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schragie 12-15-2007 04:38 PM

Moderate Bilateral Facet Osteoarthritis
Hey All:

Finally got a copy of my CT results but haven't talked to my doc about it yet. I've been trying to figure out why I have so much tushie/hip/leg pain post an L5-S1 fusion, which I had considered mostly successful the first year after it. My back is fine, just stiff and a little achey, which I can totally deal with. It's the legs I feel like sawing off!

Anybody have this problem post-fusion? I won't bore you with typing the report here, but it says that I have four levels of mild disc bulges (not a big deal, right?), including a disc bulge at L5-S1 where I had a discectomy and fusion ( can I have a bulge of a disc that's not there?!)

What concerns me about the report is that it says I have moderate bilateral facet osteoarthritis it at 2 levels (L4-S1) with spondylotic bony ridging and mild stenosis at those levels. It says my neural formamen are patent, which I think means no nerve impingement. Then why do my legs hurt so badly?

I guess the really good news I can take out of this is that it says it sees evidence of fusion and the equipment is all in tact, so I won't have to go under the knife again, thank heavens.

I read up on facet joint problems and health sites recommend injections. God help the next doc who wants to inject something in my back. I have done way too many ESI injections over the years with no success so it seems a waste of time and money to bother with any more. I've never had a facet joint one though.

Anyone have this problem? What symptoms do you have? I didn't have this before my fusion -- is it one of those problems you get after a fusion? Has anyone had successful treatment?

I wish I could buy a package of new facet joints at Home Depot (((sigh))).


ihavtwins 12-16-2007 03:59 PM

Re: Moderate Bilateral Facet Osteoarthritis
Hi! I have facet joint degeneration due to arthritis. I had an injection into the facet joint and developed increased pain that did not go away. It was awful!

The pain you are having could be nerve pain. You should try icing your back as any inflammation in your lower back can cause the sciatic nerve pain.

Also, go back to doing your stretches and if it continues, ask your doc if it could be nerve pain , if it is you can try lyrica, a med used for nerve pain and it works pretty good for my sciatic pain.

Good Luck! Hope you are feeling better soon.

schragie 12-16-2007 07:41 PM

Re: Moderate Bilateral Facet Osteoarthritis
Hi Jen and thanks for the advice.

Actually, ice is my best friend and I lie on it a lot. Lyrica, sadly, did not work great for me and I just went off it this weekend due to side effects. I hadn't thought it was working at all, but having gone off it, I can certainly say it did help some. It took two days for my brain to de-fog but I can think again after all of the cognitive side effects.

I am so sorry to hear your injection did not work (and actually made you worse). I have never felt worse after an injection, but I've had so many of them and never truly felt better for more than a week or two from any of them.

Do you have pain in your legs from the facet arthritis? Besides stretching, ice and Lyrica, does anything else help with the pain? I slapped on some Lidoderm patches here and there over the weekend and had some relief in the spots where I placed them, but the pain is in so many places that I can't really use them everywhere. I also used my TENS unit with no success.

Do you find that you are okay when you wake up and get progressively worse during the day? That has been my experience.

ms_west 12-16-2007 08:33 PM

Re: Moderate Bilateral Facet Osteoarthritis
Schraige - stand up, face forward, put your feet together, hands at your side, lean back - What happens?

If you truly have arthritis of the facet joints, it makes sense that you have pain that increases as you move around during the day. You have a mechanical problem - the movement of the facet joint - increases your pain. It is very possible that your facet joint is somehow rocking on the nerve when you move - it is being crunched. This is what was happening to me and one of the reasons I had my fusion in Feb of last year.

I had my fusion also due to stenosis. With this, it is common to have horrible cramping in your legs. You might want to do an advanced search on my user id....there is a thread entitled [B]Baybreeze....Neurogenic Claudiication Anyone?[/B] The thread is dated 01-20-2007, 07:59 AM

Baybreeze and I discussed this stenosis in great detail. Hope it helps you some.

schragie 12-16-2007 09:21 PM

Re: Moderate Bilateral Facet Osteoarthritis
Hey Pepper:

Thanks for the reply and for the explanation. I will check out the thread you mentioned but I promised myself I'd be a good girl and go to bed before midnight!

