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  • Need Advice Re: Radiofrequency Ablation

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    Old 02-15-2005, 09:16 AM   #1
    BrittleBones
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    Need Advice Re: Radiofrequency Ablation

    Hi folks. I saw my PM doc yesterday and he is advising radiofrequency ablation of my sacroiliac joints to further reduce my hip and leg pain. Has anyone had this procedure and, if so, can someone explain it to me? I'm really nervous about it and my fear is that it will be very painful. Do you have to be awake or can they sedate you? Also, if you've had this procedure, did it help? Thanks - Kathy Mac

     
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    Old 02-15-2005, 11:15 AM   #2
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    Re: Need Advice Re: Radiofrequency Ablation

    Hi Kathy, Have you had nerve blocks done that benefited you. It wouldn't make sense to have RFA without doing some test blocking to see if semi-permanantly destroying the nerve will help. They may do test blocks prior to RFA and you must be awake to report results. The actual nueuroblation takes about 90 seconds per nerve.

    The control of pain by the destruction of nerves which carry pain signals works better in theory than in practice. At its best this procedure, often called neuroablation, has about a 40% success rate. My primary reference work for neuroablation is Neurosurgical Management of Pain, 1997, by North and Levy.

    Nerve root deadening (neuroablation) is a LAST RESORT approach to most pain problems. The reasons for this lie in its poor track record and in the fact that it generally doesn't fix the problem, it merely covers it up.There are several ways to deaden a nerve. The first, called a rhizotomy, involves simply cutting the nerve; often a section is removed to prevent the severed ends from growing back together. The second procedure, called cryoablation, involves injecting the nerve with a freezing liquid, such as alcohol. This freezes and thereby kills the nerve. The third procedure, called radiofrequency lesioning, is carried out with a special needle that cooks the nerve root with high frequency radio waves.

    When the nerve root is cut, it generally doesn't grow back together. Nerve roots which are frozen or burned typically do grow back in 6 to 18 months, restoring sensation to the affected area. Before a neuroablation is carried out, the physician generally injects the suspected nerve roots with a local anesthetic. This diagnostic procedure indicates which, if any of the nerve roots are carrying the pain signals. Up to 50% of people with chronic pain feel no relief when diagnostic local anesthetics are injected into the nerve roots; in these cases the neuroablation procedure is not carried out. In addition to injecting local anesthetics, it is customary to do a placebo injection before proceeding with the neuroablation.

    It is customary to perform neuroablations on the nerves immediately above and below the "bad" nerves as well, just to be sure. Ideally, this will result in a fairly large numb region centered on the former pain site. Because the motor nerve roots are left intact, loss of voluntary movement should not occur.

    There are several reasons for the poor success rate of neuroablations. In a poorly understood quirk of neurophysiology, a sort of "self-perpetuating" pain cycle can establish itself, whereby the pain you feel in a limb is actually maintained either by your spinal cord or by certain parts of your brain! Theoretically, the diagnostic, local anesthetic injections will rule out this possibility before the neuroablation is carried out.
    Even if a person does respond well to the local anesthetic injections, it is common for the pain to return a few weeks after the neuroablation. This is probably because the intact nerves near the pain site begin to pick up on the original pain source. The nerve roots above and below the deadened ones actually start carrying pain signals that they didn't carry before, to compensate for their non-functioning neighbors (who says the human body isn't a perfect machine?...).
    Other reasons for persistent pain after sensory neuroablation have to do with the fact that even motor nerve bundles contain some sensory nerves; also, the sympathetic nervous system can maintain pain impulses in some cases.

