Sciatica causing residual leg weakness

Patient

Q: I have massive leg weakness, numbness and tingling. The numbness is in my 2 left pinky toes and along the outside of my foot, going along the outside of my calf up to my knee. Just 2 days ago, my calf has gotten so weak that I can't even lift myself off the ground with my left leg, at all. My right leg is fine. This is in some way related to a chronic lower back issue I've been reinjuring for the last 6 months. The last 2 months were spent in bed because of severe sciatic pains averaging levels 4-6 pain on a 24/7 basis, spiking to 8-10 levels if i stood or sat up. After some oral prednisolone and an epidural, the pain is gone but the numbness and weakness remained. Its been 2 1/2 weeks since the epidural and any pain. All of my other medical professionals (chiro, acupuncturist, physical therapist), except for my ortho doc, seem to be worried that the weakness has been going on for 6 months and is so bad that I can't even lift myself off the ground. My main doctor, my ortho, just says its because of my 10 mm rupture in my L5/S1. But the weakness isn't getting any better, and is actually seems to be getting worse. I respect my ortho, as he's touted as one of the best spinal surgeons in the country, but he doesn't seem to taking this very seriously. Should I worry and get a second opinion? He hasn't done any further testing too see if maybe its something else, like piriformis syndrome or even a damaged pr dead nerve. It scares the crap outta me cuz my life is centered around mobility. I seriously think I'd rather get cancer or AIDS then lose my leg.

Symptoms:  Numbness in my 2 left pinky toes in my left leg, outside of foot and outside of calf going up to my knee. Weakness in left leg, seems mostly in my calf. Some of the weakness is definitely due to atrophy, but my right leg is back up to about 85-90% and my left leg cant even lift me a millimeter off the ground.
Doctor

A:   Hello,
Thank you for your medical query at AskTheDoctor.com
I understand your concern.
It is highly unfortunate that your orthopaedics doctor has not taken your condition seriously.
Yes, you definitely deserve a second opinion and I will recommend an MRI of the spine for a conclusive diagnosis.

The symptoms still sound like sciatica. It could be due to a herniated disc. A herniated disc occurs when the soft inner core of the disc (nucleus pulposus) leaks out, or herniates, through the fibrous outer core (annulus) and irritates the contiguous nerve root.
A herniated disc is sometimes referred to as a slipped disc, ruptured disc, bulging disc, protruding disc, or a pinched nerve. Sciatica is the most common symptom of a lumbar herniated disc. The patient often presents with severe pain and progressive weakness on the affected side.

There are other possibilities that also needs to be ruled out such as spondylolisthesis or piriformis syndrome as you correctly mentioned. An MRI hence will be very helpful in finding the level of the lesion, as well as the exact cause. I will also advise you get your serum b12 levels evaluated. There is a slight possibility that the weakness along with the tingling and numbness can be associated with a vitamin deficiency. These patients also have pain, however, the weakness is never debilitating.

So I advise you get a fresh MRI and also get a second opinion. Based on the examination findings, if required a neurology opinion will also be helpful.

Please follow-up with your reports,

Regards.

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