| Multi-Specialty
Case Reviews: Sciatica |
Sciatica: surgeon viewpoint
Based on the studies history and physical exam, this would
not be a good patient for a surgical candidate. The MRI
scan does not show much in the way of any nerve root pinching
from either a disc herniation or stenosis. Although the
L5-S1 axial scans are not shown, this scan also does not
show any nerve root pinching. He actually has quite a
patent canal. Also his pain is both when sitting and standing,
and stenotic pain is usually just with prolonged standing
or walking. Lastly, the epidurals helped a bit, but not
dramatically.
Generally, patients who do well with epidurals will
do well with a surgical decompression. This is not the
case with this patient. My advice would be to continue
to look for other causes of leg pain besides stenosis.
Piriformis syndrome can radiate pain down the leg in
a L5 nerve root distribution as can sacroiliac joint
dysfunction. Surgery can only change anatomy and help
with pain due to an anatomic cause. Without being able
to identify an anatomic cause of pain in this individual
it would be unwise to consider any surgical intervention.
By:
Peter F. Ullrich, Jr., MD
May 1, 2001
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