Neck and Shoulder Pain

///Neck and Shoulder Pain
Neck and Shoulder Pain
Viewing 6 posts - 31 through 36 (of 56 total)
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  • BRONCOFAN1
    Participant
    Post count: 30

    Interesting… I did wonder if insurance was the reason I had a medial branch block rather than facet injections. I didn’t get a great explanation, and I was a bit disappointed as I know some people, albeit a small minority, get good long term relief from the facet injections. But it occurred to me that insurance might require the medial branch block before an RFA, and if so they’d be trying to skip a step to get straight to the long term solution.

    The “good” news is that the right side is orders of magnitude more painful for me, but this scenario would be most irritating (literally) for someone who had more symmetrical facet pain. Also fortunate that it appears I can proceed with the second RFA two weeks later.. I’ve scheduled for three weeks out so if the first one fails I can cancel or push back the second one.

    Thanks,
    Kevin

    Donald Corenman, MD, DC
    Moderator
    Post count: 6402

    Perfect. Some insurance companies require first intraarticular facet injections and then medial branch blocks with good results from each to warrant ablations. There is nothing wrong with that scenario but more injections than I think is needed. Please keep the forum informed of your diagnostic results.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    Donald Corenman, MD, DC
    Moderator
    Post count: 6402

    Perfect. Some insurance companies require first intraarticular facet injections and then medial branch blocks with good results from each to warrant ablations. There is nothing wrong with that scenario but more injections than I think is needed. Please keep the forum informed of your diagnostic results.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    BRONCOFAN1
    Participant
    Post count: 30

    Hi Dr. Corenman,

    3.5 days out from my right side RFA and I am starting to feel some pain relief… seems to confirm again that the facets are the issue here. I understand it can take 7-14 days for the full effect to be reached.

    A quick question in the meantime… I am noting significantly more joint stiffness when I bend my neck laterally,particularly first thing in the morning, along with increase cracking or even mild “catching” type sensations with motion. I’m 4 months out from the c5-7 mobi-c replacement. Since it now appears obvious the facets were injured going in, would it be typically for bone spurring / arthritis to develop fairly rapidly? Guess I am a bit concerned that simply trying to manage it is only going to buy a little time before it becomes necessary to explant and fuse anyway. With no natural disc to degenerate further and slow down the segment, is it correct to imagine that the facets will tend to degenerate much more rapidly than they would in a typical scenario?

    Thanks,
    Kevin

    Donald Corenman, MD, DC
    Moderator
    Post count: 6402

    It really depends upon the current condition of your facets. If they were somewhat degenerative prior to the ADRs, then the additional change in motion can aggravate them even more. “Cracking”, “grinding”, “sand in the joint” and “popping” are all typical sensations generated by degenerative facets. It may be that you did not develop fast-onset degenerative changes but simply had a change of motion to the joints brought on by the placement of the artificial disc.

    No one has studied how much faster a facet can degenerate under the influence of an ADR. That would be a good study but I can’t currently do it as I don’t have enough of these patients in my own practice to have a large enough sample size.

    It can take as much as six weeks to understand how much better (or worse) the symptoms can change from an RFA.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    BRONCOFAN1
    Participant
    Post count: 30

    Hi Dr. Corenman,

    Well, it appears my RFA pain reduction has peaked.. I had about 30% at 7 days and now at 2.5 weeks it is basically unchanged from that. I will give is some more time but I’m going to dual track the prep for a revision to ACDF at this point. Is it unusual to get such a small amount of pain relief after getting 100% relief from an MBB? I’m hoping the MBB relief is a good indication of what I might achieve with a revision to ACDF in any event. My replaced discs are at c5-7.

    Two additional questions for you:

    1) my c3-5 discs are normal on MRI and recent surgery follow up x rays show no loss of disc height. Any reason for a new MRI before considering a revision surgery? Also, would you be concerned that the flex ex shows 2 mm of motion at the c3-5 levels between flexion and extension? Seems like that is at the high end of the normal range… just curious if that will put me at more risk for developing problems at these levels after ACDF, or of 2 mm is normal enough to potentially not really mean anything…

    2). If I do go with the revision route, are there any necessary activity restrictions with a 2 level ACDF? Was hoping to get back to light jogging and such, and a (perhaps misguided) belief that ADR would be better for future activity weighed heavily on my decision to go that route.

    Thanks!
    Kevin

Viewing 6 posts - 31 through 36 (of 56 total)

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