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  • wendyltb
    Participant
    Post count: 7

    Hi. My history includes two discectomies at L5/S1, and a fusion at L5/S1 a couple of years ago. I’m doing fine from those. However, about six months ago, I began having deep pain in my left low back that radiates into buttocks and a little into posterior thigh that is:

    -worse with extension,
    -relieved by flexing forward and to the other side,
    -worse with sitting/driving,
    -initially relieved with walking but worse with long walking (>0.5 mile),
    -makes sleeping difficult,
    -doesn’t hurt when I cough or sneeze (like all my disc issues did)

    I also took a round of steroids for an allergic reaction, which helped my back A LOT for about a week. I have had other periods without pain sort of out of nowhere, but then it flares up. I have had an MRI, which doesn’t show anything compressing or any problems with my fusion hardware. I had an SIJ injection, which did not help me at all. It actually flared up the pain for a while but I never got any benefit.

    I’ve been seeing my neurosurgeon for this, and he has told me to take anti-inflammatory medications (Mobic), which I’m just starting, and that it must be some kind of inflammation. It seems to me that this could be facet syndrome of my lumbar area. A couple of questions:

    -Does it sound like possibly facet? I’m only 38 years old but used to be an ultra marathon runner (many thousands of miles on my back)
    -Would this most likely be the facet joint ABOVE my L5/S1 fusion (I’m assuming the fusion would keep the facet from being inflamed?)
    -Is my best bet to go to a reputable pain management physician instead of my surgeon?

    This pain is really affecting my quality of life and ability to sleep/do what I want. Thanks for your help!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    You are succinct and correct in your evaluation. Your pain certainly could be facetogenic and the first thing I would do would be a diagnostic and therapeutic facet block at L4-5. I would initially go bilaterally. With good temporary relief, you could be a candidate for radio-frequency ablation (RFA-sensory nerve ablation). Hopefully your neurosurgeon would recommend this direction with your evidence but if not, seek out a well-regarded pain management physician. See https://neckandback.com/treatments/facet-blocks-and-rhizotomies/

    Dr. Corenman

    wendyltb
    Participant
    Post count: 7

    Thank you so much! I feel like I have had to solve this mystery myself. I will let you know what happens.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Thank you

    Dr. Corenman

    wendyltb
    Participant
    Post count: 7

    Hi–as an update, I saw my surgeon’s PA last week and he agrees this may be facet joint pain. He has referred me to pain management next week. He said the facet pain could be coming from the fused segment (L5/S1) or the level above. If that’s the case, how will they know which to inject? I was thinking it could not be the fused level, as the fusion would keep it from moving?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    A well fused level will not cause facet pain due to the lack of motion of the segment, especially if the fusion included a posterior fusion. By definition, the facet joints are ablated by this procedure. Without seeing imaging, I would consider blocking the L3-4 and L4-5 facets diagnostically.

    Dr. Corenman

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