Post-rhizotomy pain?

[crankydull]

I've had cervicogenic headaches for the last two years. I had rhizotomies three weeks ago (C2/3, C3/4, C4/5 and C5/6). For the last week, the pain is worse than it's ever been-- burning and searing. The Percocet my doctor originally prescribed makes me sick when I take enough to affect the pain. I switched to Vicodon, but that isn't doing anything. The only thing that is helping is Zanaflex, which I've taken for a year in small amounts for headaches, but the amount I have to take right now puts me in a coma.

I started blogging about this whole process a few months ago if anyone wants to check it out:

Why I Am Often Cranky (and Sometimes Dull)

[Maria]

Try Fioricet (very old standard migraine medication). I started getting migraines after laser eye surgery and right before onset of menopause (so estrogen w/d mostly blamed). I also started to have cervical spine problems pretty intensely back in the early to mid 2000's. I found that Fioricet helped both my migraine and the cervical pain but pretty much only if I rested in dark noiseless area and fell asleep for about an hour with my neck supported in a certain way. Several years later I didn't need to sleep just relax the tension in that area (use of heat helped). Something else that helped me greatly was a 60mg injection of Toradol (non steroidal anti-inflammatory med) as it seems to greatly the effect of muscle spasms in my cervical and lumbar area.

You may have already tried these things if you've progressed to rhizotomies although I had two lumbar spine surgeries, 10 years of epidurals, various medications and about 25 years of all degrees of pain before finding out the Toradol injection helped my lumbar muscle spasms greatly and cervical as well.

Of course maybe you need something else though in the interim if these meds might alleviate some pain even if not hitting the exact cause of the pain maybe some part of the effect which could be helpful. Just throwing it out there. Sorry to read the degree of pain you've been in and are still in ~ I've been thru 32 years of it and cranky and dull probably describe a better part of some of my day at least!

[henry4956]

I had a rhizotomy in Nov 2011, a few months after my awful low back pain arrived. Specifically it was called 'endoscopic laser rhizotomy' ELR. Performed by Dr Kuaxian Liu from NJ. He met me 5 minutes before procedure and asked me 1 question. 'Does your low back hurt when you bend backwards?'
To which I replied 'NO'. Apparently all the forms and questions and descriptions of my pain were never actually passed on to him. How pathetic is that? So he did it anyway disregarding the contraindication. The result, pain increase and increased problems bending forward.
Perhaps over the course of several months whatever he did may have been reduced, hard to tell as my symptoms continued to get worse. But I feel like a new man now that I hired a true professional master spine surgeon (Dr Zeegers) and all symptoms are improving finally

[henry4956]

sorry my post was not something to help you feel better, I just feel that nerve abalations, rhizotomies are a waste of time. whatever negative impact it may have caused you will go away soon enough for the same reason that even when if benefits someone it's only temporary.

[crankydull]

What is your new doc doing that's helping? I don't think there's a surgical treatment for what I have (arthritis/bones spurs).

[Maria]

You may not need surgery or even want it or possibly not yet.. or possibly aren't a candidate. My cervical stuff seemed to have calmed down on it's own but then again I'm not super active yet still thankfully have gotten much relief compared to days (years) past.

I do wish you the best with your situation as you're still working and such. Do explore all options however if you have the opportunity and get the best consultations if possible even if you've been told you're not a surgical candidate or there's no cure/fix for your condition. Sometimes it's just that's what's said because that's the limit of the physician's scope of practice.

[LanceK]

Originally Posted by henry4956

I had a rhizotomy in Nov 2011, a few months after my awful low back pain arrived. Specifically it was called 'endoscopic laser rhizotomy' ELR. Performed by Dr Kuaxian Liu from NJ. He met me 5 minutes before procedure and asked me 1 question. 'Does your low back hurt when you bend backwards?'
To which I replied 'NO'. Apparently all the forms and questions and descriptions of my pain were never actually passed on to him. How pathetic is that? So he did it anyway disregarding the contraindication. The result, pain increase and increased problems bending forward.
Perhaps over the course of several months whatever he did may have been reduced, hard to tell as my symptoms continued to get worse. But I feel like a new man now that I hired a true professional master spine surgeon (Dr Zeegers) and all symptoms are improving finally

It would seem that if the Activ-L disc replacement was so obviously successful that would explain why your facet injections and rhizotomy were ineffective. It would appear you did not have significant degenerative facet disease. Does that make sense?

I'm really happy for you, nonetheless.

I'm scheduled for my first medial nerve block (as a diagnostic indicator for lumbar rhizotomy) in two weeks. I'm investing a lot of anticipatory emotion in this. My four-year-old MRI showed mild to moderate facet disease at multiple levels, the worst of which was between L4-L5, so the preliminary diagnosis would seem to indicate the procedure.

