Nerve block

[Gil Denis]

Hello to all

I visited with another spine surgeon from Spine Care here in WY.
She does C Spine ADR with Pro Disc.Has a very open attitude about ADR.
Her suggestions were, no fusion, no Lumbar ADR were not their yet!
To do the least as possibly to relive my leg pain.
I am going to try nerve block injections in about 45 min.
I`ll post the results
Gil

[Terry Allen Blackburn]

I had good luck with the nerve blocks. Let us know the results.

Terry Newton

[sarah.p]

Hi there,
Ive had nerve blocks after my fusion and disc replacement for nerve impingement from scar tissue causing leg pain, hed them 3 months ago and they took the pain away as soon as they were done, which is fantastic as at least I dont have leg pain with everything else, I was so grateful that they helped.
I wish you the very best of luck with your and hope that they are a success for you.
warm regards
sarah

[dshobbies]

Sometimes nerve blocks work, sometimes they don't. I hope they bring you some relief. Living with pain sucks!

[Gil Denis]

Hi
I am back from the Nerve block, a little relief.
My leg was weak and felt lost for a while.
All good for now
thanks for the replies

Gil

[Gil Denis]

Hi All

Still no results on the Nerve Block.
Dr said it may take a couple of days?
What do you think?

Thanks
Gil

[phylly]

They do take several days so don't give up hope. You may get a lot of relief.
Phylly

[sarah.p]

Hi Gil,
Im sorry that you have no relief so far from the block, everyone is different, and whilst with the numerous blocks I have had ive know straight away if they have worked or not, ive spoken to many people who have not felt any real relief for a good few days whilst the steriod begins to work.
I wish you luck and hope that you soon feel some benefit.
warmest wishes
sarah

[mmglobal]

I agree with doing the least invasive surgery that has a good chance of addressing your pain with caveat... the disc must be in good enough shape to have a chance to survive. I've seen way too many people who've had discectomies/laminotomies done on discs that were so very severely compromised that there was no real chance. Symptoms go away for a few months, but as the disc collapses further, the symptoms come back or new symptoms (other sided leg pain?) appear.

If they evacuate the disc space, you stand an increased risk of further collapse, faster.

If they don't evacuate the disc space, you stand an increased risk of recurrant herniation. (Not evacuating the disc space is considered to be old school by many of the doctors I know, but they concede the trade-off.)

I would still choose less invasive if I'm a good candidate. Doing less invasive when the disc is so severely compromised can be more wishful thinking than an effective approach. You only get so many times to cut before the laws of diminishing returns catch up with you.

Mark

[Gil Denis]

Hi Mark

What do you mean by evacuate disc space?
I don`t get it.

Thanks

Gil

[mmglobal]

If you have a protrusion instead of a bulge, or even if you have a bulge caused by a contained herniation of the annulus (contained by the PLL - posterior longitutinal ligament); then you have a hole in the fibers that is holding in the disc nucleus material (the consistency of crab meat.)

Evacuate the disc space, means to go inside the disc with little grabbers and removing most of the disc nucleus. This leaves the disc essentially hollow. There is still the surrounding annulus which can be quite strong and support you. Hopefully, the disc will fill in with fibrous tissue and remain tall.

If you don't evacuate the disc space, there is a bunch of crab meat and you still have a hole in the annulus that you can squirt it out through... hence the term recurrant herniation, or repeat disc protrusion.

[Gil Denis]

Thanks Mark

I do not think this has been offered to me yet.

Plus I do not like crab meat or lobster, bottom feeders.

Gil

[Gil Denis]

How many nerve blocks injections should i have to relive leg pain?

The Dr said it most likely its my L5-S1, if that does not work it may be your L4-L5?

Thanks

Gil

[Justin]

Hey Gil,

It depends on how you are feeling after a block (after giving it some time to "kick in," etc). A lot of PM docs like to do a series of three; however, there is not hard set rule as far as I know.

Originally Posted by Gil Denis

How many nerve blocks injections should i have to relive leg pain?

