RE: Waiting vs. Proceeding with Surgery (Facet Injections)

[SemperFi]

I'm not sure if this post goes here or not but here goes:

I was recommended to have 3 level lumbar global fusion in '98 and was glad I waited.

I was recommended to have a 2 level ADR (trial) in '03 and waited (scared of trials).

I was recommended to have a fusion at L5S1 and ADR at L4 in '06 and waited (still too scared) and by then seemed to be doing ok on low dose pain med.

Ok so this past month my back has been aching quite a bit in a.m. and have difficulty squatting as well as bending because of pain.

Saw my OSS yesterday, he did an xray and said that I now have facet degneration too badly at L4 and L5S1 for ADR and the good news is that L5S1 appears to have nearly autofused so that level shouldn't be giving me much pain now. I have actually felt that it hasn't hurt nearly as much that low anymore and I can sit a bit more and some other things tho having pain at waist level posteriorly which is higher than I normally have it.

ESI was ordered as I get good relief with these and I wondered if my facets now look so shabby what about facet injections? My PM hasn't thought them necessary and nor have I even considered them ever but I now wonder...

[Katie]

You are certainly one of the lucky ones. My pain has done nothing but grow the past four years, and I am hoping to finally get a doctor who will do adr, if it isn't too late. I think it is borderline. If I had this offer a year and a half ago, I would have gone with the ADR in two levels, but not three.

My fear is that I was forced to wait too long for my preferred treatment. If you question is whether to get facet injections or let them wait again too, I think I would go ahead with the injections. What if you run out of options? Can you still have the facets burned off, have the nerves made nonreactive if you wait? Maybe that would be another question to ask.

I am not a fan of too many steroid injections., if that is what you mean. A little is good, a lot is questionable in my opinion, but you need to do more research, not just go on my word as I don't have the science behind it.

I am very happy for you, that you havebeen able to avoid serious surgery for so long, and that your pain has not been overwhelming. I hope you get better answers than what I provided.

[Justin]

ESI was ordered as I get good relief with these and I wondered if my facets now look so shabby what about facet injections? My PM hasn't thought them necessary and nor have I even considered them ever but I now wonder...

Hi Maria,

It's a bummer to hear that your facets look worse in your lumbar spine. If you are having pain from your degenerated facets, theoretically facet injections (medial branch blocks) could help. If your blocks are successful at relieving your pain, a radiofrequency neurotomy could subsequently be done to provide you with "long-term" relief. This would be a great discussion to bring up with your pain management doctor again, especially based on your recent findings.

Here's a link to a previous discussion on SPS about Facet Rhizotomy (Radiofrequency Ablation).

[KBear]

I don't see what it would hurt to just have the injections. I'm having my first post-adr facet injections in 2 weeks, to see if that is what is causing my remaining pain. They have never worked before; but figure might as well give it a try.

[Justin]

Maria, Kathy brings up a good point about having the diagnostic facet injections. It might be worthwhile to look into having the facet injections done to help determine if they are implicated in your pain, which they very well may be due to the significant level of degeneration that you describe.

If your facets are established as being pain generators, it is a good "springboard" to look into other procedures like facet rhizotomy that might provide you with "long-term" relief.

Keep us posted, as we do care.

[KBear]

Maria, Kathy brings up a good point about having the diagnostic facet injections. It might be worthwhile to look into having the facet injections done to help determine if they are implicated in your pain, which they very well may be due to the significant level of degeneration that you describe.

If your facets are established as being pain generators, it is a good "springboard" to look into other procedures like facet rhizotomy that might provide you with "long-term" relief.

Keep us posted, as we do care.

I had a facet rhizotomy pre-ADR and got no relief. This along with the discogram, was used in determing that my pain was from the disc and not the facets and thus I was a good ADR canidate.

[SemperFi]

Just an update now that it's almost December 2009

Because I have gotten good relief with transforaminal ESIs at L4 my PM thinks my pain is mostly from this disc.. he ordered one as early as late August but with 2 denials from WC I was advised I could only have 2 ESIs/year now so I had already had 2 done this calendar year.

I went a few months w/o any significant back pain and then it flared up terribly because I switched shoe inserts (inserts for pronation) and also was unable to get my daily Forteo injection for nearly 2 weeks due a faulty pen and Eli Lily not replacing it sooner.

Now I'm status quo pretty much and not flared up tho as soon as I say that I'll probably spin right into spinal unpleasantness

thanks for the suggestions re diagnostic facet injections ~ I'll ask my PM about them next time I see him which is Feb I think (every 3 months).

[Justin]

Hi Maria,

Thanks for the update. Sorry to hear about your recent flare-up. I hope the holidays are relatively pain-free for you.

Please let us know if you need anything.