It is my opinion that the facet injections were not going to work in the first place. The painful disorder is not facet mediated. In fact, the L5-S1 facets are “disconnected” from loading in the first place. The original pars fractures have disconnected these facets. During surgery, when these disconnected facets are removed, they are normally pristine as these facets had not been loaded since the pars fracture.
The injection will declare itself successful in the first three hours only. This is the period of time that the anesthetic agent is active (similar to the length of time the jaw is numb from the dentist office after an injection). Waiting any further length of time for relief negates the diagnostic window (see pain diary).
Surgery at this point will not “repair” the pars fracture. This presence of this fracture produces other degenerative changes that are irreversible such as degeneration of the disc space and the slip of L5 on S1. Also, eventual L5 nerve compression occurs due to the collapse of this segment. All of these changes precludes direct repair of the pars fracture.
The solution of pain produced by this degenerative segment is a TLIF fusion (see website). Success rate for this procedure approaches 90%.
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.