Newbie question, meds v rhyzotomy

[diver110]

I have had back trouble for 40 years (i.e. since I was 19), but up until about a year ago I was able to manage it with massage, yoga, and chiropractic. Then things took a dramatic turn for the worse, at one point putting me in the emergency room twice in three days. I then went through a fairly intensive persiod of physical therapy and massage therapy which improved me perhaps 30%. I also tried prolotherapy, which did nothing. I also tried a decompression machine at a chrioproactor. Also did nothing. The pain is in the L3 area on the left. The range if 0-4. I can actually manage it pretty well with vicodyn. The question is whether I should try a rhyzotomy, or just stay with drugs for now. All feedback appreciated.

[mmglobal]

Do you have clear positive facet injections? Performing a rhizotomy without evidence that the pain is coming from the facets may be ablating tissues with no benefit.

A pain level of zero to four would be success after a procedure for most of the spine patients I know.

Are you fit? If not, with the relatively low pain levels, can you still get fit?

Mark

PS... I know that your pain level does not seem low to you. Many spine patients I know tend to underrate their pain. (Especially engineers and athletes!)

[diver110]

Originally Posted by mmglobal

Do you have clear positive facet injections? Performing a rhizotomy without evidence that the pain is coming from the facets may be ablating tissues with no benefit.

A pain level of zero to four would be success after a procedure for most of the spine patients I know.

Are you fit? If not, with the relatively low pain levels, can you still get fit?

Mark

PS... I know that your pain level does not seem low to you. Many spine patients I know tend to underrate their pain. (Especially engineers and athletes!)

I would need to get a facet block first. Have not had that done yet. I am pretty fit and have done extensive PT. I don't have much in the way of leg weakness or sciatica, just localized L3 pain. The major hassle is sitting. Undrugged, it is very hard to do.

[mmglobal]

If you get a dramatic, positive result from the injections, the decision to move forward with a rhizotomy will be pretty easy. I would try to get the most targeted decision possible. If you do a panel of 8, 10, 12 injections, you will not know which facets to nuke. I don't like the idea of doing large numbers of rhizotomies because I don't believe that tissue should be destroyed without good cause. Hoping to 'get it all' with one giant over application may seem like a good theory... but I don't believe that there is anything so benign that more is better. With spine, less is better.

Also, with large numbers of injections, IMHO false positives are possible because of the large volume of steroid and anesthetic will make you feel better even if the injection is in the wrong place. I think they could inject my hip and my back would feel better.

Be skeptical... especially about info you get on the internet! I'm not a doctor and may be completely wrong. (Your doctor may be completely wrong too, but he has more credibility than I do.)

Good luck... please keep us posted.

All the best,

Mark

PS... what kind of diving??? Sky, SCUBA, springboard, (dirty jokes skipped here.)

[diver110]

Well, I saw the pain doc today, one of the top pain docs in San Diego. He was unenthsiastic about long-term vicodin use, but allowed how some people are able to do so. Others have issues with addiction/dependency/withdrawal. There appears to be little downside risk to rhyzotomy, so I am going to have that done (after first getting a diagnostic facet block). The problem with rhyzotomy is that it is at best an intermediate term fix. The doc said that as it is repeated it tends to become less effective.

To respond to the query, I used to scuba dive, but have retired from the sport. Ah, the joys of aging.

[cherylstewart67]

rhiz did not work for me; laser at an LSI would be longer lasting. hope this helps.

[Keano16]

Originally Posted by diver110

Well, I saw the pain doc today, one of the top pain docs in San Diego. He was unenthsiastic about long-term vicodin use, but allowed how some people are able to do so. Others have issues with addiction/dependency/withdrawal. There appears to be little downside risk to rhyzotomy, so I am going to have that done (after first getting a diagnostic facet block). The problem with rhyzotomy is that it is at best an intermediate term fix. The doc said that as it is repeated it tends to become less effective.

To respond to the query, I used to scuba dive, but have retired from the sport. Ah, the joys of aging.

Endoscopic rhizotomy is long-term solution.

Regards

[justlooking]

I'm a newbie to this website but wanted to offer you my experience with the Rhyzotomy. I have had two bi-latteral cortisone injections prior to the Rhyzotomy that I had done this past March. Went I went back to the doctor two weeks after having it done, he told me that most people would be wowing saying its the best thing they could have done. I told him I wasn't wowing yet because I was still having pain. My issue was the L4/L5 and night time pain on my right side. Been too many doctors and they all say the same thing...Structurally, I'm fine. So whether or not the Rhyzotomy will work for you is that I would give it a shot (no pun intended). I think mine has helped me a little bit, it just took longer than what my doctors told me it would. Good Luck!

[mmglobal]

Justlooking, welcome to the forum.

I had 3 years of the doctors telling me the same thing.

>> What were the results of the injections? Were they dramatically positive?

>> Have you had a discogram?

Just because the discs don't look that badf does not mean that they are not painful. Rhizotomies will be of little value if the bulk of your pain is coming from the discs or other 'not your facet' places.

After 3 years of "your films look way too good and you are way too mobile to be having the kind of pain you are reporting" and 2 microdiscectomies/laminotomies that helped new leg pain associated with new disc protrusions but left my low back pain the same and continuing to get worse.... my ADR surgery was like magic. 7 weeks later I was off all the meds (after 3 years on opiates, 2 years on neurontin and wellbutrin.)

I'm not suggesting that I know what your problem is or what will be beficial to you... I'm just sharing my experience. We do know a lot of failed ADR patients, but when the indications are good, the results are generally good too; NOT ANYWHERE CLOSE TO PERFECT, but relatively good compared to other options.

All the best,

Mark

[justlooking]

Hey there!

They told me my problem was with the L4/L5 facet issues. I also have scoliosis at a 31% curve. Went to Stanford and they told me while it sounds bad, it really isn't as they see people with much larger curve. Right now I'm self diagnosing and thinking it might possibly be hip bursitis. Basing that theory on a friend of mine who kind of has the same general night time pain and that's what they told her. Plus several of my reports had mentioned that too. See another doc about that on Friday. All I know is that I'm tired of this and it needs to stop! I think I've had every test known to man right now and they all come back saying the same thing, they can't find anything. Which I guess in a way, that's a good thing. I did find something interesting on the internet called TMS (sorry, forget what it stands for) which kind of sounds like it but who knows. In the meantime, I just kind of have to rely on what works and what doesn't work theory for right now.

[mmglobal]

have you had a discogram?

[diver110]

What I actually got was a radiofrequency ablation. Sad to say, it did not work. See the San Diego pain doc tomorrow, head back east on 8/1. In the interim, I am being treated by a physical therapist/yoga person. She says the real problem is not left L3 (where the ablation was done) but a tight right L2, which triggers the L3 pain (the L2 problem is caused by scoliosis). I am getting some benefit from her treatment...