Radiofrequency Ablation after Facet Joint injections

///Radiofrequency Ablation after Facet Joint injections
Radiofrequency Ablation after Facet Joint injections
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  • AvatarJellyhall
    Participant
    Post count: 78

    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.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 6907

    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.
    AvatarJellyhall
    Participant
    Post count: 78

    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.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 6907

    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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