I tried your leaning back experiment and nothing bad happened. I, in fact, do that stretch several times a day and have no increase in my pain when I lean back. I can lean forward too without any sharp shooters anywhere.

Hope you enjoyed the weekend and that you see progress during the week ahead!


ms_west 12-17-2007 01:23 AM

Re: Moderate Bilateral Facet Osteoarthritis
That is great news that nothing happened from what I understand. My doctor said that simple test depicts facet joint problems. Before my latest surgery, I could not do that without coming close to blacking out. In fact they did that little flexion xray before surgery and they had to run and get my doctor down the hall. Apparently, I went completely white and almost hit the ground. My doc said it was due to the facet joint so it sounds like that is not your problem. YEAH!!

When do you see your doctor next?

I am with you about the injections, I don't think I can have another one either.

Baybreeze 12-17-2007 09:26 AM

Re: Moderate Bilateral Facet Osteoarthritis
Hi, it's Baybreeze chiming in LOL. Pep, thanks for directing Shragie to my thread about stenosis/claudication, of course I thought of that too when I read the first post here. Schragie, I'm glad that you are able to stretch and not having pain bending backwards or forwards. However, keep an eye on that over time, as I did not have those pains at first either. From the start of my lower back pains, it took maybe 2 yrs or so until I started having bad problems bending and walking. At first my pains were intermittent & I wasted alot of money buying things thinking it was due to a bad mattress or drafts or muscle strains.

I also have facet arthritis in L2 through S1, plus I keep getting herniations & bulges & problems with scar tissue. My last 3 episodes I had all the nerve pain radiating into both my outer hip areas. ON Thanksgiving night it was horrid, somethign happened & i could not even put weight on my left leg, felt like I was being electrocuted. Everytime this happens, I also get bad spasms across my back PLUS the last time I got them in my legs. So whatever your pain is might be nerve pain or maybe spasms, i dont know. Either way I do know how painful & frustrating it is!

Right now i'm having deep achiness in my entire lumbar spine area (& some other parts), my rear end right where the back ends, going across both sides kind of along the bone area. And I have this outer hip pain all the time (though it has lessened since Thanksgiving). It's the worst when I stand or try to walk around for too long. It feels as if someone put a heavy weight or cement block in there and it's pressing down on everything. However, I am having problems bending backwards, forwards, and sideways. I do have more narrowing and hypertrophy in my facets & lateral recesses since my surgery....though I am no longer having that claudication pain I had before surgery. And one doesnt necessarily get claudication right away, sometimes it can take years to develop. If you already have some stenosis from bony overgrowth, I hate to say this, but it might get worse over time. And standing makes things worse b/c it puts more pressure on your entire spine...when you have MRIS or CTs, your'e not standing up, your laying down which relieves some spinal pressure. So its also possible the imaging doesnt show the whole picture.

LOL in line right behind you at the hardware store!

Moldova 12-17-2007 05:40 PM

Re: Moderate Bilateral Facet Osteoarthritis
we all after age 25 start to get problems like DDD, osteo, stenosis, etc.
I had my surgery a year ago and 10 month later when i had my first MRI after all my surgical area and higher was re-herniated again, plus "same old" arthrities, stenosis... did not have to wait a long time for it to come back.

Arthrities means inflammation. Inflammation can cause on a near by nerves and that is why you get your legs pain. I have mine severe but my problem is on a top of all the above is nerve damage during surgery.
Ice, some stretches, yoga, meditation, hot tob - this all may help you to coope with your pain.
Best of luck to you.:angel:

schragie 12-17-2007 07:38 PM

Re: Moderate Bilateral Facet Osteoarthritis
Thank you Ladies!

I read through your claudication post Bay/Pep and it was helpful. I still haven't talked to my surgeon about my CT results because he hasn't returned my call yet. Weirdly he did not want to schedule another appt with me and instead said we should talk on the phone. My pain doc said I should see someone else for meds if I want opiates because he doesn't like to prescribe them and basically told me to go back to the surgeon and think about getting a spinal cord stimulator, which I am not prepared to do after reading about it. So I feel doctor-less right now and will ask the surgeon for a recommendation of who to see next -- a different pain doc, an orthopedist, a rheumatologist -- who knows?

