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Lower back pain and facet joint problems

charryccharry Posts: 5,657
edited 06/11/2012 - 8:51 AM in Sacroiliac (SI) Joint Problems
Question for Dr. I have SI joint and hip problems in the affected leg, can anything be done with DDD also in th lumbar spine? Also don't know if you can answer but
Can facet joints cause compression of your spinal nerves or is it just the Degenerative discs that cause it? Also if I have a compressed nerve on my EMG/nerve test why wouldn't I be a candidate for a discogram or surgery? Do you think I need another opinion. Thanks. Charry
DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN


  • Well - you know I'm not a Doctor, but I believe the facet joints do not cause nerve compression - I believe facet joint pain is more that stiffness in the morning pain. I was interested to read your L5-S1 herniation and tear had healed. I originally had a herniation, bulge and tear at L4-L5, and two years later when I had another MRI, the herniation had "resolved". I still have the bulge and the tear (and DDD). I only have one level of problems (everything else is perfect on my MRI) - But this one little spot in my spine really pulls me down - my whole life is really devoted firstly to ensuring the pain doesn't build up in that one little spot - It cripples me.

    Just because a herniation "resolves" does not mean the symptoms are necessarily resolved, particularly if it took a long time (more than 6 months)to resolve. They're not even sure how/why a herniation resolves - does it dry out? get sucked in? The interesting thing is, that it is the larger herniations (not the smaller) that are more likely to resolve, and they resolve the greater amount. Symptoms may persist after the resolution - because things have been pressing down so long on nerves, they are left permanently damaged (even after resolution of the herniation) or the tear may release chemicals that continue to irritate nerves.

    If an EMG is showing you have nerve damage - well I guess the thing is, fusion won't necessarily change that - the nerves are damaged - they don't know how to fix that. A fusion just stops a particular level from moving; a new disc just replaces the old disc; - these surgeries don't repair or replace nerves in any way - so perhaps your surgeon doesn't want to put you through all that (and the surgery DOES ultimately weaken the spine - as you surely know - the fused level causes weakness above and below the fusion). (See the thread about the "World's first disc transplant" begun by Firewater1981 - and you'll see everyone chime in that they have nerve damage which can't be fixed.)

    A discogram would only tell you which levels are causing you pain. Your L5-S1 may be causing you pain - or there may be other levels that are causing pain. The CT scan that you have after the discogram may also show damage not visible on the MRI - for example, you say your tear has healed, but the CT scan may reveal that the dye is still leaking from the disc or something - it's just a more detailed/accurate picture.

    Charry - I have always felt you and I have a bit in common, as we both have had severe debilitating pain for a few years, and neither of us have had surgery. I am not a surgical candidate because my discogram was negative - I don't really trust the results I got - but I don't want to have another discogram - because they can cause damage (especially having a second one) - there's research showing discograms can weaken healthy discs (they inject healthy looking discs for a control). I am thinking of trying to have a standing or weighted MRI, so that my spine is pictured while bearing a load (standing) which is when I experience the worst of the pain.

    So - I'm always doing long answers, sorry - but if you're thinking about this - if you want to keep going in the search - absolutely go and see another surgeon for a second opinion. I've been to 4 surgeons - and still haven't had surgery - so - What have you got to lose? Maybe they can help you to tease out all the different sources of pain and they will let you know how they could treat each source, and they can tell you the risks and the odds for success - and you can make a decision from there.

    Go ahead and see someone else. Find out what else is out there. But make sure you understand what they tell you - and for us with ambiguous pain sources, or "unfixable" damage - remember that particularly for us - we are vulnerable to becoming "failed back surgery" folks. And as bad as my pain is now - I DO NOT WANT TO JOIN THAT GROUP (no offense guys) - I know when I'm in pain now, I can take my breakthrough meds, lie down, get my ice bag, and I get relief - some of the "failed back surgery" people never seem to get any relief, ever.

    All the best, Charry.
  • I have the same problems you two have. I was told that I am not a surgical candidate also due to degenerative discs also. I was told that if you have DDD and have one level done you will need to keep have them done due to the disc became weak
  • I had a spinal fusion in the L5/S1 in 1998 and was told I would always have trouble with my S1s due to the severity of the damage. Having fibromyalgia and chronic myofascial pain did not help things,but between chiropractic care, massage, and trigger point injections I did really well for many years (especially after I retired from teaching in 2003).

    Then this past summer my pain went through the roof again so I saw my orthopedic surgeon and he felt it was bursitis and suggested I get an injection deep into the bursa when I got my next round of injections. Did not help and felt brushed off by all my doctors. I had an MRI with contrast done in November of 2010 and went to a new pain management doctor and found out I had lumbar facet joint disease and went through a series of injections in the bottom 6 discs which they knocked me out for and they really helped for 6 weeks then pain started to escalate again, but chiropractor helping control it. I am not having too rough of a time now and I make myself exercise daily as it lowers my pain levels in the long run.

    sue in ohio
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