Cortisone steroid injection - sciatica

[nathan1980]

Hi, I have had an MRI scan on my lower back at Bangkok Hospital in Pattaya

 

They have said - mild disc bulging with stenosis of Left L4-5. It correlates to your symptoms of shooting pain from the back to outside of your leg and ankle. They recommended a cortisone injection under fluoroscopic control.

 

After researching (on the internet) it suggests that sciatica can come from either nerve roots between L4 and L5 or L5 and S1.

 

There seems to be two different injections for sciatica - epidural steroid injection that covers a larger area of the spine and selective nerve root block injection that targets a more specific area.

 

My sciatica has got slowly worse on my left side following a fifth metatarsal break in 2015. I think it is linked to this as I have not had any trauma apart from that in the left side of lower limb. I was in a boot for 6 months as the fracture to so long to heal. I have tried orthotics and regular yoga and specific exercises for this but I still keep getting horrible flair ups.

 

I would like to get a second opinion from a specialist in sciatica injections.

 

Any advice would be much appreciated.

 

Thanks,

 

Nathan

[faraday]

I've had two steroid injection for l5/S1 impingement.

 

Very straightforward, & relieved my symptoms for a long time.

 

I have found now, that hanging by hands & stretching gently, is just as effective.

 

Cost was 3000baht at Fort Prajak in Udon.

 

How much did your MRI cost?

[KhunFred]

I had one of these injections about six years ago, before I left the United States. Very effective temporary relief. I have suffered with sciatica for a number of years and these shots are highly recommended. I had wondered what the cost would be here in Thailand. Not much information available.

[vogie]

First of all you have my sympathies, it is the most painfull condition I have ever suffered.

I had it many years ago and was taking pain killers like sweets, some helped a little, but not many. I was advised to seek help from a chiropractic and after two sessions the pain had gone, this was in England though.

[metisdead]

Moving the Health and Medicine forum. 

[Sheryl]

I'm not sure specifically what you are looking for but the recommendation sounds quite reasonable.

 

My sister had this done (steroid injection)  at the BNH Spine Center after consultation with Prof. Wicharn who is the top spine specialist here. The injection was done by an anesthesiologist who specializes in it. If you want a second opinion and can manage a trip to BKK this would be the place to go (bringing the MRI with you). 

 

https://www.bnhhospital.com/find-doctor/search-result/?dname=Wicharn

 

Be forewarned this is more expensive than you might expect. At BNH it ran a little over 30,000 baht if I recall correctly and BPH likely the same or more.

 

[AlfHuy]

I had big problems as well.

Started accupuncture and did help me a lot.

[seajae]

I have l5 s1 & s2 disintergrating, had it for 27 years after a fall from a roof, could barely walk for 6 months, had to be lifted on and off a toilet, couldnt bath/shower myself & have constant sciatica in lower back and both legs so know what its like.  I did pain management & after being on opoids for almost 20 years I weened myself off them and just put up with it as I was over being  a walking zombie, I have to be careful as I loose all sensation below the waist & collapse if I twist or move the wrong way, I have a few scars to show for it too plus I cant lift my feet off the ground to walk properly(I trip over grass) if I do too much. I was recomended to have steroid injections by one person but a specialist advised me not to do it as it would have to be long term. 

[faraday]

I do find that taking Arcoxia helps with the pain also.

 

 

[tifino]

I was advised Against taking the steroid injections

- as they said the Steroid treatments are useless for any specific injury older than 2 weeks

[Sheryl]

9 minutes ago, tifino said:

I was advised Against taking the steroid injections

- as they said the Steroid treatments are useless for any specific injury older than 2 weeks

 

Every case is different. Often there is no specific injury but rather a chronic condition. The key issue is whether there is a mechanical cause of the pain that is nto going to resolve on its own vs one that will.  A bulging disk will usually retract with time. A narrowed space that does not allow enough room for the nerve root to exit, will not.

 

Obviously the doctors who read OP's MRI believe a cortisone injection may do the trick. It may be worth getting a second opinion just to be sure, if he can mange the trip. Or he could decide to trust them and proceed.

[vogie]

2 minutes ago, Sheryl said:

 

Every case is different. Often there is no specific injury but rather a chronic condition. The key issue is whether there is a mechanical cause of the pain that is nto going to resolve on its own vs one that will.  A bulging disk will usually retract with time. A narrowed space that does not allow enough room for the nerve root to exit, will not.

 

Obviously the doctors who read OP's MRI believe a cortisone injection may do the trick. It may be worth getting a second opinion just to be sure, if he can mange the trip. Or he could decide to trust them and proceed.

Would I be correct in thinking Sheryl that an experienced chiropratic can massage these discs back into place?

[Sheryl]

17 minutes ago, vogie said:

Would I be correct in thinking Sheryl that an experienced chiropratic can massage these discs back into place?

Absolutely not. You can't massage a ruptured or bulging disk back into place and trying would likely increase inflammation and pain.

 

The problem is not that the disk has "slipped" out of place but that there are degenerative changes in the disk itself. The last thing one wants to do is manipulate the disk itself.

 

A chiropracter would likely try to widen the space between the vertebra to increase room for the disk. Physical therapy such as lumbar traction also does this.

 

 

[nathan1980]

I have had the MRI scan at Bangkok Hospital in Pattaya. 

 

Does anyone know if the Samitivej hospital in Si Racha have any doctors that specialise in this area as this is closer to me.

 

Appreciate your feed back.

 

Nathan 

[Saltire]

7 sessions of acupuncture 5 years ago did the trick for me, no pain since,

 

RAM in Chiang Mai and Bumrungrad in Bangkok did MRI 6 months apart that showed 'inconclusive' damage at L4 L5 same as op. Didn't stop one of them recommending a scary spine fusion operation which hapilly I didn't go for.

 

I was seriously debilitated for a year, couldnt walk more than 50 metres.

 

Good luck OP

 

[Sheryl]

3 hours ago, nathan1980 said:

I have had the MRI scan at Bangkok Hospital in Pattaya. 

 

Does anyone know if the Samitivej hospital in Si Racha have any doctors that specialise in this area as this is closer to me.

 

Appreciate your feed back.

 

Nathan 

In the Pattaya area the best expertise is found at BPH where you have already gone -- and specifically, this doctor there

https://www.bangkokpattayahospital.com/en/doctor-profile?v_id=173&depid=22

 

Better than that, need to come to Bangkok.