CT Scan

[Radar Rider]

I recently underwent a CT Scan for problems with my lower back. The transcription follows the details of my problem.

I’m a 40 year old SFC with 19 years of Army service. I’ve done the typical years of jumpin’, humpin’, and runnin’. I’ve experienced lower back pain, with various degrees of severity, for about 10 years. I had a thorough physical in 2000, when I explained the pains I got in my back and upper legs. The Doctor stated that my problem was “Sciatica�, and said that it would probably be a continual one. I’d usually have two to three serious episodes per year, lasting about three weeks. They were always non-situational; it could occur whether I had done extensive physical activity, or if I had done nothing. This year, it started to get chronic; it’s been mostly continual, but mildly painful. It’s not debilitating, just annoying. At any rate, after a couple trips to sick call, I was put on a “breathe at your own pace� profile, and had X-rays taken. The PA stated that I had compressed disks, with some osteo-arthritis. I was referred to the Physical Medicine section at 121 Hospital, for a CT Scan. I have been on profile for five months now, with three months treatment of Celebrex. The pain has been the same. The Doctor said that the next step would probably be spinal injections. He has stated that I may be on limited physical activity for the next two or three years. My concern is my future; I want to return to Fort Bragg. But, if I can’t jump, what would be the point? I am eligible for retirement; if I can’t perform with my Soldiers, I’d rather not even be out there with them. The CT Scan transcription is as follows:



Procedure: CT, LUMBAR SPINE (WITHOUT CONTRAST)

Exam Date: 21 May 2004

Reason for Order: LBP w/occasional leg pain. Please scan for L3/4/5/S1.

Procedure: Multiple axial images were obtained from the level of the pedicles of L3 through the upper part of the body of S1. Scan slices were reconstructed to be parallel to the disc spaces. No IV contrast was employed. The images were viewed in both bone and appropriate soft tissue windows.

Findings: The following levels were evaluated by axial imaging –

L3/4: Normal

L4/5: At this level a right paracentral disk protrusion is present which contacts the ventral thecal sac and the right L5 root but does not significantly displace these structures. The right lateral recess is crowded.

L5/S1: At this level a left paracentral disk protrusion is present which contacts but does not displace the ventral thecal sac and left S1 nerve root. The lateral recess is not significantly crowded.

There was no evidence of spinal stenosis, spondylolysis or spondylolisthesis.

IMPRESSION:

1. Right paracentral disk protrusion at the L4/5 level in a position to affect the right L5 root.

2. Left paracentral disk protrusion at the L5/S1 in a position to affect the left S1 root.

Transcription Date/Time: 21 May 2004, 1413 hours



Now, I’m not looking for a diagnosis here; just some opinions and/or advice. If I can perform physically without further damaging myself, I’ll do that and work through the pain. I’ve been doing that for ten years, anyway. If further jumping puts me at risk, then I’ll just submit my request for retirement. I thank all in advance for advice and assistance.

[swatsurgeon]

good CT interpretations...for 'absolute' results, any neurosurgeon will still want an MRI...much higher definition of nerve compression. It's like the CT is a black and white and the MRI is technicolor.
A epidural steroid injection (ESI) may reduce the symptoms and relieve the inflammation/edema of the disc and surrounding nerve roots. Some discs will migrate back to their proper location (mine did), but the ESI, is no guarantee of this. Also, before jumping and doind other activities that will cause an axial load you would want the opinion of either an orthopedic spine specialist or neurosurgeon. No offense to any other doc but the buck stops there, not with any one else when it comes to spinal trauma.
just my unofficial 2 cents.

[Radar Rider]

Thank you for the response, swatsurgeon. I am going back to see the doctor (He's a Colonel; not exactly sure what his specialty is) in a couple of weeks. I suspect that we will be moving on to the epidural shots.

Aside from not knowing what to do with my situation, I think my problem is that I don't know what questions I should be asking. Should I be requesting an MRI? Should I ask about a long-term (5 years or so) prognosis? If I can't run or jump anymore, I suppose that I can deal with it. :( I'd like to be active physically, even if I have to retire, though.

[swatsurgeon]

ask for a diagnosis........the MRI simplyb gives you more information. Most neurosurgeons won't do an ESI until they 'see' the problem from the MRI....it is the standard of care.

[Radar Rider]

Okay. I just got back from my latest appointment. I will be getting the Epidural Steroid Injections. Not a problem, as I expected that.

My "bummerness", though, is at max. The Colonel told me that even if the injections work, I should not put intense pressure on my lower back. :( Being Airborne is what has really kept me entusiastic about being in the Army.

This really disappoints me. I do not want to be in charge of Soldiers with whom I can not actively train. If I can't jump anymore, I might as well just submit my request for retirement. :(

[brewmonkey]

Regarding the ESI, find out what they are going to be using. I know they have been using Depo-Medrol for this procedure. I went through ESI for pain management pre and post op for L5/S1 spondylolisis/spondylolisthesis.

Some studies have indicated that depo-medrol may be one of the causes of arachnoiditis. While they believe only between 1 & 5% of those who recieve depo-medrol develop this it is still to many when there are alternatives to depo. Why do they believe this?
Depo-medrol contains benzyl alcohol which is potentially toxic when administered locally to neural tissue.

Celestone Soluspan & Kenalog have both been used in studies and have been shown to be effective in the relief of pain when applied as an ESI.

The method of delivery is also something you should address with the docs. Blind injections are not the way to go if it can be avoided. The best way to administer the dose is under fluoroscopy to ensure proper placement of the needle.

I did not know any of this prior to my pain management and I fell into the 1-5% of those who develop arachnoiditis. Wether it was from the ESI, Myleogram or the surgery itself is anyones guess. However, if anything I learned from my ordeal can help others then I am all to willing to share.

I hope your pain management goes well for you.

[Radar Rider]

Thanks, brother! I can deal with the pain (have been for ten years or so, anyway). I can see myself going back to Fort Bragg, but I don't think I could just stand by while everybody else jumps. :(

[Radar Rider]

I'm back from my first (and I hope only) Epidural Steroid Injection. I received the injection under a fluoroscope guided epidurogram, at the L5-S1 point (position?). I was a little nervous going in (it is my SPINE, afterall), but still ready to go.

After a little numbing agent, the Colonel emplaced the needle. It was like a bee sting; not too bad. A couple of minutes later, the meds were introduced. It was kind of weird, because my right butt cheek got a little cold. Quick as that, it was over. After the big bandaid was put on, he said "It's all done; you can get up now". Wow. I can still move around and walk! (Slight paranoia on my part).

The guidance now is don't do ANYTHING strenuous for two weeks, until the followup exam. All I feel now (seven hours later) is a little discomfort in my lower back. I think it's going to work. Maybe I can jump again....