Facet Joint Degeneration and ADR

[mark-Perth]

With the Discoblock U would have to have it done several times to determine the results correctly.

Each level would need to be injected individually about a week apart so U could determine the pain from each disc.

U would then have all disc's injected at one time to also determine how much pain relief U will get by having surgery to all effected discs.

By doing it this way U will be able to tell the max pain relief from having surgery but also which levels R causing the most pain.

This should also help determine how much pain is coming from other factors such as the facets and whether an ADR will at all help.

The down side of discography is that it may come up with a possitive pain result but it is still undetermined how much pain comes from other source's which often lead's to unsatisfied patients after surgery as it only partially reduces the pain.

This is a huge reason why some people have surgery that looks perfect without any complications but it doesnt resolve all the pain issues as there were other pain source's. The discoblock reduces the chances of this happening

Here is a link to an article on it that may help
http://www.medscape.com/viewarticle/705839

It can also be done at the same time as a discogram but isnt as effective as by itself as U also have some pain from the discogram that effects the results but is still worth having as the needle is already in place.

When done by itself w/out the discogram they can also use a smaller needle which helps and the disc isnt pressurized so I didnt find that it caused much pain and was easier to guage what pain relief was given.

I also had it done a 2nd time just to make sure the results were correct and a placebo effect hadnt occurred as that is definately possible.

All the best

Mark

You are right. My surgery last March didn't resolve the pain after everything settled down. The nerve burning exercise didn't help either and only made it worse. Both of which were suggested by my surgeon. It seems more like it's been a very painful "process of elimination" to see what's the primary cause of my back pain.



That's a great idea, Mark, I will definitely ask about the discoblock before they do the discogram. I appreciate your bringing it up since my surgeon did not suggest it and I was not aware of the test. It sounds a whole lot better than purposely provoking pain

The sad reality is that I'm already facing the rest of my life in pain. Believe me, however, I get that I don't want to make it worse.

Thanks ... K

[Jack-of-all-trades]

Michael,

I took a look at your x-ray and cringed. Dang.

I had to chuckle when I read your suggestion on using your assets and standing in front of the door to get all your questions answered. I always go in with a list of questions. The trouble has been that I don't always know the right questions to ask, the answer I received was vague or the question was ignored entirely.

Curious about a couple of things:

• How painful was your discogram (next thing on my list)?
• How many ADRs did Stenum recommend for you?

Please let me know how things progress for you as you heal from your recent surgery.

Thanks for your input ... K

By the time I got to the disco-gram stage, I was not a green, deer-in-the headlights back pain sufferer. Some docs want to do it without IV sedation at all. Not mine. If yours insist on this method (no sedation), find someone else. It hurts enough without being tortured. You are the patient and the boss of your body. Don't let them forget it. The whole disco-gram thing can be a controversial test. Some studies I have seen say with MRIs and specific to a single location test, the disco-gram is not needed. It is subjectively dependent on the the experience and skill of the doc doing it. If you are young with only one disc involvement, there is little need to have this "proof". I would also recommend that the test be done by someone other than the future surgeon to be totally objective.

Stenum was suggesting only L5-S1. Once I got there, if more were thought to be of benefit, we would talk about it.

[scduggan]

Dear Kathleen,
Here I am sticking my big nose in again. I am posting because I believe so strongly in Jack of all Trades post. My neurosurgeon ordered my discogram to be done at an imaging facility owned by the Neurosurgery group. Out of sheer luck, I could not get my schedule to work with theirs without waiting. Long story short, I ended up going to an independent imaging facility and the Head Hauncho performed my test. I cannot take credit for this good fortune. Also, my disogram was performed with a little something wonderful in my IV. It was not a big deal. My anticipation of the procedure was much worse than the reality. The only downside was I did have about three days of some pretty stout soreness afterward. There must be different methods for administering this test. Follow Jack's advice. You will be coherent and able to report on what you are feeling. The good stuff in the IV just makes it a little more humane. Good Luck!
CD

[mark-Perth]

Let me clarify what I have said.

I have not at all said not to have the discography. Discography is an essential part of the diagnosis which shouldnt be missed out but the discoblock can be done directly after the discography thru the same needle.

