Radiofrequency Ablation after Facet Joint injections

Tagged: Lumbar stenosis and facet degeneration pain

Viewing 4 posts - 1 through 4 (of 4 total)

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Jellyhall
Participant

August 14, 2019 at 1:23 pm

Post count: 91

#30878

Dr corneman,
After a successful L4/5 fusion with laminectomy done 9 years ago for spondylolisthesis, L3/4, L2/3 and L5/S1 all have significant stenosis now. There is also hypertrophy / osteophytes on the facet joints.

I had facet joint injections with anaesthetic and steroid of the left L3/4 and L5/S1 seperately, which gave me relief for about 6 or 7 weeks with each injection. The radiologist had a lot of problems getting the needle into my L5/S1 facet joint because of all the osteophytes. He had probably more than 5 attempts and I believe that he did manage in the end.

It has now been suggested that I have radiofrequency ablation done in the hope that it will give me longer relief. My neurosurgeon has said I should get 2 or 3 years pain relief. I have read that it can give relief for up to 1 year, but I hope he is correct.

My question is, will it be likely to prove difficult again to get the needle into the facet joint to deliver the ablation. I haven’t been told which levels will have this ablation, but I am assuming they are talking about L3/4 and L5/S1. Do you think they will only do the left sided nerves? I do also have pain in my right leg as well as the lower back.

Donald Corenman, MD, DC
Moderator

August 17, 2019 at 9:05 am

Post count: 8660

#30890

L3/4, L2/3 and L5/S1 all have significant stenosis now. Central stenosis compresses the cauda equina causing neurogenic claudication. See this; https://neckandback.com/conditions/lumbar-spinal-stenosis-central-stenosis/ to understand the typical symptoms of stenosis.

You then note: “I had facet joint injections with anaesthetic and steroid of the left L3/4 and L5/S1 seperately, which gave me relief for about 6 or 7 weeks with each injection”. Facet blocks are designed to diagnose and treat facet pain syndromes.

It is uncommon that facets are the main pain generator when you have central stenosis so I am puzzled regarding your relief from those injections. Did you have immediate relief of pain during the first three hours or was the relief delayed until a day or two? This makes a big difference regarding pain generators as the steroid effect can give you “false”relief (a false positive test). I could inject steroid into your knee and your back will feel better in a couple of days but the anesthetic injected into the facet stays locally and lasts only three hours. If you had immediate relief, the facets are implicated. If not- a false positive test.

Regarding RFAs (radio-frequency ablations); “My neurosurgeon has said I should get 2 or 3 years pain relief. I have read that it can give relief for up to 1 year”. You are correct. RFAs burn the nerve but peripheral nerves can regenerate. Maybe if you are lucky, you can get permanent relief but most RFAs last a year.

RFAs can be much more difficult with fragmented, spur formed degenerative facets as the sensory nerve could be shielded from an RFA by a cap of bone.

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.

Jellyhall
Participant

August 21, 2019 at 4:57 pm

Post count: 91

#30944

After the facet joint injections, I did experience immediate relief but then my pain returned, but about two weeks later the pain improved again.This pain relief lasted for about 6 or 7 weeks.
It is very unfortunate that each time I have had an appointment at the hospital I am under now, I have seen a different doctor. The first three appointments I saw three different Fellows but then at my fourth appointment I saw the consultant that I am under. Each doctor has had a slightly different slant on my problems, so I am left a bit confused.

Right at the beginning, I was referred to have an up-to-date full spine MRI scan, flexion/extension x-rays of my neck and lumbar spine, full spine saggital x-ray and Bone SPECT CT Scan of my neck and lumbar spine.
The SPECT CT Scan showed a lot of ‘glowing’ areas on my spine, but particularly strong were the L3/4 and L5/S1 facet joints on the left side, which I think is why they wanted to start with facet joint injections to see if they would help.

I asked the consultant at my last appointment if the facet joint injections could help my leg pain and he said they could, so I am hoping that having the RFA will give me longer lasting relief. The Radiologist who did the injections told me that they were to try to relieve my pain but also to help the neurosurgeon plan for surgery! Surgery on my lumbar spine hasn’t really been mentioned, although at my latest appointment the consultant told me that L3/4, the level above my fusion at L4/5 isn’t good, that the level below my fusion is even worse and that L2/3 isn’t much better. I did know this. A different neurosurgeon told me that he would have to fuse the two levels above my lumbar fusion and extend the existing L4/5 fusion into it. He didn’t mention the L5/S1 level, and on some MRI images it looks OK. On other views it is extremely stenotic.

At my latest appointment I was told that I might need another surgery on my neck. He is ordering flexion / extension x-rays and new MRI scan of my cervical and thoracic spine. He wants to check that my neck is fused! That was rather alarming, because I thought that my neck was the least worrying level of my spine. I had an ACDF of C3/4/5 done nearly 7 years ago.

Thank you, Dr Corenman for being available to answer our questions. It is very helpful.

Donald Corenman, MD, DC
Moderator

August 23, 2019 at 7:56 am

Post count: 8660

#30954

The information you provide seems to be in line with current treatment guidelines. If you have pain without motor strength loss, then any treatment to manage pain makes sense. If you have leg pain as your major complaint, it is much less likely (but still possible) that radio-frequency ablations can give some leg pain relief by an unexplained mechanism. It really depends upon what your pain generators are, what your spine stability and alignment is and how degenerative the discs are compared to your symptoms and impairment.

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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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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