Congenital Spinal Stenosis of Lumbar Region and Radiofrequency Ablation scheduled for 8am June 6, 2022

Back and neck pain can be very frustrating whether the cause is muscular, nerve, or skeletal. I know that sounds lamely simplistic, but no matter how many fancy adjectives I could use to describe it, if you have had or are currently experiencing it, those fancy adjectives don’t matter because pain is just pain. I now use a cane if I must walk a long distance which is relative because for me walking to and from the living room to the kitchen can sometimes qualify as “a long distance.” Standing is even worse. There are days I can’t stand for more than 10 minutes without my lower back seizing up and requires me to sit down immediately. Last year at this time I was enjoying cooking almost nightly, but right now I just can’t tolerate it.

In August 2017, throughout the course of one random day, my lower back tightened up like a vise was squeezing the muscles on both sides of my spine. I was hunched forward; my gait was shuffling. This was the first time I had a lumbar MRI and it was jaw dropping.

When I saw my OBGYN for a hysterectomy in November 2017, she brought up the scans and said, “After you take care of this, you need to take care of that” pointing at the computer screen with the MRI scans glowing. When an OBGYN can look at an MRI scan of a spine and see the problems happening within it, that’s got to be serious because really, how many times do OBGYNs look at spinal MRIs? This was when I and all of my medical doctors learned I was born with a spinal canal, the tube of fluid in which the spinal cord, vertebra, discs, and nerves call home, that was narrower than the average diameter of a spinal canal. This accounted for the severe pain because my nerves were being crowded, discs were herniated and bulging, and bones that shouldn’t be touching each other were doing just that.

I completed physical therapy and had a steroid injection under fluoroscopy so my physiatrist could place medicine in between the back side of two lumbar vertebrae and then guide the tube with medication through my pelvic bone and place medicine in the front side too. Within two weeks, it was if none of the pain, strain, agony, and doubt had never happened. It was a miracle.

With that congenital deformity of my spinal canal, I was told to be prepared for worsening problems the original MRI showed, especially as I aged.

I saw my new Nurse Practitioner in July 2021. This was a random physical to establish care in Green Bay. A Rheumatoid Factor was ordered as part of the lab work and the result was slightly elevated. The whole healthcare system in Green Bay appears to be based on “referrals”. My NP had to “put in a referral” for me to see a Rheumatologist who eventually “put in a referral” for me to be seen by Neurology/Pain Management. Referrals weren’t part of my medical process at all when I lived in Menasha. My experience with them in Green Bay is that “referrals” are something that just eats up time, making it longer before you can make an appointment to see another doctor.

My new Rheumatologist looked at my 2017 MRI and ordered another. This is when the process leading up to my Radiofrequency Ablation tomorrow, 06/06/22, began.

New lumbar and cervical spine MRIs. I tried to circle the  areas of greatest concern  in my lower back in red, but my tech skills limit me from doing so.

I learned a whole bunch of new anatomy and physiology terms such as “ligamentum flavum thickening”, “cauda equina nerve roots”, and “posterior epidural lipomatosis” after this MRI.

        1.     Ligamentum flavum thickening causes stress placed on the spine; the thicker it becomes, the higher the risks of compressing the spinal cord or spinal nerves

2.     Cauda equina nerve roots are nerve roots from L2, lumbar disc 2 in the lumbar spine down to Co1 in the coccygeal (tailbone spine)

3.     Posterior epidural lipomatosis is excessive accumulation of fat (that has nothing to do with my diet, it’s not that kind of fat) in the spinal epidural space resulting in compression of the thecal sac 

                 a.      Thecal sac is the outer covering of the spinal cord

b.     Spinal epidural space is the area between the dura matter (membrane) and the vertebral wall; space located just outside the dural sac which surrounds the nerve roots and is filled with cerebrospinal fluid

Again, I tried marking where I’m having the nerve ablation, which is where the doc will burn off the nerve endings with the goal of ending pain in these areas of my lower back but due to tech issues on my part I can't show it.

Areas I wanted circled in red are arthrosis of the bilateral facet joints:

1.     Facet joints: located at the back of the spinal column; there are two facet joints between each pair of vertebrae, one on either side of the spine; a facet joint is made of small, bony knobs that line up along the back of the spine

2. Arthrosis: when cartilage and capsules containing fluid attached to the facet joints wears down over time or becomes damaged, the facet joints may rub against other spinal bones or joints

Am I scared about tomorrow’s procedure? Fuck yeah I am. Despite all the medical understanding, descriptions, necessity and low risk for complications, my doc will still be burning off the end of little nerves inside my spine. That’s not natural. It is, however, necessary if I want some longer-term pain relief than what physical therapy and trigger point injections have provided.

I would not be myself if I didn’t include this final image from my cervical spine MRI. It’s a front image of my neck…and there’s a brain in there! Always reassuring.