The discoblock is a long acting anaesthetic injection that should give several days pain relief. It also helps relieve any pain after the discogram which may be of help 2 some it seems!

By having several days pain relief it is much easier to guage the pain levels over those days instead of on the spot like discography.

Part of the problem with discography is the pain level is subjective due to there being no meter to read about how much it hurts and it doesnt help that the discs that R damaged cause alot of pain when they R pressurized. When the Dr asks how the pain is its natural to think that its the pain U usually suffer and it may well be part of it but discography is only focused on the disc and nothing else so it wont allow U 2 know if there was also pain elsewhere at that time.

A normal undamaged disc is usually done at the same time to be able to used as a guide to pain levels which shouldnt hurt much.

I also dont see how U R going to be able to give a proper answer to the test if U R sedated. Unfortunately it seems that as men get older they whinge alot more about the pain. I hope I dont have that coming! If a women can give birth U can do anything I feel.

I still remember the first time I had R/F done back in 1997, it was done w/out any sedation at all and the guy who was sharing my room before me burst into tears when I told him what I was having done. He said he had just had it done and that it was the worst experience of his life. 2 me it wasnt a problem at all and I went thru many more just like it w/out any anaesthesia. His concern didnt help me at all though, they just made it worse.

Everyone has different pain thresholds with it effecting some and not others. It will definately hurt U more though if U fear it and expect it to hurt.

In Aus they give U a drug afterwards to wipe your memory so U R unaware that U were in pain. U just have the feeling like a big needle had been in U. Combine it with the discoblock and U feel like nothing at all's happened, if anything U fell pretty good.

The biggest problem with discography's accuracy is usually related to whether there R any other pain sources as well as the disc.

There R many people that have surgery after having a positive discography result and still have pain due to there being more problems that werent originally noticed. How is that going to help apart from put U thru more surgery?

Before my surgery I had the discography and discoblock first then later had another discoblock by itself just to confirm that I was 100% sure that the pain was coming just from the disc only.

Both times I was totally free of pain for several days which proved that the source of my pain was just the disc and nothing else.

In cases where there is possibly some facet issues the discoblock would definately be helpful I feel.

Im going to leave it at that. im not here to argue with any1 whats the best thing to do but just pass on what I have been thru myself and whats helped me. Its up 2 U what U do about it in the end. Just dont let any1 push U into making any decisions that U dont want to make. Make up your own mind based upon what U feel is best for U as U R the 1 that has to live with it, not any1 else.

I honestly dont believe that it is anyones job on here to tell some1 whos advice they should take! Thats upto U.

All the best

Mark

[Cindylou]

Is the disco-block available in the US? I have never heard of it. Thanks for the valuable information Mark P.

[WPKat]

By the time I got to the disco-gram stage, I was not a green, deer-in-the headlights back pain sufferer. Some docs want to do it without IV sedation at all. Not mine. If yours insist on this method (no sedation), find someone else. It hurts enough without being tortured. You are the patient and the boss of your body. Don't let them forget it. The whole disco-gram thing can be a controversial test. Some studies I have seen say with MRIs and specific to a single location test, the disco-gram is not needed. It is subjectively dependent on the the experience and skill of the doc doing it. If you are young with only one disc involvement, there is little need to have this "proof". I would also recommend that the test be done by someone other than the future surgeon to be totally objective.

Stenum was suggesting only L5-S1. Once I got there, if more were thought to be of benefit, we would talk about it.

Jack-of-all-trades and CD,

Hahaha, I'm not so green anymore either, but I certainly feel like a deer-in-the-headlights when it comes to ADR. How in the world does one weigh the bad results against all the patients who had excellent outcomes?

Aside from back surgery, I have been through facet joint injections twice as well as radiofrequency thermocoagulation on 4 spinal nerves on my left side. There is absolutely no way on this planet I would ever allow anyone who wants to purposely provoke pain in my spine to touch me without conscious sedation. No worries, however, as sedation is common practice here and they are quite liberal with it. I only wish I could take it home with me since each procedure was followed by a sharp rise in pain afterwards (especially the latter).

My pain specialist would perform the discogram and the firm is not owned by my surgeon or his office. Otherwise, I would definitely feel it was a conflict of interest. Also, he hasn't done enough ADRs for me to consider letting him operate. However, he was kind enough to put my case before a panel for a second opinion on ADR and to suggest a discogram before making my decision.

