[Donald Corenman, MD, DC]

#8931

Failure of the rhizolysis should not be based upon a two month separation between the C2 and the C3 facet burning.

I do not understand this physician’s injection strategy by not using an anesthetic in the injection. The lack of anesthetic negates the diagnostic use of the injection. There are many patients who do not obtain long term relief of pain with the steroid but at least the diagnostic portion of the injection (lidocaine) will confirm the presence of the disorder.

Maybe a new set of eyes from another injectionist might be something to consider.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[exercise453]

#11298

Dear Doctor,
I must first apologize for having so many threads. With diffuse pain generators and varied causes it somehow just evolved in this disjointed way.

I am scheduled for a left side c2-3, c3-4 medial branch block. The insurance requires only one block. I asked the doctor if it would be a 3-4 hour block. I was surprised when he said “maybe I will do a light block (lidocaine), it is fast acting and we know right away”. When I questioned it he said we could just as well do the long acting (marcaine). You always refer to the longer block with pain diary.

Will the short acting block yield just as accurate results or should I request and do you recommend the longer acting block????

Also the doctor said he would put some steroid for therapeutic value. I had injections of steroid directly into these facets in the past with no benefit at all. Is there a better chance of pain relief when the medicine is injected directly on to the medial branch versus into the facet joint????

And finally will the steroid in any way complicate the accuracy of the diagnosis of this long standing issue???

As always, thanks so much

[Donald Corenman, MD, DC]

#11310

Including the steroid in the injection should not affect the results of the injection.

Using lidocaine in my opinion is about as good as using marcaine. The block might be shorter by an hour (2-3 vs 3-4) but the results of the block will be the same-pain relief for that time the medication is active.

Probably the injection inside the joint with steroid will be better for longer term relief than the injection of the medial branch nerve. That is my speculation and there are no studies to prove that assumption.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[exercise453]

#11378

So I finally had the c2-3, c3-4 diagnostic block. (lidocaine + a little steroid). The block produced little to no pain relief.

The office kept me 45 minutes checking in periodically. Levels never went below 31/2-4. They started at 41/2-5. The level never went below 3-31/2, (rarely goes lower) in the next few hours and the pain was easily replicated by tilting or turning left or right and back and circular.

To refresh there was a weight lifting and a jogging fall 9 years back. 3 years ago I had a c3-8 radiofrequency with mild relief and it revealed pain above that as well. 2 months later I had a c2-3 marcaine block. THERE WAS NEARLY 100% RELIEF. After the subsequent radiofrequency I felt great for a month. Then I was hit in the rear while stopped at a traffic light. It was a minor jolt…(I needed a new bumper). Within a week or so symptoms returned. I never believed it was the jolt and that the procedures were just short lived but I do not really know.

For near 2 years I have wanted c2-3 and c3-4 blocked together. And now it has been done but…… There are bulging discs at c3-4 and c4-5, both with “moderate left lateral extension” but I do not think nerve pain is causing the troubling symptoms………..i think the facets are badly degenerated, the discs are degenerated and in certain positions I can reproduce non painful clicking. I thought this failed block was the end of it until the Dr said something strange…..

He said we could try the block one more time with a different anesthetic (marcaine) which still might identify the facets as pain generators. 2 years back when c2-3 was blocked it was with MARCAINE and the relief was nearly 100%. Back then I do remember one other block done with lidocaine and there was no pain relief.

In your opinion can the different anesthetic (marcaine) still identify these facets as pain generators whereas the lidocaine failed to do so??? In your opinion is it worth one more diagnostic block into these painful levels with the different anesthetic???

As always…thanks and gratitude

[exercise453]

#11379

One more thought as to whether to go again. If the c2-4 block is repeated it would add c4-5 which has been noted as a pain generator by a prominent surgeon (no weakness) and is the worst looking of all levels on MRI. It is possible that pain from this adjacent level diminished or prohibited benefit from the block. I do not know but as all the lidocaine blocks I’ve had in the past I get a few days of relief in the treated levels. So today the c2-3 and c3-4 levels are quiet revealing the painful, uncomfortable left c4-5. Same question as above.

[Donald Corenman, MD, DC]

#11394

If you gain relief from marcaine, then lidocaine should give you similar but shorter term relief. No relief from these blocks (in a well performed injection procedure) rules the facets out as pain generators.

Pain generation can occur from structures other than the facets. Disc pain can also simulate pain in the upper facets. If your pain has been substantial and not tolerated, you have failed facet blocks and previously rhizotomies, you might conducer a surgical work-up. This might include discograms, SNRBs or epidural injections.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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