Pain & numbness in leg/foot--negative MRI

[micgrajon]

I have had lower back pain to varying degrees for quite some time and would experience sciatica off and on.  A couple of months ago, the pain going down my legs has gotten worse/more frequent and the top of my left foot has gone numb.  An L-spine MRI revealed a slight herniation in L4-L5, but didn't appear to be pressing on any nerve roots.  Treatment so far has consisted of steroids, pain relievers, and physical therapy.  The pain relievers help with the pain, but the numbness is still present.  The cause still hasn't been found and it's getting frustrating not being able to find answers...especially since I'm uninsured right now so everything has been paid out of pocket!  From what I'm told, my symptoms are indicative of L5-S1 herniation, but the MRI is negative for that.  Any help would be appreciated.  Thanks

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

It sounds like you have an L4/5 neuropathy. It can be related to the MRI findings of the herniated disc. It is hard to say since I cannot examine the MRI myself. Other causes of sciatic nerve pain can be from masses in the pelvis or gluteal region, prolonged sitting, and hip fractures, to name a few.

If the pain is from the herniated disc (or even by a bony protrusion) compressing the nerve, the pain may spontaneously resolve in 4-6 weeks. With time, the herniated disc may actually shrink. However, a minority of patients will require surgery.  Thus, nonsurgical measures are first line as you are doing (physical therapy, ibuprofen, etc). Indications for surgery, though, can be emergent. These include muscle weakness, loss of bowel or bladder control, loss of sensation particularly in the pelvis, and severe and progressive pain.

A radiculopathy is often diagnosed on clinical examination, MRI, and EMG/NCS.

I would recommend that you be seen by your primary physician regarding this. You may need to be referred to a neurologist for the EMG/NCS which will evaluate the extent of damage done to the nerve. If you are referred to the neurologist, you should provide him/her with a copy of the MRI results AND images.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[rlee2010]

have similar problem, numbness starts with rt ft when standing 4 long period and will progress up rt leg if I don't sit down or stretch rigt ft and leg. am still working with my doc to decide what the problem, and what i'm going to do when I find out the problem.  if you don't have insurance, what am currently doing may help.  i don't and have not taken any drugs. everyday, I walk 3mi, I stretch do yoga, about 800-100 situps more if I have more energy.  I am 56 years old, I work full time and raising my 19 year old. all of this cost me nothing except time and determination.  I decided I have no choice because i am getting older and i am accepting my condition.  hope this helps a little if only another idea,  rlee2010