    The risks of neuroablation include infection and the small possibility that pain may increase. Any time something is injected into a person, there is a risk that infectious agents will establish themselves. Causes for potential pain increase lie in the fact that if you cover up your pain, the underlying problem can be made worse by the additional strain of pain-free activity. Another, scarier cause of increased pain is connected to neuroma formation. A neuroma is a sort of "nerve knot" that can form at the severed end of a nerve. The sensation from a neuroma is a lightning-like, stabbing pain. Neuromas are familiar to many amputees and partly explain the phenomenon of "phantom limbs." Neuromas form when the severed end of a nerve attempts to re-grow and unite with the rest of the nerve. If the rest of the nerve is missing or too far away, the severed end grows in on itself in a tangled fashion. If the other half of the nerve is close enough, the nerves should simply grow back together. This, in theory, is an advantage of nerve root freezing or burning: the ends should be close enough to grow together without forming a neuroma.

    What other methods to manage your pain have you tried. If it's specific to SI joints then Chiropractic may help. When treating nerve pain antiD's and anti seizure meds are often used because pain relief from opiates takes considerably higher doses than other types of pain and pain generators. You might want to get a couple opinions or ask t speak to some of his patients that are more than 1 year post procedure.

    Good luck, Dave

     
    Old 02-16-2005, 11:21 AM   #3
    MikeZ
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    Re: Need Advice Re: Radiofrequency Ablation

    I've had a few rounds of RF rhizotomy ablation at the facets and SI. As Dave indicates, they first did a test of short acting numbing medication to see if I received any period of hours in duration of relief. Since I did, I then had the RF. At the most, I got six months relief from any of the procedures. They did not lessen my medication intake and a year later, I ended up having a lumbar spinal fusion with allo/auto grafts and rods/screws.

    RF is done either as a day surgery procedure at a hospital or in a doctor's office based OR. You are given "mild sedation" (I think I got Versed and Demoral), but you are not knocked out fully, as they question you during the procedure if you can feel this or feel that. It is done with the aid of a flourscope and an IV needle is inserted into the area that is to be RFed. A wire is then inserted through the IV needle until it reaches the target area. No where as painful as something like a discogram, but you'll be sore and have some pain. I usually took the day of and the next day off to recover. When I had the SI RF and did the usually hour of recovery and monitoring (blood pressure, etc.) at the doc's office, I got up to leave with my ride and I lost control of my right leg ... just couldn't stand on it, as it would give out. They got me back in a room and I spent another hour there and the issue went away.

     
    Old 02-16-2005, 01:48 PM   #4
    carol632
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    Re: Need Advice Re: Radiofrequency Ablation

    I had this done in November with great results....same area as you. The dr. did do a "test" injection first, using only a local like marcaine. Pain relief was immediate and I got several great hours out of it. Had the RF done a week later and am still doing well. That was 11 weeks ago.

    Carol
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    2 lami's, 3 fusions
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    Old 02-17-2005, 10:37 AM   #5
    BrittleBones
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    Re: Need Advice Re: Radiofrequency Ablation

    Thanks for your replies! I did have test injections of numbing medication and steroids done before I had my SI joints fused and I had a few hours of total pain relief. That's why we did the fusions. However, after the fusions the right side started to hurt again. Now the doc thinks this ablation is the way to go. I think perhaps I'll give it a try. Appreciate your thoughts. Kathy Mac

     
    Old 02-18-2005, 05:43 AM   #6
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    Re: Need Advice Re: Radiofrequency Ablation

    Hey Kathy, I didn't mean to post poor statistics to prevent you from trying somethiing like RFA,. When were in pain and there isn't much else being offered we take the dice and roll them even knowing that the odds are with the house, so to speak.

    It's not a permananet solutioon but if you get 6-12 months of relief than it's probably worth repeating. Versed is a mild sedative that has alot of hypnoytic/amnesia properties so you don't rememeber the experience quite as clearly, probably a good thing.

    AS far as pain goes, a few minutes of added pain during the procedure and a quick recovery isn't a terrible price, rarely does it make things worse so it's not a terrible gamble. Nerve tissue does regenerate, I found the info about Rhyzotomy more interesting as far as the nerve bundling if they leave too much space between the ends they can't reconnect, that would be something that could make things worse but not the procedure your having. I certainly wish you luck and at least 6 months of pain relief.

