Sciatica, it's crippling me: Who to turn to?

@denman55 Have you consulted a spine surgeon? Personally, I prefer a neurosurgeon, but both orthopedic and neurosurgery specialties can do spine decompression surgery. I know you have been suffering with this for a while. Find the best surgeon you can at a highly rated hospital. surgery at the lower end of the spine is more painful and a more difficult recovery because you are bearing most of your body weight there.

Find a reputable neurosurgeon or an orthopedic surgeon who has done a spinal fellowship. There are solutions.

I had exactly what you describe but in episodes that would lessen in severity and then return. I had one injection to L2-L3 (L4-L5 was too constricted to allow the needle in. The timing was while the radiculopathy episode was waning so not sure it helped. My spine specialist was willing to do one more 6 months later when another episode hit. He also wanted me to consult a neurosurgeon colleague in the spine clinic. I did so and scheduled surgery at that 90 minute consult. I had anterolisthesis and dangerous degree of movement of the L4over L5 (shown in X-rays done with your back extended). I needed that to be stabilized since a large additional movement could be catastrophic. My surgery completely solved my leg and butt pain. I could walk pain free the day after surgery. I am 4 months out and gradually getting back to normal level of activity. Still so grateful for the surgery which was done with an orthopedic spine specialist attending and 3rd year neuroscience fellow assisting. I recommend finding a surgeon who spends time to explain your individual situation thoroughly. Mine along with his team spent nearly as long before surgery as during surgery (5 hours) explaining to my husband and me. They accurately predicted the hallmarks of my recovery. Best wishes. We are all different challenges but yours sounds so much like mine I had to write!

What does the MRI indicate as the cause of the spinal stenosis. Cause will dictate remedy and as intense as sciatic pain is, there is (I'm not allowed to say likely on this site) remedy. If you have a readout from the MRI check for description of the stenosis. Bulging disc, folded ligament, spondylolythesis, loss of vertebral or disc height.

I'm so sorry you're going through this. Here's my sciatica story: Around the age of 45 in 2008, I had the same issue but only occasionally now. I still have slight numbness on the side of my foot and pinky toe but it was much worse and covered most of my toes back then. I also had muscle loss in my calf. So during one ER visit in 2008, I was given IV gabapentin and an overnight stay then sent home on a steroid Medrol dose pack taper. Up to that point, the pain was so bad that I literally wanted my leg cut off! I was scheduled for surgery prior to that ER visit but after completing the steroids I never got the surgery. I even showed up for surgery and got undressed! By the time my son parked and came back up to the waiting area, I had changed my mind because I felt so much better! On discharge from Johns Hopkins for the NON-surgery😁, I was advised to keep my weight down, do the physical therapy stretches, and stay active. It's been almost 16 years and the only time it flares up I notice is when I don't stretch for awhile being lazy and don't get much exercise. My issue was at L5-S1. I also was out of work for 2 months so I think that also allowed me to heal. Good luck and speedy healing to you. I'll be praying!!

https://www.ansellchiropractic.com.au/what-causes-sciatica-type-pain/
Even a tight muscle can trap and squeeze the sciatic nerve. The piriformus. If the MRI doesn't indicate a herniated disc, you might consider a chiropractic visit. You can usually get in to see a chiropractor quickly often same day. You'll know a lot more about the pain after a chiropractic assessment because they are usually very thorough.
I didn't mean to send this in two parts.

Several months ago I posted that I was experiencing lots of nerve pain after spinal surgery. I had gone to PT for about 10 weeks, and while my muscle strength improved the nerve pain was still substantial. I decided to try a different approach to PT that I had read about called FCS or fascial counterstrain. At the time I indicated that I would update everyone on my progress. I initially found out that most issues require about 4-6 visits to get significant results. In my case it took 5 sessions to eliminate 90% of my pain. This was nerve pain that I had experienced continuously for 9 months. I am now virtually pain free. I think for anyone seeking help, it is worth investigating. To learn about it go to counterstrain.com. You will learn what it is and locate a practitioner in your area. I am now back to the conventional PT that I was doing before to regain my muscle strength.

@roma76 Thank you for sharing your experience here which is very valuable. It sounds like you had an excellent surgeon. I am glad to know that your surgery prevented a possible future serious problem by fixing the instability in your spine.

@denman55, you may want to read through this discussion started by @roma76 with her experience as she went through spine surgery.
Spine Health - "Will lumbar spinal fusion solve my leg pain or just add new pain?"
https://connect.mayoclinic.org/discussion/will-lumbar-spinal-fusion-solve-my-leg-pain-or-just-add-new-pain/
Jennifer