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Re: epidural/facet joint - Dr. Whitworth

Re: epidural/facet joint - Dr. Whitworth

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Posted by MLWhitworth, MD on May 06, 2000 at 11:11:04:

In Reply to: Re: epidural/facet joint - Dr. Whitworth posted by ila on May 06, 2000 at 07:28:48:

The facet joints also called zygapophyseal joints or zed joints are small joints which prevent over rotation of the spine. They can become damaged due to trauma, arthritis, synovial entrapment, etc. One treatment is steroid injection directly into the joints themselves (absolutely requires fluoroscopy). This actually works fairly well. A longer term solution is the radiofrequency denervation of the medial branch of the posterior primary ramus: a nerve innervating the facet joints.

: Hi Dr. Whitworth, apologies for my ignorance, I thought you guys were talking about facet joint injections back there. What's the difference? They sound the same??

: Dr. Thompson wants to give relief long enough for the physio or pain management team to work on getting back and front movement, is that lordosis?, to near normal.

: Appreciate assist, regards, ila

: :

: You are in a quagmire for which there is no easy answer. With respect to the epidural steroids, just because a doctor has been doing something for 20 years doesn't make it safe, efficacious, or ethical. The statistics on that type of steroid injection are very very equivocal and I will guarantee you your 20 year doctor has not kept any real statistics of his own with patient followups after such injections. It is just an automatic procedure requiring no thought for what is in the literature. It is also an automatic $1200 to $2000 for the series of 3 for a few weeks of relief. You can buy a lot of medications for $2000 which has the potential for helping even more with continuing PT.

: : : Thank you for your help with my question below. We talked to the doctor and he assures us that he's been doing this for 20 years and have much success. He said to wait until we have made a clear decision and not feel we are being bullied into it. We will check with our primary doctor who is a Chiropractor, who refered us to the orthopedic who suggested the shots. The idea is to releave the inflamation in his back so he can tolerate further physical therapy. The only thing is that when he did the first therapy, pain wasn't there enough to complain. So, it's possible he can do the therapy without the shots. Or, do you think he feels the shots will help with or without the therapy? I guess I should ask him. He also prescribed Soma, Vicadin and Celebrex which my husband only takes the Soma.

: : : He also had an injury to his lower back which shifted his hip so when he works the hip goes out of joint and causes pain to his back. Chiropractic worked great until he started working again and eventually needed to be adjusted 3 times a week. Then this injury happened 2 years later. The workers comp wants to know if this is a separate injury which the Chiropractor agrees. Can we see both doctors for the separate injuries or should we consentrate on the one thats worse? He doesn't seem to be bothered as much to the first one because the second one is so painful. And he is on disability and is taking it easy. But, we don't want to lose the comp case on the other one in case the second injury gets better.

: : : We do have a lawyer but she takes too much time (2 years so far) to get anything settled. It's more complicated than I can express through this board, but we don't want the lawyer involved in this case because of her lack of attention on the first one. The w/c is dealing directly with us and our doctors and we are satisfied. We just don't want the other doctor to lose out because we need to deal with the more serious injury.

: : : Any suggestions would be helpful.
: : : Thanks again
: : : Kathy

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