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  • Anyone Try Facet Joint Injections Prior to Having Fusion? And....Changing emotions

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    Old 08-31-2005, 09:55 AM   #1
    Harmony5
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    Anyone Try Facet Joint Injections Prior to Having Fusion? And....Changing emotions

    Has anyone had facet joint injections as a last resort prior to having a lumbar fusion? I'm scheduled to have a fusion, but not sure if I should try facet joint injections first. My facet joints are arthritic.

    I'm also going back and forth so much with my emotions with having the fusion. One day I want to go through with it, and the next day I say I should
    just cancel it. The Dr. said my success rate is not too good since I had problems for so many years. Are these unsettled emotions common?

    My surgery is scheduled for Sept 26th so I better decide soon! If I can
    get by with the facet joint injections, maybe that will at least be a temporary
    fix.

    Harmony

    Last edited by Harmony5; 08-31-2005 at 09:56 AM.

     
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    Old 08-31-2005, 03:22 PM   #2
    cabikerchick
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    Re: Anyone Try Facet Joint Injections Prior to Having Fusion? And....Changing emotions

    The key statement you make in your post is that your doctor says success rate won't be good because of the length of time. I would take that statement as a true red flag... and really rethink the surgery. If your facets are arthritic, then it seems the injections would be tried first before a surgery. How many levels would your fusion be? Is there other degeneration in your spine? Your emotions are not uncommon. A fusion is a serious operation, so it is very understandable. Good luck in your decision. I would follow up with your doctor, and if necessary get other opinions before making a decision

     
    Old 08-31-2005, 05:06 PM   #3
    davetheplantman
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    Re: Anyone Try Facet Joint Injections Prior to Having Fusion? And....Changing emotions

    Harmony, Our situations sound familiar. I have deteriorated L4-L5-S1 disks along with problems with the facet joints at the same locations. I have had one set of facet injections this past summer with little positive result, but am scheduled for another set with different doctor next week. The general feeling is that if they can pinpoint the pain is being generated by the specific joints, then destroying the nerves at the joint directly is a much better, if temporary, option than surgery. I am resisting fusion surgery and may opt out for the dynesys flexible fusion if I am unable to get relief from the next round of injections. Of course your emotions come into play here as these are big decisions, make sure you are well informed and educate yourself before you do something that cannot be reversed. The facet injections are unpleasant, and I did hurt for a while afterwards, but compared to surgery, I am sure everyone would agree it is worth the investigation and may put your mind to rest. Dave in Seattle

    Last edited by davetheplantman; 08-31-2005 at 05:08 PM.

     
    Old 08-31-2005, 07:48 PM   #4
    starrfish
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    Talking Re: Anyone Try Facet Joint Injections Prior to Having Fusion? And....Changing emotions

    I actually had facet injections early in my treatment plan. I had the PT, ESI's, then the facet injections...eventually I had rhizotomy at 4 levels with no real improvement.

    I just scheduled my artificial disc replacement for the end of September. I don't feel that temporary (and painful) procedures should be done when my discogram was positive for discogenic pain.

    I do, however, also have arthritic facet joints. I can't really say how the facet injections have helped, seeing as the pain has not gotten much better with all the treatments I have tried. I do know that after the injections, my back stopped making the "cracking" noise when I moved. After my surgery, I will definitely consider them again if I continue to have pain from the facet joints.

    I am very surprised they have not already tried the facet injections for you. I would definitely speak to your pain doc or neurosurgeon prior to surgery...they might help you a lot. It all depends on your condition ....

     
    Old 09-01-2005, 05:51 AM   #5
    kaybee
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    Re: Anyone Try Facet Joint Injections Prior to Having Fusion? And....Changing emotions

    First of all, Harmony, why does your dr. think the success rate isn't too good? Is it due to permanent nerve damage? Is he thinking you have a good chance of not fusing at all? If the success rate is so low, why is he considering a fusion in the first place?

    Secondly, will he be doing a foraminotomy or laminectomy also? If your dr is pretty experienced with doing those procedures, I don't see how they could fail to help anyone's situation.