The Dr said it most likely its my L5-S1, if that does not work it may be your L4-L5?

Thanks

Gil

[trkdoc714]

Mark,

You're right about discectomies. I had a recurrent disc a few months after a discectomy. The issue was a 1 cm x 1.2 cm piece of the annulus broke off and came to rest on the nerve root. The surgical notes reflected evacuation of the nucleus during the first surgery and no nucleus present during the second. The disc height was noted (using an MRI measuring tool) as being 8 mm before the first surgery and 3 mm in a 1 year follow up MRI (from surgery #2) but that the disc was "patent". They also noted only mild bilateral bulges at that level. The PM doc mirrored your comment as to the disc being able to provide stability even though the nucleus was gone.

Gil,

I've had nerve blocks that worked well and some that didn't provide any relief at all. It sounds like they're using a systematic approach to isolate the potential problem level. I hope they picked the right level on the first try. Finding the source of pain gave me a sense of relief by knowing exactly where the problem was.

In the meantime, try to enjoy the drugs and wait for the block to kick in.

Good luck,

Bob

[mmglobal]

Bob, I've never seen a free fragment that was thought to be annulus??? It's typically pretty stuck onto the ligament. 1.2 x 1cm is freaking huge.

As the disc space collapses, the annulus and ligament can buckle. (It has to go somewhere.) This can cause substantial stenosis, especially in people with some instability or other reasons for stenosis that may make things worse.

mark

[trkdoc714]

Mark,

I thought it was physically impossible too. I questioned the size thinking it was a misprint of mm but both the surgeon and radiologist concurred. My original surgeon thought it may have migrated through the opening he made for the discectomy as it was a widebased rupture. The MRI shows it resting comfortably on top of the nerve root.

The stenosis diagnosis is the most recent (as far as being the primary reason for pain). Although the canal measurements are at the minimum during the CT scan, the dynamics of standing up (collapsing the discs somewhat) pushes the cauda equina posteriorly, effectively narrowing the canal dimension at 3 consecutive levels, L3 to S1.

My opinion is the multilevel spine issues are a result of having an ex-wife on my back for 16 years. But that's just an opinion....

[Gil Denis]

Hi Bob

That was funny
Still no relief from the nerve block, I think it may be another level?
Or should they give me more at the same level?

Good luck with resolving your pain

Gil

[trkdoc714]

Gil,

Sometimes it can take a few weeks to "kick in". My PM doc told me the nerve block irritates the nerve root at first due to pressure or touching the root during the procedure. I hope your relief begins today.

Bob

[Gil Denis]

Thanks Bob
Still waiting for the results?
Dr wants a call on Monday to hear the results and possibly inject other levels

Will keep you posted

Gil

[trkdoc714]

Gil,

It sounds like you finally found a decent PM doc. Let's hope he/ she finds the problem and gets you the relief you need.

I have my appointment with the European surgeon this morning. I put all of my spine related notes in a folder. Before I got finished, I had to go back to the store to get a wider binder and more page protectors. It was kind of sobering looking through the notes of all of the doctors, surgeons, neurologists and radiologists. It's been an interesting journey. I'm just grateful we have the support of our loved ones and the great people on this forum to help us through these issues.

Bob

[Gil Denis]

Hi Bob

Let us know how your meeting turns out? Wishing you the best,God bless.
I hope your folder is not to heavy,would not want to throw your back out

Later Gil

[Terry Allen Blackburn]

Gil:

Any pain relief yet from the nerve blocks? Have they said anything about the possibility of SI Joint injections with you? That kind of pain is localized at the base of the spine and then radiates downward.

It has always taken up to a two - three week period of time to get any pain relief from the injections. I got SI joint injections prior to going to Minnesota for Christmas and it took all of three weeks before the pain relief set in. I am still feeling pretty good from those injections.

Hang in there.

Terry Newton

[trkdoc714]

Gil,

The appointment went great. Vanita is convinced she should have the ADR instead of fusion. She had been leaning toward fusion but at her age, that leaves a definite adjacent disc issue while it's considered a "possibility/ probability" an ADR may delay/ eliminate adjacent disc problems.

