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Old 12-10-2003, 03:39 PM   #1
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standingman HB User
Selective Nerve Block Used Diagnostically?

Hi All--I'm wondering if anyone has any experience with a short-acting selective nerve block used for diagnostic (not treatment) purposes. In other words, temporary numbing of a particular nerve (L3, L4, etc.) to see if all one's radicular pain symptoms could be attributed to irritation of that nerve (whatever other underlying cause).

Has anyone had this and found it to be (or not be) useful?

Thanks,

Standingman

 
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Old 12-10-2003, 05:11 PM   #2
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Re: Selective Nerve Block Used Diagnostically?

Standingman,

Not sure if it is the same thing or not, but my daughter had two blocks to determine if her problem was in the facet joints as suspected. The theory is that if you get pain relief from the block then they are in the right place and therefore is diagnostic. I understand that sometimes people also get longer relief from this procedure, but in our case, she didn't. It simply was diagnostic for her. The recommendation being made now for her is radiofrequency neurolysis, which is supposed to deaden the nerves for a period of time until they grow back.

Hope that helps,
Peri

 
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Old 12-10-2003, 06:02 PM   #3
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Re: Selective Nerve Block Used Diagnostically?

Standingman,
Yes, I had two diagnostic nerve blocks done this past summer. The second was done to confirm the first. The nerve blocked was the left nerve root at the L5/S1 level because the Dr. suspected Foramenal stenosis. Yes, the pain down my left leg was temporarily gone so the Dr. was sure this was the problem so in August I had surgery to open up the Foramen to take pressure off the nerve. I didn't get any better after the surgery so he ordered a Discogram which indicated a problem with the disc at that level, so next week I am scheduled for a fusion at that level. What this tells me is that blocking the nerve may indicate that the nerve in question is the problem nerve but since the nerve runs from the brain down the spine it does not pinpoint the area where the nerve is being aggravated. My Dr.(Neuosurgeon) did admit that the science of the spine is an inexact science. Isn't that terrible since "back problems" is the #2 health problem in this country. I hope this helps.
Good Luck,
Larry
__________________
1990-Myelogram=L4-5 LAMINECTOMY.1998-Myelogram,Discogram,CTscan=L 4-5 FUSION w/BAK cages. 2002-Prolotherapy injections. 2003-April-MRI Lumbar spine=DDD,bulges,arthritis,low disc height,Physical Therapy.2003-May-MRI Thorasic spine=Two herniations displacing nerve roots.2003-July-Nerve blocks/epidurals; 2003-August-L5/S1 FORAMENOTOMY.2003-October-Lumbar Discogram=2003-December-L5/S1 FUSION w/BMP/LT cages. 2004-Jan-Pain much worse than before surgery. CTscan & L1/L2 nerve block & Myelogram.

 
Old 12-10-2003, 06:21 PM   #4
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Re: Selective Nerve Block Used Diagnostically?

Larry,
I noticed that you listed prolotherapy as one of the treatments you had. What was your experience with that, did it help at all? Did you have any side effects? I'm hearing very conflicting opinions on the subject.
Thanks,
Peri

 
Old 12-10-2003, 07:23 PM   #5
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Re: Selective Nerve Block Used Diagnostically?

Peri,
I did have one session of Prolotherapy which involved about 40 injections in my lower back. It wasn't that painful. It is my understanding it requires several sessions to do any good. Prolotherapy is intended to treat soft tissue injury ie., tendons and ligaments. My wife had the injections in a very aggravated elbow (tendonitis) and it really helped her. My problem is more mechanical so it didn't help me. Hope this answers your question.
Regards,
Larry
__________________
1990-Myelogram=L4-5 LAMINECTOMY.1998-Myelogram,Discogram,CTscan=L 4-5 FUSION w/BAK cages. 2002-Prolotherapy injections. 2003-April-MRI Lumbar spine=DDD,bulges,arthritis,low disc height,Physical Therapy.2003-May-MRI Thorasic spine=Two herniations displacing nerve roots.2003-July-Nerve blocks/epidurals; 2003-August-L5/S1 FORAMENOTOMY.2003-October-Lumbar Discogram=2003-December-L5/S1 FUSION w/BMP/LT cages. 2004-Jan-Pain much worse than before surgery. CTscan & L1/L2 nerve block & Myelogram.

 
Old 12-10-2003, 07:47 PM   #6
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Re: Selective Nerve Block Used Diagnostically?

Larry and Peri--This is beginning to become poetic!

Thanks to both of you. Larry, does that mean you continued to have leg pain, even after the foramentomy? Or was it primarily back pain that remained? Is is your view, or your doc's, that if you'd had the discogram in the first place, the first surgery might have been avoided?

