ADR and Facet issues- need advice/support

[lkastl]

Hi

I am thankful for this site and hope to find advice and support from the members as I struggle with what to do. Maybe there is someone here in the same or similar situation as I am. I am 9 years out from a l5-s1 prodisc. I was part of the US clinical trials. I had a prior posterior decompression at that level,(what I thought was a foraminotomy, but was perhaps more) which I now know is a contraindication in todays criteria. At the time, the surgeon was aware of it and didnt feel it was a issue as I was stable at that level.

Anyways, I had many good years, with a few bad flare ups when I did too much, that I managed to get over, although they took a LONG time to settle back down.

I have been in another bad flare up for the last 5 months. Perhaps it will settle down too over the next year, but it is the worse one yet. I am being treating conservatively by a physiatrist, who suspects it is my facets at that level. At first we were doing s1 nerve root injection, because I had a lot of leg pain along with the back pain, but we were getting minimal results. Last injection he did both the facet and the nerve, and the results were better, so he thinks it might be the facets. We are thinking of more steroids in the facet to calm it down or a RF lesioning.

I am depressed, anxious and scared. My life is ruined again and I cant do anything for myself and my family. I fear a revision is in my future at some point and I don't seen any successful revision patients posting, so I don't think the results would be very promising. Maybe I just have to learn to live with this and go on pain management.

So, I guess I am looking for help and advice from anyone who has facet issues post ADR. How have you managed? Did steroid or RF lesion get you over the hump? Anyone had a revison? Any new facet technologies worth waiting for ?

Sorry so long and rambling . . .

Thanks
Laurel

[FreeFallin]

Hi Laurel,

I am sorry to hear that you are in so much pain but I think I have an idea of what you are going through. I am new to this site and I wanted to share some of my experiences and results in hopes that it may help you through this tough time. I have damaged discs and damaged facet joints in both my neck and back so i too am looking for any new facet technologies but need it to be combined with the artificial disc replacement (ADR) and all I have found so far is the Total Spine Motion Segment system.

Of course, different things work for different people but the RFA procedure works for me. If your pain is anywhere close to what mine was before the RFA procedure it has the potential to ruin lives. The constant stabbing like nerve pain in both my lower facets, became so intense it was difficult to stand or walk far at all before I had to curl into a ball to stretch out and try to control the severe pain. It eventually became completely unbearable in both facet joints on either side and even pain meds could do little to control this super severe joint pain and that is when I found the RFA procedure through my research.

I suggest you research and find the most reputable and capable pain management doctor in your area. They are highly trained in Pain Medicine and will most often work out of a nearby surgery center where they perform Radio Frequency Ablations (RFA), Injections, ect… The doctor will talk with you and review your MRI in order to try and pinpoint the source of the pain. He will then inject one or both facets and this numbs them for a week or two before the permanent RFA procedure. If that was the source of your pain you should know right away and will usually be anxious to get in the next week and have the nerves permanently fried. The nerves usually grow back within 3-12 months and the procedure has to be repeated but it is worth it for me, without question!

Both of my legs still constantly feel like they are being crushed in a vice or a compactor and the only procedure that has ever relieve my leg pain was an Epidural Steroid Injection directly into the disc. The injection they simply spread around my low spine had little to no effect whatsoever. I personally feel the time I spent seeing a physiatrist was a complete waste of time because they are usually not trained in pain management and when that is what you need, dealing with a physiatrist can cause undue stress.

I hope this helps a little bit

MRI L5-S1

Right greater than left facet hypertrophy contributes to moderate to severe right and moderate left neural foramen stenosis, stable on the left and increased on the right compared to previous exam. Persistent disc bulge touching the thecal sac and narrowing the neural foramina. L5 nerve root impingement cannot be excluded.

[WPKat]

Laurel,

I share your problem.

In March of 2009, I had a laminectomy on L3/L4 and laminectomy with disectomy on L4/L5. This operation failed; I was left disabled and in 24/7 pain. I was given no options in Alaska or anywhere else the United States aside from a lifetime of pain management. I broadened my search worldwide for relief and in June of 2010, I had a double artificial disc replacement using M6-L, which was done by Dr. Ritter-Lang in Germany.

