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Old 11-12-2008, 11:22 PM   #1
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helenoftroy HB User
Arrow acdf of C4-C5 in '00, C5-C6-C-7 in '06... still in pain. now facet injections?

Hello everyone, I am new to healthboards but I have gotten a lot of reading posts over the past couple of weeks. I have a question for people who have had their symptoms return after surgery. Basically, if 4 ESI's haven't helped, what about facet injections? to get there, I need to give my history.

My situation: I am 33 years old and trying to practice law but experiencing a lot of pain in my neck and arms, weakness, tingling fingers, and nausea. In January 2002, after about 18 months of problems and conservative treatment, I had ACDF at C4-C5, with cadaver bone and no hardware. I woke up in the hospital without arm pain, recovered completely, and put it behind me. I was able to carry my books and laptop everywhere in law school, able to water ski, jog, rollerblade, & work out without any trouble.

A little over a year after I finished school, and almost 5 years after my first surgery, the familiar pain returned. After 2 months of pt, they did an MRI and the NS scheduled me for surgery immediately. (A different NS than before because I live in a different state). I had ACDF at C5-C6-C-7 in December 2006, again with cadaver bone and this time with hardware.

Both times, surgery was necessary because of disc herniations (reason given by NS: genetics and bad luck). The second time, the NS told me that the first fusion put stress on the levels above and below it. The first NS had not warned me about that. I recall that the herniation at C6-C7 was worse than at C5-C6, but we did both because C4-C5 was already fused and C5-C6 would have gotten much worse trapped between two fusions. I recovered pretty well and was able to work and travel for work without concern starting two months after the surgery. After that surgery, however, I started having migraines for the first time (age 32).

Then, about a year ago, 11 months after my second surgery, my pain returned. I had x-rays and an MRI in November 2007 - both were normal and showed the fusion healing well. My pain, weakness, tingling, dizziness, and nausea roblems intensified, and I had a myleogram of my c-spine in March 2008. It was very painful, but it turned out normal. I had a brain MRI to investigate my dizziness. It was normal. I started physical therapy, including meditation, yoga for strength, and cranio-sacral therapy in February. I am still working with my physical therapist and it really helps with the pain and has helped me gain strength. I started feeling a little better and was able to work full-time for May-August. In September 2008, I had an episode on an air plane with an on-set of intense pain, throbbing in the neck itself, which caused me to vomit repeatedly throughout the flight. They had to take me off the plane in a wheelchair, throwing up the whole way. This was after I had taken all the medicine prescribed - including phenergan. I saw my pain management doctor and decided to do another ESI. I forgot to mention that I had epidural steroid injections in 12/07, 1/08, and 7/08. So I had another on 10/1/08. It didn't help, so I had an MRI.

The MRI came back showing a right central bulge and annular tear at C3-C4, according to the radiologist's report. I went to the NS expecting another surgery but he said the C3-C4 issue couldn't be causing my symptoms, which he said were associated with the levels he'd already operated on. He cannot explain the level of pain I am in. It has gotten markedly worse in the last two weeks. Last Wednesday, the last time I went to the office, I was overcome y pain and vomitting (from the pain). Again, I had taken my phernergan and taken OTC emetrol but I couldn't keep them down. My NS prescribed a different anti-nausea, zofran, but I took it yesterday and threw up twice. The vomitting is a real problem because (1) it hurts my neck and (2) if I can't keep pain meds down, the nausea gets worse. The pain management doctor increased a bunch of my medicine to try to keep the pain to a level that it doesn't make me nauseated (both the pain and the pain meds make me nauseated; yes, if I took pain meds wihout phenergan, I would feel sick, bu if I take nothing or pain medication that isn't strong enough, the pain itself makes me sick).

My pain management doctor also suggested facet injections, but he didn't want to schedule anytjhing until the NS had seen the new MRI. I asked my NS about it and he said it was worth a shot. I asked if I even have joints with movement at the fused levels and he said I did. He said it would only help the neck pain and not the radicular pain. Does anyone have any experience with facet injections? Any other ideas for managing pain and symptoms coming from levels that are already fused? I will try anything within reason.

 
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Old 11-13-2008, 11:31 AM   #2
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Join Date: Aug 2006
Location: seattle
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matt3507 HB User
Re: acdf of C4-C5 in '00, C5-C6-C-7 in '06... still in pain. now facet injections?

Hi Helenoftroy: I read you entire post and am sorry you are having so much trouble. My probs. are much less than yours, but one thing came to mind. I couldn't tolerate my meds for a while, and then I started taking them w/ 2 big glasses of water and a half of a granola bar. Another big glass of water 20 min. later. Then a snack or meal. My stomach is much better now. Worth a try. BTW, do you have a University/teaching hospital in your area? Lots of bright young minds. I'll be watching for your posts.
matt3507

 
Old 11-13-2008, 06:05 PM   #3
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Join Date: Jun 2005
Location: Utah
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BobM HB User
Re: acdf of C4-C5 in '00, C5-C6-C-7 in '06... still in pain. now facet injections?

Wow, what a horror story you are experiencing, I am so sorry for you.

I've got a very similar condition to yours - fused C4/5/6/7 with two ACDF surgeries, about a year apart, and now C3/4 showing signs of degeneration where a couple of years ago this level was fine. The surgeries were very effective at 'fixing' the pain from discs pressing on nerves, but I am left with chronic pain. My Dr described it as kind of 'man made' arthritis - bones fused, lots of scar tissue, things don't move like they are supposed to anymore, and inflammation from all of this.

I've had both ESI and facet joint injections - which are primarily a steroid drug to help reduce inflammation. I've had pretty good luck so far, and the injections 'last' about 6 months. They still don't make me free of pain, but it helps to reduce the pain.

The facet joint injections are a logical 'step' to try - most likely they will do only a single level at a time, to help diagnose exactly which levels are causing the pain. Worth a try, in my opinion.

However, your symptoms seem so severe - perhaps not typical of what people here talk about after several surgeries, etc. You are wise to keep looking for what is causing such a bad problem for you. From what I have read, the more surgeries we have in our necks, the less likely we are to get back to a pain-free situation - but what you describe seems much more severe than what most of us have after having so many levels fused.

Good luck - and please keep us posted on how you are doing
Bob

 
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