I must say I am very frustrated but since my insurance is changing in January it's an opportunity to find some new docs. After I speak to my surgeon I will probably call Moldova's pain guy at *** fin Manhattan for a consult (thanks, Moldova!) It's worth the $ just to have a doc listen to me for a change.

In the meantime, I'm just trying my best to cope. I took two Vicoden 7.5s tonight, because the first didn't help, but neither did the second. The pain is sciatic down both legs, in the outer hips, both fronts of my thighs and tonight it's in one of my feet too. Nothing is really helping me these days, but I may switch to warm heat (from my old standby, ice) and see if that makes a difference. I took a really long hot shower after work, but no help. I do have spasms in one leg, but they're not too bad so I didn't think it warranted taking an anti-spasmodic. I get feelings of warm water running through my legs sometimes (like when you get an epidural) but it doesn't hurt, just feels funny. All I know for sure is that something is definitely WRONG!

I've gone from docs telling me it's nerve pain (I had an enlarged S1 nerve on my last MRI) to now having a CT tell me I have other problems. I saw one bulging disc on my MRI in March when I looked at the film myself, but the report didn't note them and both my surgeon and pain doc didn't think it was a big deal when I pointed it out to them. Now the CT 9 months later says there are four, albeit mild. I wish science were a more exact science!
I don't know what to believe anymore. Surgeon says he saw facet problem on my X-ray and now CT appears to confirm it.

I'm willing to try just about anything to feel better and if another course of PT will help I will go (I had 6 months of it already this year!) In the past I have been on NSAIDS but saw no difference in my pain level and stopped after about 4-5 months on them. I am about 30-40lbs overweight, and am losing weight, but even at my thinnest the pain doesn't disappear. I also do tons of walking, which helps with the weight loss, but not so much with the pain.

I think I am venting right now (thanks for reading, but feel free to skip!), but I am tired of feeling like this. Before I had my fusion, it was very clear where the pain came from (bad disc) and even then I had a hard time getting good pain management. In fact, once I told my jerky pain doc I was having the fusion, he changed his tune and gave me enough meds to sedate an elephant for the two weeks before the surgery so I wouldn't have to suffer. I've only seen him twice since the surgery, but both times I had to argue with him to get Vicoden. The crazy thing is I haven't missed a day of work with all this pain but sometimes I feel like murdering my coworkers because I am irritable and get impatient with them.

I guess it doesn't matter if I get Vicoden anymore because it doesn't help anyway. I might as well bite on a bullet or something! Maybe there's an arthritis medicine that would help me. Or maybe something long-acting that will help manage my pain while I'm working without making me feel groggy.

But enough about me. Thank you all so much for listening and being so supportive. With the exception of my husband who is amazing, my friends and family don't really want to hear or can't understand what I'm going through. Moldova, I'm counting down till your surgery....and Pepper, I hope each day brings you closer to a successful outcome from yours. Bay, thanks for chiming in with your experience and I hope XMAS is a MUCH better holiday than Thanksgiving was for you.


chatterboxsd 12-17-2007 07:56 PM

Re: Moderate Bilateral Facet Osteoarthritis
Schragie - I've been reading some of your posts. So sorry you're having such a rough go. That's about all I can say about that. :(

I'm a thoracic person - so take what I say after this for what it's worth - I had a facet injection this summer and it did bring relief for about 2-3 days and then it wore right off. My PM and NS believed it was diagnostically relevant at least. It indicated that it was indeed the right nerve that was grumpy. It is very difficult to contain the cortisone in that area because it is not a closed space like a disc is. I opted not to have another (and another!) injection because I, too, am fed up with the cost, pain, and all too short relief they bring. The long term impact of cortisone creeps me out a little bit, too.

On your doctor search, Moldova's group sure sounds enviable! I'd take Diet's parents and Moldova's medical team, ok? Back to reality now, have you looked to see if there is a "Spine Center" anywhere near you? They're becoming more popular. I'm now in San Francisco and I've been going to one as part of my care (still getting 2nd and 3rd opinions other places and went with the 3rd opinion for my upcoming surgery - that's another story). But the Spine Centers are nice because they have doctors and testing resources all in one. Just a thought.