    It's interesting you had your SI joints fused, that procedure is pretty contreversial itself. I certainly know about hypermobile SI joints, It's pretty much a probllem with most fusions to the sacrum as our unfused joints try to compensate and become hypermobile.

    Did they use plates to fuse your SI Joints and how did they imobolize them while you healed, It's a tough area to protect with a brace like the turtle shell/clam shell braces or the bivalve braces.They do come down to abut the SI joints but it seems they would need to imobilize things a little more than relying simply on plating as the bone hopefully takes. JUst curious about the mechanics of it all. When it comes down to it, everything is mechanical, whether it's your water pump "heart" wiring systm"nervous sytem" or structural mechanics. Looking at it as mechanical correction really is about the best analogy I can think of for the things they put us through surgicaly and procedurally. It also allows doc to seperate themselves from the actual person and focus on th mechanical goals of the ops and procedures.
    Good luck Kathy and let us know how it goes.
    Take care, Dave

     
    Old 02-18-2005, 07:55 AM   #7
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    Re: Need Advice Re: Radiofrequency Ablation

    Dave, thanks so much for responding. I don't know what your background is, but you sure sound like you've spent many years working in the medical field or suffering through it! I had an appointment with an orthopedic surgeon yesterday. This is not the surgeon who did my original fusions, but one that I wanted to see to get a fresh opinion on my condition. First, I wanted to answer your questions on the SI Fusions. You are correct, my SI joints started to move because I am fused from T-3 to my pelvis. I have a compression deformity of the upper instrumented vertebra. I have had an anterior reconstruction with vertebrectomy cage and plate in the midlumbar spine and a vertebroplasty at L4. The doc says that it appears that my sacral screws are loose. I have bilateral anterior SI joint plates. All of this work was done in stages to respond to compression fractures caused by severe osteoporosis. Anyway....the SI joints were fused to give me relief from the pain that occured whenever I would try to move my legs, walk, turn over in bed, etc. I had diagnostic injections into the SI joints to see if numbing the joints would relieve my pain. The injections did work, but only for a few hours. The original surgeon said that was a good indication that fusing the joints would be the right procedure. After surgery I was in a nursing home for 6 weeks, totally bed rest, I couldn't put any weight on my legs and had to be transferred from bed to commode or wheelchair. That was a nightmare. Anyway, the fusion worked on the left side, but didn't resolve the problem on the right side. Radiographs show that the fusion is healing, but it still is extremely painful. I'm on Methadone to control most of the pain, but I don't want to be on this the rest of my life. The other problem I have is that I can't walk without crutches because I can't stand up straight. The doctor told me yesterday that I've been fused in my current "leaning forward" position and that he doesn't see a solution to my problem unless I were to undergo some massive surgery to cut my back in half and straighten it. I don't have enough bone left to even consider something like this. Needless to say, I am really devestated today. Since the SI fusions last July, I've really been thinking that I would reach a point where I could stand up straight and walk without crutches! I've tried some PT in the past, but I'm still going to try more to gain some strength in my upper body and back. The doc told me yesterday to get a scooter. I'm only 49 and feel like my life is over. I know I'm much luckier than most on this board (after all, I can walk!), but it's hard not to be depressed. Have you ever heard of someone with my history and surgeries that has recovered to the point that they could forgoe the crutches and walk standing up straight? Sorry this is so long Dave, but I'd really appreciate your comments. Thanks in advance... Kathy Mac

     
    Old 02-19-2005, 08:13 PM   #8
    sned2121
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    Re: Need Advice Re: Radiofrequency Ablation

    I had Cervical Spine RFA after some very limited relief on the Facet Blocks.
    I have the Cervical RFA about 6 weeks ago and I am worse off now than before the RFA.
    I wish i did not have it. On top of that the Pain Doc that did the RFA is not giving the level of Pain Meds I need. So Is still suffer.

    I posted my own thread about my experiences on this board:
    4 Bad Cervical Discs - In Extreme Pain - Please Help

    Last edited by sned2121; 02-20-2005 at 09:53 PM.

     
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