?Downsides to facet joint injections? Help!

[dalhousie]

I just wanted to hear other people's opinions as I'm absolutely dreading further interference with my spine but I'm waiting for facet joint injections.

My history is:

2005 - Operation number 1: 11 admissions for various injections (including facets, epidurals, disc injections, facet nerve ablations) I had a fusion at L1/2 & made a full recovery.

2009 - Operation number 2: ADR with activ L.

I've had enough of hospital operating theatres especially when it's to do with my spine!!

After overdoing things last year, while still recovering from my ADR op, I haven't been able to get going again due to a muscle problem (which only occurs when I'm deconditioned) which I've previously treated with NSAID's which I can no longer tolerate. My specialist x-rayed me & the implant was OK but there was a facet joint which had quite a big gap between it & the others looked a neat fit together. He theorises that when I'm deconditioned my muscles aren't supporting this facet joint & causing me pain & inflammation in my back muscles. He proposes doing a facet joint injection to give my muscles an 8 week "holiday" so I can get more active. I really don't want more interventions when I've got my spine more settled from the disc/ADR perspective.

I'm stressing that it might affect the more settled situation with my spine or implant. I'm just worried generally. It won't affect my ADR in any way will it?

I don't know whether you have these meds in the US but after NSAID's I tried a Butrans patch for pain relief & when I moved up from 5 mcg to 10 that reeked more havoc with my IBS than the NSAID's did. I just take Co-codamol (30mg Codeine/500mg Paracetamol) as I'm OK with them but they're not very strong - when I have pain flare ups it affects my GIT tract badly - extreme nausea, diarrhoea, abdominal cramps & I look like a ghost (white as a sheet).

It's over 10 years ago since I've had a facet joint injection (which was before my 1st op) but when I had an epidural before my 2nd op (ADR) it really inflamed things badly for about 10 days which was hellish . If I remember rightly (as it was a long time ago) I don't think facet injections were as bad but I may be wrong.

Any thoughts or am I being paranoid? Please help.

[KBear]

Ruth, I had facet injections 4 or 6 months after my ADR because of residual pain. While they didn't help, I don't think they set my recovery back any (though I'm sure increased pain for a few days will happen- always has for me). I would definitely give it a try.

[Hooch]

Hi Ruth, sorry to hear you're still not getting relief after the adr op esp after going around the 2nd time..

Facet injections, I've had em, no probs, just make sure whoever does them is reputable. It's still a needle in the spine and some clown can stick it in a nerve. If they're not doing it under x-ray guidance I would find someone else pronto.. I think the x-ray would be pretty standard tho.

An over-distracted facet can be pretty damn painful. For the muscle side of things, have you worked on your multifidus? It is the major posterior stabilising muscle, and if you've had a lot of pain, it probably isn't working.

It should co-contract gently either side of the spine.. if u have no access to up to date physios you can buy 'spinal stabilisation' by Jemmet off Amazon for US$40. It can be a difficult muscle to retrain once it isn't working, I know from experience, and it will cause pain if it's not stabilising everything like it should.. esp if you have facet problems.

I'm sure the steroid will help, hope it gets you over the hump.

Chris.

[Cindylou]

Ruth, I'm having a facet injection on this Tuesday, and have had numerous in the past with no ill effects towards my spine. I think you should be just fine. Do make sure, as Hooch recommended, that you have it done under fluoroscopy. Good luck! Cindylou

[Justin]

Hi Ruth,

This should help answer some of your questions and give you a good overview of facet injections:

Pain Management: A Patient's Guide to Facet Joint Injections.

Good luck.

[dalhousie]

A big thank you for all the replies. It's all helped to reassure me. You only get a fairly short time with the specialist during a consultation & I thought he’d recommend some increased pain relief I’d be able to tolerate. I wasn't expecting him to say let's do a facet injection so I didn't get my brain into gear to ask all the questions I've been asking myself since.

Kathy – I found your post op ADR thread & found the bit where you had your facets injected which doesn’t sound too bad afterwards.

Cindylou – Good luck with your facets tomorrow. Will say a prayer for you tonight. I’m having mine done next Monday (21st).

Hooch – thanks for the book tip. Is that a really good book then? I do have a local physio who also teaches pilates so I'm hoping she is as clued up on these things as much as I need her to be. I’ve been paying for my spine treatment privately & my specialist is highly recommended & he will be doing it under x-ray control. I hope your recovery is going OK. I have read quite a bit of your post op thread but will catch up with your latest.

Justin – Thanks for the info. I did do a search which found other people’s reports of facet injections but what you have posted is good info which will help to put my mind at rest. I did dig out some old anatomy & physiology books I had but they’re nowhere near as good as the proper info you’ve got.

I’m hoping my specialist's theory is right & the pain generator is this facet joint with a gap in it that’s making my back muscles sore.

I'll be saying my prayers on Monday morning with avengeance as I haven't been eating properly for the past 8 months because the muscle pain has been aggravating my IBS making me very nauseous with abdominal cramps. I've had sores round my mouth because of a vitamin deficiency but they've cleared up now thankfully.

Thanks for listening. It means so much as I've felt in an increasingly bad place over the last 8 months. It's so frustrating as my spine isn't too bad now it's just my silly muscles or should I say silly facet joint.

[Hooch]

Hi Ruth, if your physio does pilates too she very likely knows her stuff. Mind you I was in the UK recently for the op and the hospital physios had no concept of muscle deactivation so who knows. Yes it is a very good book which sums up the most modern technique for rehabbing lumbar pain, written in simple language and is cheap.

I hope a steroid shot and a round of physio settle things down for that facet.

[dalhousie]

Mind you I was in the UK recently for the op and the hospital physios had no concept of muscle deactivation so who knows.

I'm surprised there weren't good specialist ADR physios where you were. In quite a few places the surgeon & physios tend to work together to get rapid post op results.

As long as you know what you should be doing though - that's the main thing.

I live some distance from my treating hospital & they don't do ADR ops in my immediate area but a new physio has set up in my town & she is pilates trained - she hails from your country & is a member of the Australian Physiotherapy & Pilates Institute.

[ajj1001]

Hope you managed to get some rest and are feeling a bit less sore today. x

[Cindylou]

I hope your injection went as well as expected Ruth. Keep us posted on its results. Thinking about you, Cindylou