I know it's so hard to advocate for yourself and look ahead when you're feeling crummy. Do your best to be kind to yourself.

My best to you,

ms_west 12-17-2007 08:14 PM

Re: Moderate Bilateral Facet Osteoarthritis
Schriage - I am so sorry sweetie. I want you to know your vent helped me tonight -- bet you didn't expect to hear that one -- I hurting so bad and reading your post made me realize I am not alone and so thankful to have this board so that we may lean on one another for that much needed support. I am lifting you up in prayer that those vicodin kick in for you.

schragie 12-17-2007 08:50 PM

Re: Moderate Bilateral Facet Osteoarthritis
Thanks, Margareta and Pep!

Yes, they have opened a new spine center near me at Riverview Hospital and one of the docs takes my insurance so it's possibility. I actually got their brochure in the mail this week. I live in NJ but am in Manhattan every day for work so I need to decide whether I want to see city docs or country docs (ha!).

My new tack on this pain is that I am really mad at it. Anger is more motivating for me than feeling helpless, which leads to depression for me. I've gone from being really sad about it to becoming a petulant child wanting to say "But you promised!" or "It's not fair!" to the surgeon who fixed me. I'm going to kick this pain in the butt as best I can. Well, maybe tomorrow. Tonight I'm going to lie on some heat and get those extra special puppy kisses from my dog that make everything better instantly.


chatterboxsd 12-17-2007 10:37 PM

Re: Moderate Bilateral Facet Osteoarthritis
I tapped into my adolescent "entitlement" phase and decided I was entitled to feel well in my life - kind of like your being angry at the pain. I agree - it has been much more motivating and effective than depression and passiveness. Perhaps a bit immature or unrealistic on my part, but it's gotten me through a couple months on a more upbeat feeling. Aw, heck, what can we do when we're stuck with these darn spines, eh?

I have a kitty and he's been perhaps the best companion of all throughout this ordeal. Granted, he's a champion relaxer, so he's always game on my worst days. :D

This board has been a savior in many ways - concrete information and just commradarie (sp?) in what is otherwise a very isolating situation.

Thanks for the share. You can vent any old time!

I hope you found some relief with your heat. I go back and forth myself. Sometimes it's ice on my back, electric blanket on my front to stay warm. My husband calls me "Baked Alaska!"
- Margaret

Baybreeze 12-18-2007 05:45 AM

Re: Moderate Bilateral Facet Osteoarthritis
Isnt it something that we all go through those phases when we have something painful happen ( it's kind of the same feelings you get when someone passes away), depression, woefullness, anger, and many times acceptance. I've gone through all these several times over as I'm sure you all have. It really is like losing a part of yourself.

Schragie, I know how it is too to have to go to work in that pain. I know my work has suffered b/c of it when I'm in agony. People at work have told me I should get a wheelchair for when I have trouble walking. I think they are more afraid of me falling there or something. I am lucky, though, b/c my department boss has been really good about it to me. I am even still standing through many different lay-offs, so I guess even though at times my work suffers, I guess when I feel better my work makes up for it, so they kept me around so far. My boss has even gone so far as to make me call, say, my rheumy whos just down the street, get in real quick and she drove me to see him. And now she has to have a knee replacement done & gets alot of pain. She always tells me she doesnt know how I do it, how I come to work every day. I honestly don't know how's part stubborness, not wanting to give in, plus I NEED money, so no choice but to work. But even so, there are times that it's absolutely miserable. Then I also think, if I would stay home all the time, I might think about it all too much and get really depressed.

carol632 12-18-2007 05:55 PM

Re: Moderate Bilateral Facet Osteoarthritis
I just have to say this to all of you: your bravery in the face of all this pain and misery is just mind-boggling. I could no more go to work every day with the pain I was in prior to this last surgery, than I can fly! Kudos to both of you!

I am going to go read that thread that Pepper and Baybreeze talk about. Tho I doubt it pertains to me, I suspect that there's a lot of knowledge in those words. I have to say, too, that you guys sure have done your homework and research and you should be proud of that.

Thank you all for being here.


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