You have continued lower back pain as your primary symptom with some nerve related symptoms as your secondary symptoms. The report notes a likely non-union of L5-S1 and possible facet degeneration of L4-5 above the fusion. There is consideration of repairing this non-union with an ALIF (anterior lumbar interbody fusion).
How did you do symptom-wise during the first three hours after your facet injections? This is the critical time period that the anesthetic is working. You needed to aggravate your symptoms initially and then record how much (or little) relief that you obtained from the injection using a pain diary (see website). If you did not, then you will not know how much pain these L4-5 facets are causing.
The long term relief that this facet injection might afford is not related to the potential diagnostic data that is needed to determine if the facets are pain generators. You can have a repeat of the facet blocks but this time, follow the recommendations found under “Pain Diary” on the website. If these facet blocks give you substantial temporary relief, you might be a candidate for rhizolysis (see website).
Most likely, if you do have a non-union at L5-S1, this is the cause of your current pain. It might be likely that an anterior approach is needed (ALIF) but repairs can also be performed through the posterior approach depending upon the findings of the CT scan and MRI.
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.