I'm not sure if they offer discoblocks because it's not listed as a procedure they do on their Website, but I will find out soon enough and let you know. If they do them here in Alaska, they most certainly would do them in the lower 48.

I appreciate all your input!

K

[scduggan]

Dear Kathleen,
You are doing a great job of researching. I can also tell from your posts you are a tough cookie! Please forgive me if I sounded like I was trying to tell you what to do. I am way too unqualified for that. When I found out a discogram did not involve big hair, blue eyeshadow and a mirror ball-I kind of freaked out. I would have loved it if a few people told me before the procedure that it was not that bad. I don't remember having a choice about whether or not to have the test. All the research we do and medical opinions we receive can help alleviate our worry. We all know ADR is not perfect and definitely not a fix-all. Sometimes you find yourself at a crossroads and have to make tough decisions. I never got a letter in my mailbox from God about what to do......still looking for it. I am a believer and have been very prayerful...all the while knowing God has my back. The best thing is that you are making progress in the right direction. You are just around the corner. Please keep us posted!
CD

[WPKat]

Dear Kathleen,
You are doing a great job of researching. I can also tell from your posts you are a tough cookie! Please forgive me if I sounded like I was trying to tell you what to do. I am way too unqualified for that. When I found out a discogram did not involve big hair, blue eyeshadow and a mirror ball-I kind of freaked out. I would have loved it if a few people told me before the procedure that it was not that bad. I don't remember having a choice about whether or not to have the test. All the research we do and medical opinions we receive can help alleviate our worry. We all know ADR is not perfect and definitely not a fix-all. Sometimes you find yourself at a crossroads and have to make tough decisions. I never got a letter in my mailbox from God about what to do......still looking for it. I am a believer and have been very prayerful...all the while knowing God has my back. The best thing is that you are making progress in the right direction. You are just around the corner. Please keep us posted!
CD

CD,

You are the first person to say that the discogram was not that bad, and believe me, I do appreciate hearing it. Up to now, I have only heard two bad experiences. And no worries, I didn't get the impression you were trying to tell me what to do at all.

When I'm in a lot of pain, I sure don't feel much like a tough cookie. I've been through a lot because I believed that whatever I was having done would get rid of the pain and I would get my life back. Obviously, it hasn't worked out the way I thought it would.

Hey, I am waiting for my letter from God telling me what to do as well.

Thanks for your input!

K

[Cindylou]

Amazing stuff.

[Lynda]

Hi Kathleen,

I find your thread interesting as I have developed facet joint degeneration after my lumbar surgery.

I have facet arthrosis at the level of my two lumbar ProDiscs unfortunately. It seems the theory that disc replacement prevents further degeneration is not so in my case. My Lumbar surgery was six years ago and was a great short-term success. On my two-year x-rays there was evidence of the further degeneration but at that time I was asymptomatic, however, as time has passed, there has been progression of my degeneration to the point that it is now throughout my lumbar spine up to the thoraco-lumbar junction. The ProDiscs themselves are working fine but I have facet arthrosis at those levels and the adjacent segment degeneration (the four levels above the prostheses are involved - too much for any further surgical intervention I'm told). I believe this is a natural progression of the disease although I have no way of knowing if it is an acceleration of the degeneration; I have no regrets about undergoing the surgery, I am still currently better than I was prior to the surgery most of the time. Only time will tell whether I continue to worsen or not.

I have been offered radiofrequency ablation (which I've declined for now) and am due repeat facet blocks in a couple of weeks time. I believe devices which address both the disc and the facets will be helpful in situations such as mine but there seem to be few surgeons undertaking such procedures at this current time. The evolving facet replacement surgeries, which are in their infancy, look very interesting. I am not unique but am in the minority as the abstracts Justin posted mention. That said, I still feel I am fortunate to have had the oppourtunity to have both my lumbar and cervical disc replacement surgeries and have no regrets at all.

I wish you all the best in your quest for pain relief, don't stress about the discogram, yes it hurts but it's over very quickly, see it as a means to an end. Many of us have been through them and survived, if you're not sedated just take a deep breath and try to relax as its easier to get the needles in if relaxed. Do let us know how things progress.

Kind regards

Lynda