[alexm]

#25494

I have had chronic sciatica for well over two years, with a 5 month period where it went completely away until May of this year. Essentially I have very low back discomfort just right of center above sacral area, radiating into the right glut, right leg and foot. Tingling and pain in right and left feet but no left leg pain. First MRI showed small bulges(2mm at l4/l5) and small annular tear at l5/s1. Second MRI 16 months later showed same issue at l4/l5, but also 3mm bulge at l5/s1 and small fluid level in left facet joint. I did an injection at l4/l5 within the first year of the issue. Even though I walk fine, I am active and no weakness, the tingling has gotten worse in the feet. The pain doc wants to do a two level injection. My concern is that I did an injection within the first 8 months of the sciatica which was minimally effective, maybe one week of relief. I am concerned about repeating injections and the possibility of Arachnoiditis.

1. Is it harmful to keep injecting cortisone into the lumbar area where it may effect the bones, tissues and nerves long-term?
2. I assume injections are only temporary and if I have had a chronic condition for over two years an injection most likely will be minimally effective?
3. Concerns about radiation exposure since I have had many exposures(abdominal/pelvic CTs, fluoroscope assisted blocks, back x-rays, etc) for this and that over my life.
4. If there is no true weakness, loss of bladder control, overwhelming pain, etc. do some people live with chronic sciatica through there lives without treatment? Risk for nerve damage?

Thanks you so much for your time,
Alex

[Donald Corenman, MD, DC]

#25518

First, tingling (paresthesias) in the feet bilaterally may indicate peripheral neuropathy and not nerve compression. This can be superimposed on a nerve root disorder (sciatica) like you also describe (“I have very low back discomfort just right of center above sacral area, radiating into the right glut, right leg and foot”). See this hyperlink https://neckandback.com/conditions/peripheral-neuropathy/ to understand peripheral neuropathy.

Your questions.
1. Is it harmful to keep injecting cortisone into the lumbar area where it may effect the bones, tissues and nerves long-term. Generally not if there is aa limit to the numbers of this injection over one year. It is assumed that 3 injections/year are somewhat safe. I do have patients who receive as many as six injections/year in different spinal areas. The greater the number of injections, the greater the risk. The skill of the injectionist is also quite important. Arachnoiditis can occur if the injection is not placed epidurally. “Epi” means above the dura If the injection is inadvertently placed into the dura, this can cause arachnoiditis in the lumbar spine and can cause a stroke if particulate steroid (Celestone) is injected into a vein or artery in the cervical spine. Patients who take steroids regularly (rheumatoid arthritis, glomerulonephritis) can develop significant steroid issues and more unusually, constant chronic spinal injection steroid patients can also develop the same issues.

2. I assume injections are only temporary and if I have had a chronic condition for over two years an injection most likely will be minimally effective? There are some patients who are “cured” by one steroid injection but that is the exception-not the norm. This injection can “knock down” the intensity of pain to a point that is livable. I have some patients who get injections every 4-6 months and do well-trying to avoid surgery. The injections do generally become less effective over time but I have some patients who are still going strong with injections after 15 years.

3. Concerns about radiation exposure since I have had many exposures(abdominal/pelvic CTs, fluoroscope assisted blocks, back x-rays, etc) for this and that over my life. If you are going to have treatment of your spinal disorder, imaging is necessary. You have a right to be concerned about X-ray exposure but it is necessary to make sure the disorder is diagnosed and the injection is performed safely.

4. If there is no true weakness, loss of bladder control, overwhelming pain, etc. do some people live with chronic sciatica through there lives without treatment? Risk for nerve damage? Many individuals have chronic sciatica and live with it. By definition, chronic sciatic is chronic nerve damage (unless there is a surgical solution that the patient does not want to consider in which case the symptoms could still be considered chronic but due to compression and not intrinsic nerve injury). See https://neckandback.com/conditions/chronic-radiculopathy/.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[alexm]

#25521

Thank you doctor…could I ask a few follow-up questions:

1. As you stated in your answer above: “The injections do generally become less effective over time but I have some patients who are still going strong with injections after 15 years.”
Are these people that have been doing injections for over 15 years? And they have had no ill effects from the injections?

2. Can an annular tear cause sciatica type symptoms and tingling/pain in the feet or are compressions more likely to do this? Also, can these compressions cause muscle twitch in the legs? Over the last two months I have seen muscle twitching which I never experienced before.

3. Also, my radiology reports(from two MRIs and two different radiology groups) said no stenosis but I consulted with a chiropractor who teaches radiology courses and is a spine researcher. He looked at my MRI and said I had lumbar stenosis at 12MM….could the radiologists have missed the stenosis? Can it be that easy to miss?

[Donald Corenman, MD, DC]

#26190

These patients who have been getting steroid injections for 15 years have yet to demonstrate complications of these injections in general.

Annular tears can allow a “chemical radiculopathy” as the nucleus is neurotoxic and a “leak” of this substance can irritate the nerve root. This condition is somewhat rare however. Muscle twitching is not generally an indication of nerve compression unless there is motor weakness present which would be obvious on examination.

Unlikely that a 12mm diameter spinal canal is causing nerve compression. It is possible but unlikely.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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