Very Interesting Patient !!!

I came across a very interesting case which i am handling since about a month. Patient ( f/46) presented to me with intense leg pain ( left radicular pain). Her pain was from buttock down upto ankle. She came almost crying with pain.

Examination was uneventful , except Extensor Hallusis Longus/ Extensor Digitorum Longus weakness indicating predominantly L5 root involvement. SLR was restricted. So i thought , surely patient is suffering from acute disc prolapse and ordered urgent MRI. To my surprise MRI could not show any significant neuro-compression.

I put her on conservative management. Started her with anti-inflammatory medicines , rest and gabapentine. Patient did improve but still ws complaining of significant pain.

I took an opinion of my neurologist , he conducted EMG/NCV and concluded to be having L5 root radiculopathy with L5 root weakness. He was of the opinion that one should go for a surgery.

My problem was on MRI, I was not able to find a compressive lession neither intracanal nor foraminal or extraformainal.

So i decided to go for L4 and L5 root blocks. Under image intensifier , i injected local anesthetic. Patient improved in her pain immediately. Its been two days since i have injected her and she is doing extremely fine.

I am hopeful that she shall do good, but if her pain shall recover , mostly I am planning to get a frest MRI and CT scan to detect any compressive pathology.

Will post the Update as and when i have results.

till than Cheers !!!