Left sciatica

In this video by Dr. Castanet, he’ll show you the lumbar MRI scan, and share with you, the clinical history of this young man who is suffering from left sciatica. Recall that sciatica is pain that radiates down the buttock, back of the thigh, back of the leg, and into the foot, or any part of that distribution. Sometimes, if the pain is not radiating beyond the buttock or thigh, clinicians may not call it sciatica, and may just consider it referred pain, rather than radicular or a pinched nerve, i.e. sciatica.

As you’ll hear this young man has done treatment intermittently for the last 10 years, with reasonable relief. Now he may want to try some injections with a pain management group, and physical therapy with a local physical therapist. I think those are fine ideas. It is definitely not the first approach to treatment that I would recommend, but that is what he wants to try, so I will make the referrals.

On this MRI scan you’ll see three herniated discs, two of which are relatively mild, and a larger one, the culprit of his pain, at the L4-5 level, on the left side, which correlates with, and explains his pain.

After he gets to see how much, or how little, physical therapy and injections help him, I will discuss with him how to deal with these problems, long-term, through some combination of approaches. He may also opt for a lumbar discectomy at L4-5, if he doesn’t improve enough. That would be reasonable. But, since he has multiple disc herniations, and he is too young to do a lumbar fusion, which at his age is not advisable, he will have to manage his back problems, non-surgically, and I think the best way to do that is with spinal decompression, when needed.

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