Esi ?

[Gil Denis]

Hello

A quick question

How many injections, nerve blocks, should I let the PM Doc stick me with before I have to say that is enough

I just had four ,one nerve block nothing, one esi at L-5, nothing, one at S-1 with a cathader a little relief did not last long so did another same little relief did not last long.

I fear my L-5 S-1 disc space is gone what next???

Thanks

Gil

[Justin]

Well, the idea with ESI is that a patient should exhaust less invasive measures before surgery is even considered. Surgery is the absolute end of the road.

90% of patients with herniations and other issues spontaneous recover in 6 months. Less than 10% of patients with spine "trouble" require surgery.

Gil, I know you fit into a different category. If the injections feel as if they are not working discuss this with your physician. I did this and it was advised that we should throw in the towel and think about other options.

Good luck and keep us posted!

[phylly]

Hi Gil,
Sounds like you are done with these injections. What does your surgeon say? I guess at some point you have to decide on quality of life and wether it is time to do something and what that might be. Have you gotten several opinions from doctors on what the next step might be. This part is the most difficult and I understand where you are coming from. I had several years of injections, always hoping they would help. I finally had a discogram of my lumbar spine and at that point had to make a surgical decision about whether to fuse or have ADR's. I have had a long journey having ADR's and then revision. Most people do very well with them. My biggest advice is to get someone you trust and go with them.
Phylly

[dshobbies]

Gil,

Kind of damned if you move forward, damned if you don't. You're the one who says enough. It's your life, your spine and your decision. When less invasive procedures don't help and nothing else is left, surgery might then be indicated. Only when you're satisfied that you've tried everything and no longer want to live with the pain should you agree to surgery. While most seem to come away with positive outcomes, some don't.

When you're living with such constant pain that you can't function, the decision seems easy. If you're still functioning with the pain or meds control most of it, the decision isn't so cut and dry.

Any life altering decision is a tough one. Good luck, Dale

[Kathy]

Gil,
I agree with all the above posters. It took a doctor showing me and explaining to me that my disc would never get better, that I had DDD, it was bad, and the wait and cross your finger approach wasn't going to work. When I was shown, on my MRI, the disc, the severe tear and explained what DDD was, I realized that surgery was the only way I had any chance of getting out of pain. I knew that I could not live like this forever. I then researched drs, procedures, etc and made the best decision I could with the information I had. I wanted to have no regrets, regardless of my surgical outcome and I don't. I do feel that my old pain is gone and that this is just surgical pain, that time and therapy will heal. I guess time will tell if I am right. Make a pro and con surgery list and then decide what is best for you. There are a lot of strong opinions on both sides of the surgery decision, strong opinions on what surgeon is the best, etc, etc. Your job is seperating fact from opinion and deciding for yourself, what is best for YOU (because ultimately, you are the one who lives with your decision, not the surgeon, not those of us on this board, nobody but you).

Like Justin said above, they told me that I am in the 10% that for whatever reason did not improve with conservative treatment (damn, too bad I couldn't have used my crazy odds to win the lottery!). My hubby is in the 90% that the first injection worked for and has done great for 2 years with it. With all they know about spines, there is so much they don't know.

Good Luck in your decision process, researching and whatever route you decide to go,
Kathy

[treefrog]

Gil, what everyone else has already told you is the same thing I would tell you. Only you can decide when is enough. You should always try conservative treatment first, but if that isn't working then is the time to consider surgery. You need to talk to your doctor about the likelihood of another injection working, and if that is a reasonable thing to do, or not.

It took me almost two years before I would consider surgery. I tried PT, ESI's, a facet block, and acupuncture, all without much success. It was then that I asked my doctor about doing a discogram. Because I understood that with DDD, my discs were not going to get better. My pain may not get worse than it is right now, though it may, but it's not likely to get better on it's own. When the discogram showed that it was indeed my two discs causing the pain, I knew surgery was the only chance I had for getting rid of the pain.

And I know that surgery is no guarantee, but it's the only shot I have. I am ready to take that chance. Because I am tired of living with this pain, not being able to enjoy the things I used to like to do.

And like Kathy said, you need to then decide what type of surgery and which surgeon is the best choice for you. I wish you luck in making this very difficult decision.

[Maria]

Is only your L5S1 disc problematic not L4? I'm also wondering what approach was used for the ESI? I know when I had one done in the beginning for L3 it did nothing for my back pain even tho I have an anular tear there but L4 and L5S1 both had discectomies and I wonder what is even being quelled now at L5S1 as the disc has been reported to be fibrotic .. guess it's the nerves that are being calmed by the steroidal bath.

I had a bilateral transforaminal approach at L5S1 yesterday and today I have been out all day on my feet until just now.. and still I feel good *down there*.

I realize that ESIs don't work for everyone tho and perhaps you just won't get relief with them no matter the approach or anesthesiologist's/PM's talent performing them.

Facet blocks I don't know about as I've never had any and I've had a few nerve root blocks but do better with the ESIs in general for low back pain and even pain that went beyond this area or radiated.

[Gil Denis]

Hi All

Thanks for the replies

Maria the injection was a nerve bath and yes to maybe L4-L5 or even L3-L4

I will see my PM on Tues will keep you posted. Also need to talk to Mark but I would rather let him rest and heal.

Thank You All So Very Much

Gil

[Gil Denis]

Hello

I just finished my appt w/ my PM no more injections, now surgery She called it a roto router to remove bone that is pressing against the nerves I need to see someone else
Also suggested fusion at L5-S1 but the other levels are to far gone and would create a chain reaction

I will keep moving forward

Gil