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 spinal 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.

• Article written By:
• Peter F. Ullrich, Jr., MD

May 1, 2001

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