Peri--there's a variety of experiences with prolo if you look for it on the search engine of this site. I don't recall if it was you who'd asked before, but the general review seems to be mixed.

Thanks,

Standingman

 
Old 12-10-2003, 08:13 PM   #7
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Re: Selective Nerve Block Used Diagnostically?

Standingman,
You ask a tough question. Remember, hindsight is 20/20. When I went back to my Dr. after the Foramenotomy and told him I had no change in my condition (leg pain & lower back pain) his comment was " Based on the results of the nerve block I was sure your problem was the restricted foramen but since you still have the same problems I recommend a fusion because I feel the L5/S1 disc is your problem" but I did not want another fusion surgery and asked him about Nucleoplasty and IDET. He referred me to a Dr. who does nucleoplasty, in fact he does the training video for the company that developed and sells the equipment to perform this procedure. He did the Discogram and based on the results said the disc is too far gone for Nucleoplasty so he also recommended fusion.
An inexact science, Right.
Larry
__________________
1990-Myelogram=L4-5 LAMINECTOMY.1998-Myelogram,Discogram,CTscan=L 4-5 FUSION w/BAK cages. 2002-Prolotherapy injections. 2003-April-MRI Lumbar spine=DDD,bulges,arthritis,low disc height,Physical Therapy.2003-May-MRI Thorasic spine=Two herniations displacing nerve roots.2003-July-Nerve blocks/epidurals; 2003-August-L5/S1 FORAMENOTOMY.2003-October-Lumbar Discogram=2003-December-L5/S1 FUSION w/BMP/LT cages. 2004-Jan-Pain much worse than before surgery. CTscan & L1/L2 nerve block & Myelogram.

 
Old 12-10-2003, 08:23 PM   #8
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perianthal HB User
Re: Selective Nerve Block Used Diagnostically?

Thanks to you both, yes it was me that asked before, we are wanting to make sure we have exhausted all possibilities. The research we are doing seems to be confirmed by your experience Larry, that for soft tissue problems, there well may be a place for prolotherapy, but not likely to be helpful with our bone to bone problem. Thanks for relating your personal experience. It is helpful in trying to get the full picture.
Peri

 
Old 12-10-2003, 09:36 PM   #9
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Re: Selective Nerve Block Used Diagnostically?

Thanks for the word, Larry. Did your earlier fusion help at the relevant level? Is it possible to say what the theory is about how your disc may still be causing leg pain? (I know and agree with what you said--inexact, to say the least.)

I also have recently learned that getting "nuked" most likely would not be helpful because of what's causing my stenosis--the disk height is OK, but too much other stuff going on re: bone, ligament, etc. So.....probably would be lami for me if it is anything at all.

The NS who wants to do the diagnostic nerve block thinks it would be informative in ways disco might not be, but I'll need to get more clarity from him why he thinks so. Needless to say, I'd prefer not to "disco" if that's the choice; but I'd also prefer that we all have as much useful info as possible if surgery is going to happen.

Again thanks and best,

Standingman

 
Old 12-10-2003, 10:06 PM   #10
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Re: Selective Nerve Block Used Diagnostically?

Standingman,
Yes, the fusion at the L-4/5 level did eliminate the terrible stabbing pain in my lower back but as time went on I started getting the pain down the leg. The Dr. (Ortho-surgeon) who did the first fusion (he was featured on Dan Rather's CBS Evening News) said he took a conservative approach and did not want to do a double fusion. My current Neurosurgeon in Santa Barbara says that based on my Discogram prior to the first fusion I should have had at least two levels fused. Again hindsight is 20/20.
Larry
__________________
1990-Myelogram=L4-5 LAMINECTOMY.1998-Myelogram,Discogram,CTscan=L 4-5 FUSION w/BAK cages. 2002-Prolotherapy injections. 2003-April-MRI Lumbar spine=DDD,bulges,arthritis,low disc height,Physical Therapy.2003-May-MRI Thorasic spine=Two herniations displacing nerve roots.2003-July-Nerve blocks/epidurals; 2003-August-L5/S1 FORAMENOTOMY.2003-October-Lumbar Discogram=2003-December-L5/S1 FUSION w/BMP/LT cages. 2004-Jan-Pain much worse than before surgery. CTscan & L1/L2 nerve block & Myelogram.

 
Old 12-10-2003, 11:34 PM   #11
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Re: Selective Nerve Block Used Diagnostically?

Makes sense, Larry. Sounds like you've worked to get the most expert opinions too. Which gives one even more pause to get into the prophecy business in this realm. My neurosurgeon is a kind of Garrison Keillor character from Minnesota. Tells me odds of laminectomy helping would be about 50-50. When I tried to get him to fill that out a bit, he elaborated: "It's a toss-up."

Maybe this was more Yogi Berra than Lake Wobegon.....

Standingman

 
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