My severe facet degeneration existed prior to ADR. Despite this, my condition improved immediately. Before ADR, I could barely walk with the help of a cane; a short walk around one aisle of a grocery store spiked my pain beyond tolerance and sitting was even worse. After ADR, I retired the cane, stood upright and walked with a normal stride. Although it took a lot longer to improve and I am still limited, I can sit for longer periods as well.

I was told that the M6-L artificial discs would restore proper disc space, reposition my facet joints and that they would calm down so I could live a normal life. But unfortunately, I am still plagued with powerful muscle spasms, intense body aches, a deep, burning pain on the left side, leg pain and numbness, periodic "ice pick" jabbing pains, abdominal swelling and exhaustion. The intensity of which is associated with activity; the more I do, the higher my pain levels and the more problematic my symptoms become.

If I micro manage my activity beforehand and maintain a physical therapy routine (avoiding trunk rotation and back extensions), I can make it through a grocery store, drive short distances and sit for longer periods then before ADR. The bottom line: I am better off then before ADR despite an imperfect outcome.

I attempted to return to work from June 13, 2011 to December 2, 2011. It did not take long for my pain levels to rise significantly with little relief from pain medication. Four days after I quit work, I had a medial branch block done on both the sides of my lumbar. While I have had this procedure done twice before with no procedural pain, when the numbing medication was injected, I experienced lightening bolt pain down my leg along with my leg muscles seizing up twice ... once on both sides. My pain specialist said my facet joints were super inflamed.

Once I stopped working, it took over 2 months of high pain levels and little activity for my pain levels to subside. I am still recovering as my pain levels still rise higher and quicker with activity then before I tried to return to work.

At my pain specialist's office, I have the following options:
(1) Epidural Steriod Injections
(2) Radiofrequency Thermocoagulation (i.e., RFA)
(3) POSSIBLE Stem Cell Injections (not yet scheduled)

Aside from option 3, I already tried the other two with limited relief. In part because only half of the affected area was treated with RFA (before ADR) and only one epidural steriod injection was tried (after ADR). I could opt for a total of 8 epidural steriod injections (a distinct possibility) or 8 RFA's (no thanks, the healing process from 4 was excrutiating). I would love to try Stem Cell Injections. However, the technology is brand new to our area, the focus so far has been on cervical patients and I would be the first lumbar recipient (I offered) ... my pain specialist is all for it, but it's up to the head of department.

My pain levels and limitations have brought me back to the place of searching for a more permenant solution ... this time for my facet joints. So far, I have contacted 5 surgeons abroad. My case has been evaluated and approved for 2 different facet resurfacing devices (which currently are under clinical investigation and not approved medical devices in Europe). I just recently contacted 3 other surgeons outsite of the U.S. as well. Before I go forward with any surgical intervention, however, I need to do more research into available facet technology and have all my questions about each answered first.

If you have any questions about what I learned so far, or you know of other solutions, please let me know.

K

[cherylstewart67]

i have heard that laser is more long lasting. i have rhizotomy and it failed ;o(

[Jim M2]

I had facet pain post Charite ADR almost 9 years ago. RF rhizo of the facets helps. Surprisingly SI injections help. I think suspected L4-5 discogenic pain makes any clear diagnosis impossible. There are too many layers and flavors of pain and discomfort going on down there.

[zfontana]

Originally Posted by Jim M2

I had facet pain post Charite ADR almost 9 years ago. RF rhizo of the facets helps. Surprisingly SI injections help. I think suspected L4-5 discogenic pain makes any clear diagnosis impossible. There are too many layers and flavors of pain and discomfort going on down there.

My facets kill me with this prodisc. should of had it fused.

[Jim M2]

About 1.5 years after ADR surgery I started getting very slow reduction in facet pain for awhile. At some point I stopped getting reduction. Since then other problems have arisen to torment me. These include the SI joint, L4-5 and cervical spine pain.

[mmglobal]

Jim... great to see you here again. It's been qute a long time since we have caught up.

Search this forum for info on John Stark. He specializes in SI joint disfunction. You mentioned SI injections as an aside. I find that most spine surgeons won't seriously pursue SI issues, I think because they don't have anything to do for it. Call me if you want and I'll tell you more.

Take care my friend,

Mark