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SteveC's picture
User offline. Last seen 12 weeks 5 days ago. Offline
Joined: 11/22/2008
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Points: 134
Value of RFA/Rhizotomy when not in active pain?

I had a recent flare up which got me on a prednisone dose pack. The PM's PA said a rhizotomy was probably called for. I have already had one on the right side and am unsure if it really helped or not. This one would be on the left.

The issue right now is the pain being quite manageable (contast 3 peaking to a 4 - during the flare up I was at a 7). What are your Spiney's' thoughts on having this procedcure done when not in actiuve pain?

Thank you!

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L5-S1 lam/disc for nerve entrapment on 7 Jan 2008 in Annapolis correcting a condition which first exhibited in 2006. Bulging disc with small herniation at the same level now causing leg issues...

Intonsofpain's picture
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Joined: 01/25/2012
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Points: 64
Hi

I had an RFA done, and it really did not do anything for my pain, so for me it was a waste of time and money. I know of people that have got good results from the procedure, but not me. If you are not in active pain, in the other hand.. why would you want to put your body through such an invasive procedure? I don't know, but I wouldn't do it.

Take care,

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5 lumbar spinal surgeries (07, 08, 09) including a multi-level/360 fusion and 4 Laminectomies due to fail surgery syndrome and complications. ACDF C5-6 in March of 2010. Right tibia repaired with titanium and screws due to a terrible ankle fracture in Sept. of 2011. Cancer survivor, and mother to 4 human children that are grown and gone, and one 4 legged one.
I've had over 20 surgeries in my life time, including a Thorocotomy to remove part of my left lung (Cancer). I am currently on Fentanyl patch 100 Mcg's, with Dilaudid for break through pain, I had a Spinal Cord Stimulator installed in June of 2008, and it has helped me with my neuropathic pain, but not my mechanical one. I am hoping to get an intrathecal pain pump some time this year, I just moved to the central part of my State, so I am seeing a new PM Doc. I have been on social security disability since my failed lumbar fusions. I am Social Worker,and mostly worked with HIV/AIDS patients and their families. I know that God has a plan for me, but he forgot to send me the memo! Smile

***I am NOT a Doctor, Nurse or medical professional, so whatever advice I give, I give from the heart; so personal experiences,stories, annecdotes, etc. that I might mention here, are based on MY personal experiences, and are not meant to be taken as "Gospel". ALWAYS consult with your Doctor, he knows you best!!"

" Been positive or negative are habits of thoughts that have a very strong influence in life"

SteveC's picture
User offline. Last seen 12 weeks 5 days ago. Offline
Joined: 11/22/2008
Posts: 67
Points: 134
I personally don't view a

I personally don't view a rhizotomy as any more invasive than an epidural. The thing is the severe pain is not constant - so perhaps that is the answer I was looking for...save the rhizotomy for constant pain.

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L5-S1 lam/disc for nerve entrapment on 7 Jan 2008 in Annapolis correcting a condition which first exhibited in 2006. Bulging disc with small herniation at the same level now causing leg issues...

User offline. Last seen 7 hours 41 min ago. Offline
Joined: 02/07/2012
Posts: 75
Points: 150
diagnostic

Has your doctor mentioned a diagnostic first? Even though he has been doing the RFAs for a few years to me now, my doctor always starts with a diagnostic short-term procedure. It's just a shot of anesthesia to the nerve. Even if you're in a 3 or 4 pain, you should still know if it is effective or not. I've gone in with a 1 (due to fentanyl patch) and could still tell. Once your doc knows if they're in the right spot, the RFA should be a 'no brainer'. If you have no pain relief from the diagnostic, and RFA won't help. If you get relief from the diagnostic, the RFA is (at least) in the right spot. Whether you get relief from it or not is, like any treatment, up to your body.

I get a tremendous amount (85-95% if not 100%) of relief from the RFA procedure. It has lasted about 9 months for me in the past. My doctor office bought a new machine that is supposed to do a "more thorough" burn (much more painful too!) but it did give me longer relief in the SI

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MRI reports:
Bilateral facet hypertrophy from L3 to S1. Broad-based left foraminal/posterolateral disc herniation L4-L5, with underlying focal annular tear abutting the existing left L4 nerve root. Bilateral facet hypertrophy, with resultant mild to moderate left neural foraminal narrowing (L4-L5). Small posterior central disc herniation at L5-S1. Small right paracentral disc herniation at T7-8, indenting the right anterior thecal sac. 1.5cm rounded T2 hyperintense lesion in the T12 vertebral body.

Veteran of many RFAs (ask me anything about them). 50% disabled Army Veteran. Proud CPAP wearer (ask for advice).

