Help/Opinion on Facet Joint Hypertrophy
 

So a little background.... I started having symptoms in early 2010... they started out very mild, and manageable. I was in the Army for nearly 2yrs by that point and just thought I was having normal back pain like everyone gets. Fast forward a few months later, we are doing a battalion run which is a very slow pace and more up and down motion than striding out.... when all of a sudden it felt like a knife had been jammed in my back.

I battled with the Army for a couple of months before finally being sent to ortho at which time they ordered x-rays, mri's, ect and determined I had "facet joint hypertrophy". Treatments included tramadol, epidural steroid injections, and facet joint steroid injections. The injections did nothing for me.

Me being a dumb soldier kept trying to soldier on, as the doctors told me which probably made it worse. Fast forward to late 2011 and I've gotten to the point where my daily life is compromised. I find myself constantly changing position, standing up, sitting down, and I can no longer run anymore without severe tightness in my lower back, and sometimes making my left foot go numb.

I change duty stations and get to Ft Lewis where Madigan Army hospital is. The Army determined it would take longer than 1yrs time to "heal" me, so a med-board was initiated on me. Once in the med-board process they seemed to not really be concerned with treating me, just processing me out as fast as possible (14 month process).

I do have a minor bone spur, and I have very minor disc deterioration, but nothing out of the ordinary I am told. It is not listed as a concern. I was finally sent to a chiropractor (Army treats them like witch doctors) who immediately was concerned with how I walk, my very limited rear flex of motion, and my posture. Ordered xrays and told me my core issue issue was the curvature of my lumbar spine. He seemed very confident that he could fix this with adjustments, supine traction, and a home regimen, but the med-board would not let me see him more than a few times.

As of October of last year I was medically retired and I now deal with the VA who is very slow (been waiting 4 months to get into physical therapy) and don't seem to want to "fix" me, rather just have me accept that I am phucked and pay me more money (sounds good right?)

I go to the gym 4 days a week, I do a 2-day body building split. My I do core strengthening and my lower back exercises consist of rowes, dead lift, ect. The only exercise I CANNOT do without nearly crippling myself is the lumbar extensions.

I do cardio 5 days a week, I can't run because of what it does to my back, but I do the elliptical and bike. I am in pretty good shape but am severely affected by my low back.

My ultimate goal is to get my back into a condition where I can possibly run again... try to live a normal life, and ultimately I want back into the Army. I joined a forum to ask for advice because I'm stuck in the VA system where I have no advice, and that is what I rely on. I am to the point where I am desperate enough to come out of pocket to get seen by civilian doctors, but I'd like some facts and advice going into it first.

If anyone on here is experienced enough and would like to see some of my xrays/mri's I have all of them on disc/photo to show the spine curvature. I also have my written diagnosis.

If there is a better place in the forum, or a better forum to ask this on, I would also appreciate that.

Thanks for listening,

NMB2

Hi ~ First, let me say THANK YOU FOR YOUR SERVICE TO OUR COUNTRY! We don't thank our service people often enough!

Secondly, do you have the written report of your MRI? I'd rather see that than the MRI itself. I can make sense of the written report MUCH better than I can the MRI. LOL So if you'll print out the report, I'd appreciate it. ;) It sounds like you've had a rough time of it.

And I cringe at the fact that they sent you to a Chiro before even knowing what was wrong with you. YIKES. But, that's the Army for you. LOL

I'll be looking for your MRI report. Take care and talk to you soon. Hugs, Lee

I have one MRI more recent than this from the beginning of 2012, but I'm not sure where the results are right now. This is the MRI that they used to give me my actual diagnosis back in 2011. In the newer one, I do remember they said there was little to no change in it from the previous one other than my spine alignment. I'll find it when I get home tonight.

Dated: 2/17/11

Pulse Sequences: Sagittal T1 and T2 weighted images of the lumbar spine and axial T1 and T2 weighted images of the lumbar spine are presented.

Findings:

Todays study is compared to a prior study of 10/1/09. The height of the lumbar vertebral bodies is maintained and there is normal lordotic curvature and alignment. The lower cord and conus are normal. A small schmorls node involving the superior and end plate of L2 is unchanged since prior study.

L1-2: no disc herniation, central canal stenosis or neural canal narrowing is seen

L2-3: no disc herniation, central canal stenosis or neural canal compromise is seen.

L3-4: no disc herniation, central canal stenosis or neural canal narrowing is seen.

L4-5: There is ligamentous and facet hypertrophy bilaterally at this level. No disc herniation, significant central canal stenosis or neural canal narrowing is seen. The appearance is unchanged since prior exam.

Impression:

1. Small schmorls node involving the superior end plate of L2

2. ligamentous and facet hypertrophy at the L4-5 and L5-S1 levels

3. no disc herniation, central canal stenosis or neural foramen narrowing is seen. no interval changes are noted when compared to prior study.


and here is a picture attached of my spine from the side. the line drawn on the left is what I was told my curvature should look more like.

Also, in case it makes much of a difference my only range of motion significantly impacted is bending back. I am limited to 5* travel, not necessarily by pain either... that is just literally all I can bend.

I mis-spoke earlier. I have no record of bone spur... just the schmorls node, and in one of my reports makes mention of very minor disc degeneration.

Hi again ~ Well, what can I say? I sure wish MY MRI looked like this. :rolleyes:

I know you're in pain, I'm not trying to minimize it by ANY means. The ligamentous and facet hypertrophy means that there is overgrowth of both. I assume they're talking about the ligamentum flavum? That's a series of ligaments of yellow elastic tissue connectiing the laminae of adjacent vertebrae from axis to sacrum. The facets are the "wing-like" structures on each side of the spinal cord that you can see and feel if you hunch your back over.

And a Schmorls node is a spinal defect characterized by a protrusion of the nucleus pulposus into the spongiosa of a vertebra. The pulposus is a mass lying in the center of each intervertebral fibrocartilage. The spongiosa is paart of the bone made up of spongy cancellous bone.

Is that more info than you wanted?? :eek: :D

Seriously tho, this doesn't look like anything serious, and NOT anything that any surgeon would touch. I hope that PT will help you. Keep us posted, ok?? God bless and please take care. Hugs, Lee :)

I usually walk around at about a 3-4 on the pain scale... very manageable. The only activity I cannot really do is running, which is a pretty big deal. Those lumbar extensions also basically cripped me last night putting my feet to sleep and back very very tight.

I know a surgeon will not touch it.... I have been told this but not given any solutions. It seems to me like this is something that needs to be fixed now before it turns into something more serious.

When I walk I wear out the front edges of my shoes because it has my hips tilted, and I kind of walk leaning forward a little bit, without noticing.

What types of treatment do you think I need? I have an appt. with my PCM on Friday and I want to go to him with a list of doctors/specialists that I wish to see.

Spinal specialist? chiro for lumbar traction? 1 on 1 physical therapy? (I tried group, and it was a joke).

I really just don't have much info on what I need, and I the more I learn before walking in there the better off I will be.

You say there doesn't seem to be a reasonable mechanical reason. Do you think my spine curvature actually looks ok in the x-ray then? That was the reasoning they gave me for my lack of range of motion, and the change in how I walk. He said that its pushed so far back, that you cannot see the opening any longer in the L5 (i think?) and that is likely the reasoning that my foot falls asleep.

As for the other advice for the specialist. If this turns out to be the issue or part of it, is there a solution? It looks like I already do what it says to do for treatment, without any significant results.