Soldier with bilateral neural foraminal stenosis
 

I am a 35 year old Soldier in the Army,a Combat Medic, and I recently got the results back from an MRI (which I had been pushing many months for) and the impressions are

MILD NEURAL FORAMINAL STENOSIS AT L4-5 AND L5-S1
MILD DEGENERATIVE DISC DISEASE WITH POSTERIOR PROTRUSIONS (APPROX 2-3MM) AT L4-5 AND L5-S1.

What TX (treatment) should I push for? What should I expect? All my main doctor has done is just dope me up on pain medications. I go to a military orthopedic surgeon next month for an evaluation of a permanent physical profile (An Army document saying you are broken, and limits the exact duties you can perform). I am getting sick and tired of just taking pain meds daily for this, and need to get some ideas on how to pursue this..

Hi. I'm sorry you are feeling so much pain :(.

If it were me (and I have been in the same situation as you with comparable diagnoses), I would do my best to guide the ortho. surgeon to refer to a PM (Pain Management) doc.

I state that, though, without knowing how your films appear to a medical specialist, which I'm not. Mild may not "read" like a huge deal, but the effects are felt differently or person-centered; we're each unique.

The ortho. surgeon will assess based not only on your radiographic imaging, but also on your history and symptoms, and other assessment tests.

If you do see a PM doc, please, please keep this in mind: It is not in your best interest for any doc. to perform procedures without the use of a C-Arm or live-guided x-ray. No way, no how would I sign off on such. In this day and age, there is no justification for a doc not having the equipment that allows for a targetted approach toward treatment.

Thanks
 

I am hoping that with an Army Orthopedic Surgeon, things will fall in place, and I will get the treatment I need.

I have also had two major shoulder surgeries (on the same shoulder, in less than one year) repairing every single structure in my shoulder. "Lucky" that my shoulder injury is considered "Line of Duty" so long term treatment on that will be easy.......

Both fortunately and unfortunately, there is more time before you see the ortho. surgeon, which means more pain for you during the wait :(.

I suspect that the surgeon you'll be seeing will make the appropriate referral(s) :). That's the good news, I think.

Hi Armymedic and Welcome to NT. I'm guessing that you'll have to wait until you see the Ortho and weigh your options then. Bobbi gave you some great advice... I am currently having disc herniation problems, so understand your pain.

take care and glad to have you w/us.

Update
 

Well, I saw the lead Army Orthopedic on post, and he has referred me out for pain management to get Epidural Steroid Injections to try to narrow down the exact cause of the pain. He said that the possibility of surgery is still out there. I feel like I am in better hands now as he is the lead Ortho Surgeon, and a Lt Colonel (for those that don't know, a Lt. Colonel has been in for a while and has a lot of experience in the Army)

Armymedic,

Glad to hear you are getting the injections. The ESI should help; if not, there is Selective Nerve Root injections. I have had only one ESI, a few Selective Nerve Root injections and plenty of Facet injections. They have always helped. And allowed me to keep the meds low. My husband (btw a retired Sargeant Major turned civilian for DOD) just received two ESI's. He is scheduled for a Selective Nerve Root injection in a couple of weeks. He is also looking at surgery; possibly a Laminectomy. But for now it is a wait and see kind of thing. I agree...you are in great hands with an OS Lt. Colonel....he won't mess around! :) Oops, forgot to add...we both go to a Spine Center as there are not any large military bases around here anymore. We would both have to go to Dayton for a larger facility. But we could always fly to San Antonio. ;) Just teasing...the Spine Group here is fantastic so we know we are in good hands. I wish you well and hope the injections give you some relief.

Thank you. I go for my initial consult at pain management this upcoming Friday 28 March 2008. I will be sure to post updates. I was told they will not be doing an injection or any kind of intervention on the first appointment.

dr jho
 

check out dr jho. i had cervical spine surgery with him a little more than 3 weeks ago. so far so good, and others have faired well.

Armymedic,

That's right. They will get your history first and then probably schedule the injection(s). I think you are far from being a surgical candidate just yet. ;) And I hope the injections help; they always do for me. Oops, and yes, spinal stenosis and facet issues at L4/L5 and S1 for me.

And HOOAH right back LOL! You guys (military) scared the heck out of me one time when I was TDY at Ft. Campbell. I wasn't expecting it and about fell out of my car LOL!

I'm sure you know about the medical review board, if someone in your chain of command puts you up for it you can get early retirment due to medical reasons then you go file a claim at the VA but make sure you get all of your records from your docs and the clinics and keep them for the VA before you get off active duty. The VA will start you at 20% for this type of a back condition but if you do things right you may get 30%. Once you get your DD214 you can get real therapy and you will have tricare for life to pay the privet doc's and you can file for social security disability as well then sign up for the vocational rehab program at the VA and they will pay for your school pluse books pluse $900 a month check. Also you can get all the free real good treatment you want if you concider studying acupuncture or chiropractic because there are no fee to student clinics built into the school and with that kind of a life change and the people around you that care about you healing you will get fixed. That is exactily what I did and it has been great and I am healing with 3 herneated disks and ligament damage in my neck snd no surgeries or anything.