I had a great meeting with Dr. R-L as well. I'm convinced that I'm a candidate for a single level lumbar disc. He nailed the commonalities of other diagnosis and eliminated some of the goofier comments I've been left with. I'm very comfortable with him and his facility.

Now all I have to do is get the funding. Does anyone have a US Treasury Bailout Application Form they could send me?

I didn't hurt myself with the folder. I made my wife carry it. She has cervical problems, not lumbar.......

Bob

[Gil Denis]

Hi All

Thank You all for the replyies

I am scheduled for more injections on Monday, still tingling and numbness in my leg

Bob congrats on your meeting

Take care

Gil

[Gil Denis]

Hi All

Just returned from another injection at S1, no relief and some tingling in my leg.
I fear still not the correct location?Will know more in a couple of days
Hope this will locate the nerve pain location?

Thanks

Gil

[Gil Denis]

Hello
As I sit here typing this post my leg is throbbing pain is a 8.The highest ever, is this normal or am I going into the black hole

Thanks

Gil

[Justin]

Hey Gil,

What you are experiencing after your nerve block is, unfortunately, a normal experience for most patients. Sorry about your increased pain. Give your nerves some time to calm down... keep us posted!

Originally Posted by Gil Denis

Hello
As I sit here typing this post my leg is throbbing pain is a 8.The highest ever, is this normal or am I going into the black hole

Thanks

Gil

[trkdoc714]

Gil,

If it's the same pain pattern (same leg, same area) it may be a good sign. Wait for the "fresh injection" pain to settle down. I had the same experience. I went from 6+ pre-injection to 8+ for a week or so post injection. It finally settled down to to 3-4 for 3 months. Unforunately mine has worn off so I'm headed back to the PM next week.

Good luck,

Bob

[trkdoc714]

Gil,

I had another round of selective nerve blocks yesterday. The PM injected L2/3, L4/5 on the right and L5/S1 bilaterally.

I usually handle these pretty well but he ordered an injection of Demerol for pain after he finished.

He finally uttered his approval of ADR being the best course for me. I think his clinic normally forbids him from mentioning any procedure they don't do.
He was going to get his insurance clerk to give me advice on getting precertified with Aetna to go to Germany for a Maverick.

He added that he'd be happy to remain as my PM afterward. He's a great doc. He's 5' 0" and weighs about 99 lbs. At the beginning of the first epidural with him, while I was lying face down on the table with my shorts pulled down, he told me I was going to feel a little prick. I couldn't help laughing when he said that. Needless to say, we both hit nerves that day.

Hopefully the pain level will come down today since I have to work.

How has your pain level done since your series of injections?

Bob

[Terry Allen Blackburn]

Originally Posted by trkdoc714

Gil,

I had another round of selective nerve blocks yesterday. The PM injected L2/3, L4/5 on the right and L5/S1 bilaterally.

I usually handle these pretty well but he ordered an injection of Demerol for pain after he finished.

He finally uttered his approval of ADR being the best course for me. I think his clinic normally forbids him from mentioning any procedure they don't do.
He was going to get his insurance clerk to give me advice on getting precertified with Aetna to go to Germany for a Maverick.

He added that he'd be happy to remain as my PM afterward. He's a great doc. He's 5' 0" and weighs about 99 lbs. At the beginning of the first epidural with him, while I was lying face down on the table with my shorts pulled down, he told me I was going to feel a little prick. I couldn't help laughing when he said that. Needless to say, we both hit nerves that day.

Hopefully the pain level will come down today since I have to work.

How has your pain level done since your series of injections?

Bob

Bob:

Your sense of humor is amazing no matter the pain you are in. This story of the doctor brought laughter tears to my eyes.

I hope the injections work for you. Mine did for me. I got them before Christmas and they are still working for me. I am glad you guys got scheduled for ADR's during your doctor visit. You hang in there and keep the good humor coming our way.

Terry Newton