    I'm not a big supporter of epi's or facet injections depending on an individual's circumstance. My dh went that route (5 epis, 1 facet injection series in 1 year) and received no relief at all. He wasted time, money, and a heck of a lot of pain on trying to mask the symptoms while his nerves sustained compression over a long period of time. After the neuro went in to do a 4 level fusion on him, he said that none of the traditional treatments really had a chance of working. He had no choice but to go ahead with a fusion which was, in his case, a last resort.

    It sounds corny but maybe you could make a list of the pros and cons of having/not having the surgery and maybe being able to have a visual on your feelings and doubts will help you decide what you think will be best.

    Maybe someone on the board can help you with the list but first let us know what your dr hopes you'll get out of a fusion.

     
    Old 09-01-2005, 02:08 PM   #6
    Quietcook
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    Re: Anyone Try Facet Joint Injections Prior to Having Fusion? And....Changing emotions

    Harmony,

    I became temporarily paralyzed when I had facet joint injections in 1998, as a final diagnostic tool before fusion. Please, don't get scared away, but let me offer some suggestions.

    At that time I was seeing a general ortho and general neuro team, and they, like so many doctors used the hospital's anesthesia department for such tests/injections. That does fine in a lot of cases, by my back was in bad shape. At that point I thought these were the only people out there for back problems, not realizing that there were both ortho's and neuro's who were truly spine specialists. When the doctor's reaction to my paralyzation was one of backing away, I knew I had to find a new doctor. It took a major search by finding specialist as I have described in my post "How to find a spine specialist in your area", by going to see a number of these specialists to see which one I could work with, but it was well worth the effort.

    We all have different personalities, different wants as far as how active we are in our own care and recovery, and what we want from the doctors such as whether we want a PM or whether we want our spine specialist to handle all our pain meds (I prefer this as I feel the spine specialist should understand my pain from the spine better than anyone other than myself) whether we want a specialist who does his own spinal injections or uses other doc's as my first one did, whether the specialist reads and interprets tests/films himself or strictly relies on the reports, plus otther things like being able to ask questions. When I found my current doc, even though he told me he had to repeat the facet injections which had paralyzed me a few months earlier, I was confident things would be okay when he said he believed in doing all his own tests when it came to invading the spinal area.

    We all heal differently and handle our illnesses differently, but I can tell you that with the care of this wonderful spine specialist (and if you don't have a true spine specialist, please at least consider if maybe you should), I'd dealt with 8 spine surgeries, four were fusions. This last one back in Dec was 10 levels, fusing me from T10-S3. Sure, I still use lidoderm patchs on some days, still use Ultram tabs on rougher days, but I am and have been active since about 3 months after this major surgery, and doing more every day. Yes, it is a bit harder with the recovery as we age, and I am an active senior, but I must admit that this last surgery was a rough go for the first couple of months. Still, my spine specialist had nuring/PT come to my house 3 days a week the first month, then I began PT at a local facility at one month, and I firmly believe that immediate proper activity has been a major plus in my recoveries.

    Facet joint injections are no more a major risk than many of the other tests we must endure, but I will not have another one done by anyone other than a spine specialist.

    Best wishes and hope you are better soon.

     
    Old 09-02-2005, 12:34 AM   #7
    Harmony5
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    Re: Anyone Try Facet Joint Injections Prior to Having Fusion? And....Changing emotions

    Thanks Cabikerchick; Dave, Starrfish, Kaybee and Quietcook for each
    one of your replies! Your advice and imput is very helpful.

