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Old 02-28-2008, 07:33 PM   #1
Junior Member
Join Date: Oct 2006
Location: Dallas, TX
Posts: 26
EricG301 HB User
Facet Joint Injections AFTER failed Rhizotomy?

Hey all,

I need some help understanding my PM doctor's logic. I've had two rhizotomy procedures done on my neck in the past year -- both which failed. The most recent one was done in October.

I've since switched doctors. My new PM wants to do a facet steroid injection, to be followed with botox in the muscles. It made sense when he suggested it the other day, but the more I think and read about it, the more confused I get.

Everything I'm reading about facet injections say that they should be done first -- and if it provides relief, then a rhizotomy should be done to provide more long-term relief. But if I've had two failed rhizotomies, then what makes him think that the injection will yield a different result?

The only thing I can think of is that the rhizotomy attacks the nerves that come out of the joint, and these injections attack the joint itself. But if those nerves have already been burned twice, and in theory no longer transmit pain signals to be brain, then...I'm confused.

Any help?

Old 02-28-2008, 08:30 PM   #2
Join Date: Apr 2006
Location: United States
Posts: 372
kera4 HB User
Re: Facet Joint Injections AFTER failed Rhizotomy?

Dear Eric, Hi! I have had facet injections and lumbar rhizotomy several times. It lasts 8 months for me and then I re-do it, since it helps to control my pain. Had you been helped by the facet injections in the past? You're right, usually, doctors will do the facet injections first. If they work, but do not last too long, they will procede with RFA (rhizotomy) after doing a lidocaine test (as a double check). It could be your new pain Dr. wants to inject again to see if there is any inflammation in those joints now. Do you have issues with your discs that are part of your pain? It seems that the pain management procedures are often a process of elimination. If one doesn't work, they proceed with the next to see if that will clarify where the pain is coming from. But, I agree with you, it does seem like a "back step" to re-inject the facet joints. Did your doc see inflammation "light up" in the facet joints on a recent MRI? I know my joints look that way on the MRI. Good luck-I know how hard it is when things are confusing....and spinal issues always seem to be that way, unfortunately. Take care, Kera4

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Old 02-29-2008, 05:30 AM   #3
Junior Member
Join Date: Oct 2006
Location: Dallas, TX
Posts: 26
EricG301 HB User
Re: Facet Joint Injections AFTER failed Rhizotomy?

Hi Kera4,

I have two torn discs, but according to the discogram I had about a month ago, they aren't the source of my pain. I find that kinda hard to believe, but that's what my physical medicine doctor and spine surgeon said.

My new PM said that if the facets are inflamed, the rhizotomy wouldnt necessarily make me feel better. I guess his logic is that the rhizotomy is more of a "band aid" for the pain, where as the steroid in the facet itself treats the actual cause of pain. Does that make sense to anyone else?

Old 02-29-2008, 09:54 AM   #4
Join Date: Apr 2006
Location: United States
Posts: 372
kera4 HB User
Re: Facet Joint Injections AFTER failed Rhizotomy?

Dear Eric, Actually that does make sense. There are times when my back gets painfull, despite the rhizotomy. And, I have received facet injections along with re-doing the rhizotomy. For example I got facet injections in November, followed by the lumbar rhizotomy in December. For me, I have chronic arthritis in the facet joints, and if my arthritis meds are not doing enough, my doctor will shoot more steroid in the facets. You are right, the rhizotomy is a "pain management" procedure, not curing anything. It just makes getting through the day easier-for me I can sit longer when the rhizotomy is in place. It sounds like your doctor has a plan, and you may need to get the inflammation level down. Let us know how it goes. Kera4

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