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Trying to decode between SCS or RFA for facet arthropathy

ryno_msprryno_msp Posts: 6
edited 10/26/2018 - 6:26 PM in Spinal Cord Stimulation

So here is some background info on what I have been experiencing:

About a year ago, I experienced a work related injury to my back. After several failed attempts at medication (muscle relaxers) from my PCP, she referred me to an ortho specialist. Upon seeing the ortho doc, I had an MRI done which per the radiologist report, didn't show anything that could be causing the back pain besides something that indicated DDD at the L4-L5 level. So the ortho doc did a lumbar ESI, which caused severe pain. For several months, i was averaging a 6-7 on a scale of 1-10, with some incidences of an 8 or 9.

At one point, i was sick of getting the run around from the hospital system so I went to another provider. Upon that provider viewing the MRI imaging, he saw an annular tear at the L4-L5 level, and stated that that was what was causing my back pain. (Around this time, i also started seeing a pain management doc to get
started on new meds as the ones that i was being prescribed were not
helping. He prescribed gabapentin and celebrex, which have been helping
at reducing the pain to 3-4). He suggested doing another injection, but with my horrible experience the first time, i was hesitant. Finally, around the end of March 2018, i decided to give the ESI another shot. This time it worked :) ! My new ortho doc stated that per the imaging done with the first injection, it didn't look like the "hit the right area." 

Well, the next 4 months were great. I was averaging 1-2 on a scale of 1-10. I was in heaven. But, when August comes around, i start experiencing pain again, averaging a 4-5, sometimes a 6. I go back to my new ortho doc and he suggests having another injection. I agree. At the end of August, i get my now 3rd injection. As the next two weeks go by, i am experiencing no relief. I finally go back in to my ortho doc and he orders a new MRI.

The new MRI shows facet arthropathy at the L3-L4 and L4-L5, which he believes is causing the pain and it may not have been the disc at all. So last week, when I go in to review the imaging, he tells me that i have the option to have a medial branch block done to determine if that is what is causing the pain, and eventually do an RFA. So i had the MBB done this week and it reduced my pain by about 80%, which is great, so i have a follow up to discuss next steps. In the meantime, the meds that i have been on have not been helping as much, so i also had a pain management appointment today. In discussing with him what my ortho doc's plans were, i asked him if there are other options out there in the case the RFA doesn't work. He brought up having an SCS implanted. In talking with him and his experiences with his patients, he noted that only about 50% experience pain relief and in those that do, the average pain relief is about 6-8 months.

So this is where i am. I am wondering if anyone with facet arthropathy has decided between getting an RFA done and having an SCS implanted. My major concerns is that the RFA is not permanent. Anyways, any thoughts on the subject would be appreciated. Thanks

Also, i know no one here can give medical advice. Just looking for other's experiences.



  • Hey Ryno,

    Sounds like a bit of grief, and I'm sure you will find plenty of others here who can relate.

    I'm not sure where you are based, but where I am, no one will do an SCS without having already tried RFA/RFN.

    I have had multiple RFA done. The first time got me relief for almost 2 years. Over time they have become less effective and 18 months ago (7 years after the first RFA), I got my SCS implanted. 

    Don't be in a hurry to be cut open. Yes, the SCS are great and without I'd never be able to get out of bed, but I still operate at a daily level of 6/10.

    Do your research before you decide on a SCS. I had the Boston implanted and am about to add a Nevro as my pain has changed in the past 12 months. 

    I'm not saying don't do it, just make sure you try to exhaust the conservative options first. 

    July 2009 - L1, L3, L5 disc hernation
    Jan 2011 - L5/S1 Microdiscectomy
    Dec 2012 - return of neural symptoms
    June 2014 - fusion recommended - awaiting insurance approval
  • Hi Rino,

    I have severe facet arthritis in L4-L5 L5-S1 with ddd and a couple of bulging discs. I have had the RFA done many times over the last few years. On a total of 8 sites, 4 one day the other 4 a few days later. Let me say this also, I’m a weird one my nerves regenerate rapidly. My last RFA was done in October. I have gotten relief over the years up to 100%. Now I’m not getting  much, maybe 10% and have almost constant neuro pain in both legs. This is not related to the RFA, just the disease process going on in my back which is at a rapid pace, only 55 but my mri looks like an 80 yr old. My SI joint is now a mess too. I am in the beginning stages of going with a SCS. I have my Physc eval tomorrow. If I had to do it all over again I would do the RFA but have caved sooner for the SCS. The last year has been hell. As I type this I have my tens on, took meds, and am sitting on heat. 

    My advice is try the RFA first. It’s not as bad as it may seem. You can also supplement it with steroid injections which I have have also done. 

    Best of luck to you and I hope you find relief. 

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  • In full transparency, I do not have an SCS.  I have had two RFA's done with some improvement, but nothing to write home about.  Do your research on SCS's.  The Federal Government (US) is coming under fire for not properly overseeing the SCS market and treatment.  There was an article in the local paper a month or so about that showed several popular SCS units have caused a serious number of negative impacts on patients.  The numbers were reported to the Government, but they took no action.  Some people swear by them for relief.  I've heard from a couple people in my neighborhood who had SCS's and had them removed in less than six months of use.  I would go the route of being conservative first and have the RFA done.  See what happens after that.  But, I think I would ask the doc about the Pro's and Con's of an SCS versus a pain pump.  I really hope you get some relief soon!  

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • Hello, I am new to the Forum and am posting to this discussion because you have the most recent activity.  Having a hard time finding anything recent about success/risks/side effects about the Nervo HF 10.  Hoping somebody replies to this for a discussion.  thank you!

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