    To answer some of your questions, I need a level 1 (L5/S1) fusion and the Dr. wants to do the anterior approach with BMP and cages. He will not be doing
    the foraminotomy or laminectomy as he doesn't think I need that and also that
    would involve going in through the back. I was told my facet joint is too arthritic to have the ADR. Starr, I was interested to read you are having the ADR and your facet joint is arthritic. The Dr. is giving me a 60% success rate and says my chances are not as good since I had this for over 30 years. Of course, it has progressively gotten worse over the years. The disk is completely collapsed. The other disks have moderate degeneration, some mild. It's very painful for me to stand or walk. My Dr. said the facet joint inj. are an option, but he said it's only temporary and the side effects may not be
    good. Believe me, he has waited for 3 years before telling me a fusion is my last resort. He did a microdisectomy on me 2 years ago to try that first since it's less invasive. Of course, that didn't help one bit since the disk is collapsed. I had a facet joint inj. once only for diagnostic purposes to see if it relieved my pain. It did but only for one day since they didn't use cordisone.
    So that indicated my facet joint is arthritic causing much of my pain.
    The pros and cons list is a good idea and I thought about doing that too.
    I've gone over and over it in my mind but should write it down. Dave, what is
    a dynesys flexible fusion? Quietcook, it's nice to see you back. I missed your posts and wonder what happened to you.

    I hope you all are doing okay and thanks again for your help and taking the time to care!

    Harmony

     
    Old 09-02-2005, 12:55 AM   #8
    davetheplantman
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    Re: Anyone Try Facet Joint Injections Prior to Having Fusion? And....Changing emotions

    Harmony, type the folowing into google.
    Dynesys Dynamic Stablization System.

    Last edited by davetheplantman; 09-02-2005 at 12:56 AM.

     
    Old 09-02-2005, 01:01 AM   #9
    Harmony5
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    Re: Anyone Try Facet Joint Injections Prior to Having Fusion? And....Changing emotions

    Thanks Dave! I'll do a search on that. I see you're up late here too.

    Harmony

     
    Old 09-02-2005, 06:34 AM   #10
    kaybee
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    Re: Anyone Try Facet Joint Injections Prior to Having Fusion? And....Changing emotions

    This is interesting, Harmony. My husband also has severe DDD throughout the entire lumbar and cervical regions and his fusion ended up being major with the rod, cages, bilateral 4 level foraminotomy and 4 level laminectomy when the surgeon saw the extent of the arthritis. The reason I mention this is that the neuro knew it was bad in there and put off the fusion for as long as possible. There was no mention of the foraminotomy or laminectomy but when he got in there, he could see that there were extensive bilateral compressions at each level. I think he had anticipated it, however, and that's why my husband's 7 hour surgery was the only one scheduled for the day.

    I can't help but feel that there is a better success rate out there for someone like you. No neurosurgeon/spine specialist can put a 100% guarantee on that, but I think that if they feel confident with what they are going to tackle and have the experience, it is a success. To me, if your arthritis is slowly closing in on the nerves, it can be relieved successfully. If the nerves are too damaged to expect much recovery, that's a different story but at least there is less risk for further damage if the compression is taken off. So, is the dr talking about a reduced rate of success for nerve recovery? Or, is he saying that you have a reduced chance of actually fusing?

    I have to mention again that I have a real problem with using drugs to 'fake' the nerves into thinking they feel good. That doesn't take care of what is causing them to be damaged. As you've indirectly pointed out, the longer those nerves stay compressed, the more damage that's done. Dh had the facet injections at five levels during the one treatment. It was rough and didn't work a bit.

     
    Old 09-03-2005, 02:27 PM   #11
    Harmony5
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    Re: Anyone Try Facet Joint Injections Prior to Having Fusion? And....Changing emotions

    Thanks, Kaybee for your post. That's interesting about your husband's surgery. I hope he's doing okay now. I don't seem to have nerve damage and my legs are okay so that is a plus. The Dr. just thinks I have a less chance of fusing since I have had this so long. That's the way I understand it anyway. You're right though, I don't think he would do it at all if he didn't think there was a chance of success. I think I would be better off having the fusion than masking the pain with the injections that may not work either.
    Something that might hinder me having the fusion right now (Sept. 26th) is the Cardiovascular Surgeon who has to do the surgery along with the Neurosurgeon is not covered by my insurance. The Neuro. is appealing it but so far still not covered. So, I'm waiting to find that out. Otherwise, it would be too expensive. He is the only Cardiovasucular surgeon my dr. will use so I don't have a choice in surgeons to assist.

    Thanks again for your advice! I appreciate it.

    Harmony

    Last edited by Harmony5; 09-03-2005 at 02:28 PM.

     
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