Question
I am a 37 y.o female who has been suffering from low back pain for about 5 years. I have been treated by the same Dr. throught the whole ordeal.

I have received the following treatment:

1. Years of pain medication that I developed a physical dependence on and am now taking Suboxone.

2. Countless rounds of Prednisone.

3. Epideral Injections.

4. Nerve Block.

The MRI I was given on 2/25/09 reported the following:

TECHNIQUE: Lumbar Spine MRI was performed at 1.5 Tesla utilizing sagittal T1, sagittal T2, axial T1 and T2 sequences.

FINDINGS:Sagiital sequences demonstrate no destructive lumbar vertebral lesion, compression fracture or paraspinal mass. The conus terminates at T12-L1.
T12-L1 through L2-3: Normal disc signal and height. No disc protrusion or annular fissure. No canal stenosis or foraminal stenosis. Facet joints are unremarkable.
L3-4: Normal disc signal. Facet joints bilaterally have mild arthropathy. Thecal sac midline AP diameter is approximately 11 mm. No forminal stenosis.
L4-5: The disc is midly desiccated and slightly diminished in height. A broad-based posterior protrusion measures approximately 3 mm AP. There is a tiny right foraminal height T2 signal annular fissure best appreciated on image 9 of the sagittal T2 sequence. Facet joints bilaterally have mild to moderate arthropathy. Central canal stenosis is present with thecal sac midline AP diameter approximately 9mm. Mild foraminal stenosis bilaterally secondary to foraminal disc bulging along facet joint hypertrophy.
L5-S1: The disc is desiccated and moderatley diminished in height. There is diffuse annular buldging. A poterior central high T2 signal annular fissure is best appreciated on image 7 of the sagittal T2 sequence. There is no compression or displacement of the S1 nerve roots. Facet joints bilaterally have mild to moderate arthropathy and there is a mild degree of foraminal stenosis due to a combination of diminished foraminal height, minimal foraminal disc bulging and facet joint hypertrophy.

IMPRESSION:

1. Mild L4-L5 lumbar canal stenois is due to a combination of a broad based posterior disc protrusion and facet joint arthropathy. Thecal sac midline AP diameter at this level is 9 mm.
2. L5-S1 diffuse annular disc bulge with T2 signal poterior central annular fissure.
3. Small right foraminal L4-5 annular fissure.
4. Mild foraminal stenosis bilaterally at L4-5 and L5-S1.
5. Moderate L5-S1 disc degeneration. Mild L4-5 disc degeneration.
6. Mild to modrate facet arthropathy bilatterally at L4-5 and L5-S1.

SYMPTOMS:

Extreme low back pain with weakness on right side. I can not lay flat on my back or on my stomach. I have to sleep sitting up with the aid of sleeping medication and can only relieve the pain by putting myself in the fetal position. I have to urinate (urgently) at least 4 times a night (I am woke up by the urgency) and at least 4 times during the day. This is new within the last couple of months with the increased pain.

My current Dr. wants me to have a Neurotomy. Is this an appropiate treatment? Is this the ONLY treatment that I should be receiving?

Answer
Chris,
SICK!!! You need to find a new doctor and fast.  Can you send me any of the pics from the MRI?  Do you have any X-Rays or MRI of your Cervical Spine as well?  Please include your location so I can see if I may be able to you or at least find someone else who can.
In Your Best Health,
Dr Robert Arnone
Upper Cervical Specific Doctor
"Brainstem Specialist"
Arnone Clinic
711 Old Ballas Road Suite 104
St Louis, MO 63141
(314)995-5719