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.