God bless you and good luck
,Michael

me too
 

I hope I'm doing this right first time on anything like this . I have been dealing with the same problem for 8 years . i was on pain pills the whole 8 years. I also went and still do go to pain management they can give you steroid shots and they can do a procedure calle gangelion root radiofrecuncy howerver spelt these may relieve some discomfort I had 3 emergency surgeries and I would not go that route there is a new procedure that they do in cal. which is 30,000 but Tri care doesn't cover it but it is suppose to have a 87% cure rate I wanted to do it but we just retired military and don't have that kind of money. they go in and use a lazer. look under spine institute under google. Do watch out at the pain Dr some just put you on methadone or higher the new drug subutex for the pain, not for drug addiction if I can go into this a lot more indepth and tell you what tri care has coveredand what they don't (even being active duty.) I can also tell you look up everything you can before surgery and if you do have surgery go to the Mayo Clinic they are the best and they take Tri Care. you know what I am saying as a medic. I don't want to dish an military hospitals but come on after 22 years we know they aren't the best. I hope I could help oh do you still have feeling down your legs or any numbness down you legs or buttux if so and they want you on Lyrica it is a new drug and I was on it for 8 years also it has left some horrible side effects I would go for norontin but only you can decide I trusted my Dr and didn't look up anything now I do. .
also call around and see if the table alinment might help some say yes some say no. also go to weilabs.com and call them and tell them your problem they have some natural stuff they garentee ypu get all your money back . try accupunture I wish I did before having surgery but no choice what I'm tring to say surgery will probably make it wores and they will not tell you that but pain Dr's will. and I live with pain everyday it goes to a 10 and my life went from very active to stationary and I don't wish that on anyone. MILD NEURAL FORAMINAL STENOSIS AT L4-5 AND L5-S1
MILD DEGENERATIVE DISC DISEASE WITH POSTERIOR PROTRUSIONS (APPROX 2-3MM) AT L4-5 AND L5-S1.

What TX (treatment) should I push for? What should I expect? All my main doctor has done is just dope me up on pain medications. I go to a military orthopedic surgeon next month for an evaluation of a permanent physical profile (An Army document saying you are broken, and limits the exact duties you can perform). I am getting sick and tired of just taking pain meds daily for this, and need to get some ideas on how to pursue this..[/QUOTE]

So far the orthopedic surgeon has put me on Neurontin. I do have some pain in my right hip as well

update
 

I saw pain management today, and the doctor is going to do the Epidural Steroid Injection next month, and trigger point injections. In the meantime, she put me on MS Contin, and Skelaxin, and gave me some samples of LidoDerm (patches)

Sounds like you have a good pain management doc! :) I hope the ESI is helpful. I know it has helped my husband a great deal. I also know of other "spinies" who take MS Contin and swear by it. I have tried Skelaxin myself but for me most of the muscle relaxers don't help with the exception of Valium. So, I hoard those for the bad times. :) Lidoderm will help too. I just asked for some refills the other day. They do take the edge off. And I am also having hip pain. But, like, you...everything is supposedly mild degeneration. So, hang in there...again it sounds like your PM has you pretty well covered. :) And, one other thing, and I am speaking strictly for myself...stay away from any Chiro's or manipulations of any kind!!! What I have found to be helpful is aqua therapy in a hot pool. Other than that...let your PM advise and good luck to you. Keep us all posted as to how things are going. :)

Sounds like it is the old 'wear and tear,' part of the ageing process. In your case maybe a bit earlier because of contributing activities.
Pain meds help but don't stop the cause, and only mask the pain-if you're lucky. Sometimes they can't do that.
I have the same sort of thing in my neck. I'm 63, but had the problems for at least 10 years-it just sneaks up.
I relied on handfuls of pain meds for years, then learnt about Mersyndol, which was better as it helps relax muscles. Then it was on to the NASAIDS, until the good ones were taken away.
I then asked for a referral to a pain consultant, and that lead to getting steroid facet joint injections. Have had 6 now, and I know where the pain is being caused.
My next one is in a month and I'm getting virtually the entire neck done!
Even with these injections, complained to the doctor that I couldn't sleep, waking every 40 mins or so. He prescribed Mobic, which I've been on for 2 weeks. And it seems to have made a huge difference. Along with the injections, I'm now pretty well pain free, and sleeping much better.
So it looks like the Mobic has made a big difference, as the injections alone weren't enough.
You might also inquire about using Mobic.
Also, it may take a while with the injections to find which procedure to follow and where to inject.

This is very good advice.

,Mike