Viewing 6 posts - 7 through 12 (of 16 total)
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  • exercise453
    Member
    Post count: 53

    Hi Doc,
    I anticipate c2-c3 and c3-c4 facet blocks next month. My current PM Doc will not burn the c-2 medial branch because he feels it is too risky but he has no problem pulsing the c-2 level and will do so if the blocks provide the significant relief. He would then burn the nerves below. I do believe this board certified, long time PM doc is both experienced and skilled. Yet some doctors will burn the c-2 level without hesitation. After all the frustrating obstacles from the insurance companies it is depressing choosing between what might be a less effective method or the revolting chore of starting over with another Doc. Also top doctors I would definitely switch to are either not on the network or perform what is done as an in office procedure in expensive surgical centers.

    Is there anything at all that makes the radiofrequency burning of the c2-medial branch more risky than those below in your opinion???

    Would you recommend waiting and finding a Doc that will burn the c-2 level or would you go ahead with what I have now.???

    As always
    thanks Doc

    Donald Corenman, MD, DC
    Moderator
    Post count: 8427

    I cannot comment on this physician and his choice of pulsed “disruption” vs. an actual rhizolysis. I can tell you that pulsed disruption is probably less effective but safer than rhizotomy. Possibly this individual had a problematic experience earlier in his career and wants to stay away from C2. I do know many docs who have no hesitation with rhizotomy of the medial branch of C2.

    Dr. Corenman

    kristina76
    Participant
    Post count: 8

    Hi Dr. Corenman,

    Somehow I missed your response to my last post from a few months ago. Sorry about that!

    I haven’t had much relief from facet injections into C2-3, C3-4 (except for one time), but I can tell that they are hitting an area of pain for me when the needle goes in and I have all the symptoms of facet pain- cracking, tenderness to palpation over facets, degeneration on x-rays, can’t turn my head, headaches, severe spasms, etc.. I can literally feel the facets grinding on each other.

    Any thoughts on why I may not be responding optimally? I know it’s not disc pain or severe instability. Have you seen anyone who did well with rhizotomy even if they have not responded as expected with the injections?

    I had asked you previously about the benefit of Cat Scans. Coming from a surgical stand point, if I were to consider a minimally invasive procedure at some point, would it be of benefit to have a Cat Scan to see if there are bone spurs rubbing on nerves, or foraminal stenosis, or should that have already shown up adequately on my x-rays and MRI?

    Is there a minimally invasive surgeon that you could recommend that is close to Mass? I’m having a hard time finding one that isn’t a long distance away. It would be good to have someone thoroughly look at my tests and give me their opinion. Do you ever look at exams and give a consult over phone/email?

    Help!! ;)

    Thank you,

    Kristina

    Donald Corenman, MD, DC
    Moderator
    Post count: 8427

    The results from facet injections are “diagnostic and therapeutic”. This means that two different substances are injected, a numbing agent like Lidocaine and a therapeutic agent like Kenalog (a steroid).

    The first three hours should have given you good temporary relief if the injection was placed in the correct location. This is the diagnostic portion of the injection. Good relief for three hours confirms the diagnosis of facet syndrome. If this is the case but you did not gain longer term relief (the therapeutic reaction), the diagnosis is still confirmed but these injection will not manage your symptoms.

    If that is the case, you are still a candidate for rhizotomies.

    There are occasional situations where the facets are highly degenerative but the injections yield no relief. This is where the facets are so deformed due to wear, there is bone pain present. Bone pain might not yield relief from these injections. This is where a CT scan can be valuable. The CT will indicate significant bony damage to the facets.

    Forget “minimally invasive” surgeons as this is a catchword that really means nothing. You need a great, experienced surgeon for this disorder, not a “minimally invasive” one.

    Dr. Corenman

    exercise453
    Member
    Post count: 53

    Doc Did not understand one thing in your last answer to Kristina76 just above.

    If the cervical facet block yields only minimal to mild relief over the next three hours and a CT scan shows “significant bony damage to the facets” does that mean go ahead and have the rhizotomy or do not have the rhizotomy.

    Thanks as always

    Donald Corenman, MD, DC
    Moderator
    Post count: 8427

    If there is good temporary relief from the facet blocks (about three hours), then the patient is a candidate for a rhizotomy. There are insurance companies that require relief from intracapsular facet blocks and medial branch blocks (numbing the actual nerve but not entering the facet capsule) before they will approve a rhizotomy.

    Dr. Corenman

Viewing 6 posts - 7 through 12 (of 16 total)
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