SteveC's picture
User offline. Last seen 12 weeks 5 days ago. Offline
Joined: 11/22/2008
Posts: 67
Points: 134
Not a bad idea...

I've had nerve blocks before as a diagnostic and I thought that was a more uncomfortable procedure than the rhizotomy! During the rhiz. procedure I recall he placed the various conductors and asked me when I felt throbbing so he cound confirm placement of the probes.

Right now I am back at physical therapy in preference to another rhiz. The PT seems to have a good handle on my situation and we are trying a combination of traction, and stretching with a minor amount of core strength (I work out a lot, so don't need to have a PT tell me how to do pure strength exercises). So far, so good Smile

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L5-S1 lam/disc for nerve entrapment on 7 Jan 2008 in Annapolis correcting a condition which first exhibited in 2006. Bulging disc with small herniation at the same level now causing leg issues...

User offline. Last seen 7 hours 41 min ago. Offline
Joined: 02/07/2012
Posts: 75
Points: 150
PT

Yeah, the nerve blocks for diagnosing and locating the pain do kind of suck. You only get a short-term relief (a few hours! LOL) and now you're sore for a bit from the injection too. If you're lucky, your doc might squeeze some steroid in there too. That helps lessen the pain, in my case, for the 2-weeks I wait for the RFA to be scheduled.

Glad to hear you're in PT and it works so well. I tried PT a few times, but only had 1 therapist that was effective. She put her hands on me. I was so surprised by this simple difference between her and other therapists I had seen. None of the others had worked on posture, actually pushing my hips back to the proper position. This gave my muscles the memory of where they're supposed to be to support my spine. What a massive difference.

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MRI reports:
Bilateral facet hypertrophy from L3 to S1. Broad-based left foraminal/posterolateral disc herniation L4-L5, with underlying focal annular tear abutting the existing left L4 nerve root. Bilateral facet hypertrophy, with resultant mild to moderate left neural foraminal narrowing (L4-L5). Small posterior central disc herniation at L5-S1. Small right paracentral disc herniation at T7-8, indenting the right anterior thecal sac. 1.5cm rounded T2 hyperintense lesion in the T12 vertebral body.

Veteran of many RFAs (ask me anything about them). 50% disabled Army Veteran. Proud CPAP wearer (ask for advice).

SteveC's picture
User offline. Last seen 12 weeks 5 days ago. Offline
Joined: 11/22/2008
Posts: 67
Points: 134
You got it!

Good posture and remembering what good posture is, is really important. My first experiences with PT were pathetic...ride the bike do the weights. One time I was chastised for doing lat pull downs with the entire stack as "[you] aren't supposed to be working out!" You have to listen to me...I am not weak in a gross sense, you have to help me out with the smaller parts which add strength to the whole.

The PT Group I am with now definitely understands the issues of spine sufferers and they actually noticed that my pelvic bones were not "level" so they did some chiropractic style manipulation and the relief was near immediate. Just in case you are interested. you lay on your side, hips stacked, legs and knees together at 90 degrees (as if you are sitting down), with your legs off the table/bed. Have someone push gently on your knees and you resist. Hold for a while, relax and then drop your feet down about 30 degrees and repeat, then do 60 degrees.

The other great fix was applying firm, significant pressure to tight and spasming muscles. The pressure cuts off the blood flow to a degree, and without the blood flow, the muscle loses the energy source to keep contracting. Amazing!

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L5-S1 lam/disc for nerve entrapment on 7 Jan 2008 in Annapolis correcting a condition which first exhibited in 2006. Bulging disc with small herniation at the same level now causing leg issues...

User offline. Last seen 7 hours 41 min ago. Offline
Joined: 02/07/2012
Posts: 75
Points: 150
PT

That's about the same experiences I had (minus the scolding). "Do this exercise, now do this, pay on your way out". I was blindsided by this one therapist I had, she was amazing. She just started grabbing my pelvis and moving me around, but I quickly realized how important that was. I don't continue the exercises like I should, but try to keep the posture she taught me. It's such a basic thing, I guess that's why the other therapists I went to didn't even cover it. Unfortunately, it's probably the most important since I haven't herniated any more discs since!

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MRI reports:
Bilateral facet hypertrophy from L3 to S1. Broad-based left foraminal/posterolateral disc herniation L4-L5, with underlying focal annular tear abutting the existing left L4 nerve root. Bilateral facet hypertrophy, with resultant mild to moderate left neural foraminal narrowing (L4-L5). Small posterior central disc herniation at L5-S1. Small right paracentral disc herniation at T7-8, indenting the right anterior thecal sac. 1.5cm rounded T2 hyperintense lesion in the T12 vertebral body.

Veteran of many RFAs (ask me anything about them). 50% disabled Army Veteran. Proud CPAP wearer (ask for advice).