I can't imagine why it would NOT work.....but I've been wrong before.

[mmglobal]

Lance, welcome to the forum.

You said that your four year-old MRI shows...... Do you have more current imaging? I'd be cautious about moving towards procedures that destroy tissue or ablate nerves without having an updated look at how things are now.

Does your pain syndrome present with mostly facet type issues?

All the best,

Mark

[LanceK]

Originally Posted by mmglobal

Lance, welcome to the forum.

You said that your four year-old MRI shows...... Do you have more current imaging? I'd be cautious about moving towards procedures that destroy tissue or ablate nerves without having an updated look at how things are now.

Does your pain syndrome present with mostly facet type issues?

All the best,

Mark

Thanks for the welcome, Mark!

Yes, the MRI is my most recent imaging. I had a CT scan a year or two before that which diagnosed osteophytosis in the lumbar spine. Also, the MRI identified some central canal stenosis at L4-L5.

My pain is in the lower left lumbar and is most acute when bending forward and reaching toward my feet and exceeding a specific range of motion. In fact, it was a similar motion eight or nine years ago that was the precipitating incident of my current problems, although I had had some prior symptoms that I now realize were preliminary evidence of a developing chronic lumbar issue(s).

Apart from the range of motion issue, a dull, aching pain is present upon a very few minutes of standing or walking which becomes unbearable after twenty-minutes or so. This duration can be extended somewhat by wearing a compression belt.

My pain is usually fully mitigated upon sitting down. I have no referred pain in the buttocks or down the sciatic nerve.

Two neurosurgeons (the most recent being a year ago) have declined me as a surgical candidate. I was hoping my problems could be addressed by a mechanical interspinuous spacer, like the X-stop, but I guess not.

Epidural series and four different rounds of PT and two chiropractors have been to no avail.

The procedure I'll have on the 21st is a diagnostic medial nerve block on both sides of the lumbar spine and at multiple levels to see if, and to what extent, the pain is reduced by anesthesia and thus indicative of a successful ablation at a follow-up appointment.

I don't know how to distinguish my pain from a facet vs. stenosis origin, but I suppose if I walk around with a "numbed up lumbar" for four or five hours and still have the same physiological demand to sit my butt down after twenty minutes we'll know that the facet joints are not my primary problem.

And if that happens, I'll be one sad, depressed puppy because I don't know what we do after that.

[pittpete]

Lance, ive been a back pain sufferer for many years.
I also have that constant dull ache in my lower right side through L4-S1.
Long story short i had a successful facet joint block right side only at L4-L5 and L5-S1. Relief was instant and lasted almost 3 weeks. I just called to have my second set of shots. If these work also, i'll schedule the ablation.
I have moderate arthritis at L4-L5 right side.

[LanceK]

Originally Posted by pittpete

Lance, ive been a back pain sufferer for many years.
I also have that constant dull ache in my lower right side through L4-S1.
Long story short i had a successful facet joint block right side only at L4-L5 and L5-S1. Relief was instant and lasted almost 3 weeks. I just called to have my second set of shots. If these work also, i'll schedule the ablation.
I have moderate arthritis at L4-L5 right side.

Good luck to you, Pete! Keep those success stories coming!

[LanceK]

Reporting back in after diagnostic bilateral medial nerve blocks (S1-L3).

Relief was immediate and dramatic upon leaving physicians office. Range of motion did not seem to improve substantially, but I attribute much of that to lack of exercise due to the presence of pain. I believe that to be somewhat reversible if upcoming rhizotomy is effective.

Most notable was the increased stamina for walking and standing. Did a mall walk and window shop of at least 25-30 minutes without batting an eye. I could also squat down to pick up dropped objects rather easily and quickly. Previously, I had to stand there and plot out a strategy for descent and ascent.

Anesthetic lasted about 24 hours, and then I turned back into a pumpkin. But it was a very, very good day.

Rhizotomy scheduled for first week in September. I am extremely excited.

[LanceK]

Reporting back five weeks post lumbar rhizotomy performed on Sep. 3 and 4.

Results have been rather disappointing compared to what I experienced immediately following the medial nerve block diagnostic procedure. Whereas the nerve block resulted in immediate relief in the range of 80% to 90% pain reduction, the rhizotomy procedure itself has so far been effective only to about 50% at most -- probably less, to be honest.

I'd like to maintain some degree of optimism, but everything I've read online indicates I am already at the post-op point where increasing passage of time would be expected to produce less, if any, improvement.

If that turns out to be the case, I'm not sure what options I would realistically have for the future.

Any ideas?