.

Upon my review of his last treatment series, I noted that he needed 15 treatments, six years ago, to get over his sciatica. The number of treatments can vary considerably, from 4-8 on the short-end, to 20+ on the long end. These kinds of problems are slow to occur, and can be slow to improve. You just have to be patient with the healing process. But I will note that improvement usually starts with the very first treatment, and if someone does 20+ treatments, its because they improved from the outset, but it just took many treatments.

If I can help you with your back or neck problem, please call me at 404-558-4015.