Doctor responses to patient questions: sciatica related numbness, progressive loss of leg strength

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• Questions: Spinal Stenosis Surgery, Leg numbness from Spondylolisthesis
• Questions: Pinched Nerve, Discectomy or fusion, soft tissue and continued pain
• > Questions: Sciatica related numbness, progressive loss of leg strength

The following explanations, insights and advice about numbness and leg pain are provided by Peter F. Ullrich, Jr., MD, an orthopedic spine surgeon and Medical Director for Spine-health.com.

Patients frequently e-mail us questions about leg pain and numbness caused by back problems. While we don’t provide individual responses, periodically, Dr. Ullrich will take time to respond to the more frequently asked questions and we publish the responses in this section of the site.

Please understand that the following responses to questions about feeling with numbness and leg pain represent the opinion of one physician, and are intended for informational purposes only and not as a substitute for professional medical help or advice.

Diagnostic tools for sciatica-related numbness in leg

The Question:
I experience numbness and tingling in my leg. I have a lumbar herniated disc at L5, which is causing sciatica. Besides an MRI, is there another test to determine if the sciatica is caused by nerve compression and to identify which nerves are being compressed?

Doctor's Response:
A CT scan can provide an image of the vertebral disc if it is sizable, but does not give quite as detailed an image as an MRI. Likewise, an EMG study (electromyography) of the leg can indicate if a muscle group is affected, but the test is non-specific and typically does not detect herniated discs. The best test to evaluate nerve compression is an MRI scan. For patients who have claustrophobia, newer MRI scanning equipment is no longer designed like a tunnel and is less likely to cause claustrophobia.

Progressive loss of leg strength and numbness in leg

The Question:
I have a prolapsed disc at L5/S1 that just happened. After a few steroid injections, the leg pain is mostly gone; however there is still numbness in my lower leg and progressive loss of strength in my right leg. Is low back surgery the only way to fix this (I would rather not have surgery)? If I do need surgery, can endoscopic surgery be used to remove the offending part of the disc?

Doctor's Response:
If you are having progressive loss of strength in your leg due to a prolapsed disc (herniated disc), then surgery would be advisable. The surgery can be done either as an endoscopic surgery or as a micro surgery. With an experienced surgeon, both types of surgery can work well. Both are usually equivalent in terms of being minimally invasive and having quick recovery times. However, micro surgery is still probably the gold standard and more surgeons are experienced with microdiscectomy surgery. Endoscopic surgery is generally more difficult and does not provide as good of visualization of the affected nerve root as microsurgery.

I would advise you to consult a spine surgeon (either an orthopedic surgeon or neurosurgeon who specializes in spine surgery) as soon as possible so as not to lose more strength.

What next?

If you have questions about your leg pain, numbness or back problems, please use this site to find peer-reviewed health information about spinal conditions, diagnosis and treatment options. The quickest way to locate information on the site is to use the “keyword search” box located in the upper left hand corner of each page. Also, if you want to talk online with others who may be in a similar situation or exchange information with other patients with a leg pain and/or numbness, please go to theSpine Forum Message Boards.

Additional disclaimer: Spine-health.com does not offer medical advice or treatment. This information does not replace the physician-patient relationship, and the information is not medical advice or treatment. It should only be considered as one physician's opinion based on an extremely limited amount of information. Patients should always seek the advice of a trained health professional for back pain or any health condition. Please note that the contents of this section have not been peer reviewed by Spine-health.com’s Medical Advisory Board.