Foraminal stenosis: what if completely stenosed?

[ans]

Hi. I have extensive DDD, blown facets, and one UCLA doctor told me that I'm inoperable.

I have severe spinal stenosis at L4-L4 *and* S-I joint pain that's controlled by epidurals.

My concern is that I'm autofusing and if I do autofuse, what happens to the stenosed foramens? Obviously, they will get clogged by osteophytes and apparently one/more facets that block them.

If the MRI says that I have "severe" foraminial stenosis now, what then? Would Neurontin or other anti-epileptics control the unbearable (and weird) pain and do I risk having the nerve torn to pieces by the ostephytes and being permanently number at that level?

So this is what I'm getting opinions about next week and I do not think that I am a candidate for a foraminotomy-hemi-facetomy as my discs are totally flattened.

Thus, I may have to go for a multi-level fusion.

I could spend the rest of my life trying to figure out why multi-level fusions don't help back pain.

So: What happens if the foramen(s) are completely stenosed. I suspected that I'm screwed.

Thanks and best to all.

ans

[Harrison]

Alan,

Sorry for the late response. Indeed, you have some spine challenges. You and I have talked about some of this, but at a minimum, consider:

- Getting a more thorough work-up for metabolic dysfunction(s). Some spine docs are performing these blood diagnostics for both pre and even post-op patients, trying to assess any problems in D dysregulation, parathyroid or blood chemistries that could be related to bone turnover & growth. This may not help pinpoint a localized vertebral osteoporosis problem, but these are possible data points that may help them in their diagnosis;

- Given your problem, a team approach may be wise, e.g. consulting with these kinds of medical professionals: spine surgeons, interventional pain mgt docs, functional or integrative medicine docs, nutritionists, naturopathic docs, immunologists, etc.;

- A rheumatologist would normally be a good professional for you to see. But I’ve observed that in advanced cases, they don’t do much for the patient – other than give you drugs. For that reason, I created the Q & A with Dr. Katherine Poehlmann, an arthritis patient that “figured it out” and wrote a book about various arthritides, especially RA. This book is cheap but is a veritable goldmine of information to help any arthritis patients – especially those with arthritic spines.

- At this point, it may be that you need a combination of therapies; surgery to remove any severe impingement on nerves; and various therapies to quell the inflammation. That may sound obvious, but it implies that you reach out to docs in these different disciplines.

Sorry bud. No magic wands from me, just more things to read…more calls to make. Hope this helps in some way. What appointments, if any, are pending for you with medical professionals?

[ans]

Thank you Harrison. No "magic wands"? I was hoping for shamanic healing from you? Appreciate your input lots. - ans