Facet Nerve Block after cervical ADR - questions

[SandyW]

Yesterday I had my very first appointment with a PM doc. Am 1 yr. post-op from 4C ADR's.

Have daily pain while taking tramadol/muscle relaxant, can't ride in car for long, can't sit in movie or at computer or walk rapidly (slow is ok) without considerable increase in pain. Lying flat is most comfortable, so not able to do what I would like and am tired of the constant pain. I know, no different than many, but better that lots of you.

I can ask for stronger pain meds and will, but want to know what is causing my pain. My x-rays show the placement of the disc's is very good and I have good movement. Was hoping for better results.

I had diagnosed my problem as being musculature and thought that trigger point injections might help. Had massage therapy on Wed and this was my report. Muscles found taunt: Trapezius. Rhomboids (bilateral, I feel these were taut due to the bilateral infraspintus tautness & trps pulling the shoulder blade laterally). Suboccipitals (especially right side). Right Levator Scapula (probably producing pain on left side and pulling on suboccipitals). The sports med therapist thought I wouldn't get better until I stretched the muscles manually or with injections since they were locked.

However, the PM doc feels that my muscular pain has snowballed from the facets and has scheduled me for a Facet Nerve Block. What would make him believe this?

I've searched the ispine site and understand that this procedure is more diagnostic. If the block stops the pain then facets are the problem. But how can the block alleviate my musculature pain? Should have had the block before ADR surgery??

Also read here that a facet nerve block may cause an infection if you have ADR's, not good. Cleveland Clinic PM has not done nerve blocks on ADR recipients, but the doc didn't seem concerned - he did raise his eyebrows when he asked me how many ADR levels and I answered 4. I asked him if there would be a problem treating me. He said "No, we are just more conservative." Yea, I have learned this the hard way!

My 2007 MRI refers to C3-4 as having some degenerative changes in the facets and overall spinal canal is small suggesting congenital stenosis and degenerative foraminal stenosis here and there. 2009 x-ray's say nothing about facets. Also read here in the February 2009 annual meeting of AAOS on the comparison of MRI and CT in predicting facet arthrosis in the cervical spine that MRI's were not accurate.

I understand that Dr. Bertagnoli cleaned up bone spurs, but to my knowledge nothing was said about facets. If I had facet problems wouldn't he have seen it and discussed this with me after the surgery??? I also have read that ProDisc is not facet friendly, but can't imagine a deterioration from them in a few months. I had the muscle knots/spasms before surgery.

Any suggestions? I am confused?? Should I go ahead with the facet nerve block and then go from there? Would greatly appreciate your thoughts even though you are not PM doc's and I understand that all your suggestions would be "IMHO".

Thank you, Sandy

[Terry Allen Blackburn]

Sandy:

Even though they use the injections for diagnostic testing of the facets you may still benefit from the medicine that they use in the injections. I had facet blocks and SI joint injections prior to my 4 level ADR that did not help in the least. After my ADR surgery I had facet blocks or SI joint injections every three months for the first year. Then a year lapsed before I needed another set of two SI joint injections that I had this past December. I still feel really good since this last set of injections. So I am telling you that it may be worth having this done to see if you get any relief. It took about up to three weeks to get relief after each set of injections in the past.

Hang in there as you are still in recovery. It took me all of twenty months to start feeling really top shelf after such major surgery.

Terry Newton

[mmglobal]

facets are the $500,000 question. If the facets are the main problem, ADR may not be indicated. Some doctors will consider grade II facets a contra-indication, while others will usually do grade II, and sometimes do grade III facets.

I reality, some with minimal facet degeneration will have their facets go south with ADR. It's not magic and if there is some other reason for your facets to go, they may still go bad. Some doctors will do grade III facets and I've seen many films of facets that have actually recovered after ADR. Not that ADR is designed to halt facet degeneration, but in some configurations, restoring the disc height, more normal facet loading and kinematics; may actually allow the facets to recover. I wish there was some way to tell who is who in advance. If we could do that, spine surgery wouldn't be so exciting.

[SandyW]

Terry and Mark,

Thanks for responses. After more googling, maybe I understand this??

I had two choices, since my diagnosis was surgery not elective because of spinal cord impingement. I needed fusion or ADR. Chose ADR for more movement. Dr. B thought ADR was appropriate even though Dec '07 MRI showed "some degenerative changes in facets at C3-4". Was beginning to doubt Dr. B's decision, silly me! ADR may provide enough height to actually improve facet problems, maybe not. ProDisc-C or deterioration from aging, 16 mos. since last MRI, may be the culprit in facet pain.

Correct or close so far, even though stated in layman's language?

The facet at C3-4, where the PM doctor will administer a facet nerve block, might be causing pain. So will have the block. Since they are only temporary, don't want the block to work since that would mean facet problems exist. I am just hoping it's musculature. Won't worry until later!

And yes Terry I'll try to be more patient since I'm 69 yrs. young and only 1yr post op from 4 cervical ADR's, 15 mos post-op from knee surgery, 9 mos from gall bladder surgery, 4 mos cataract surgery. Know these are mickey mouse surgeries, but all take a toll.

Sandy Wade

[Terry Allen Blackburn]

Originally Posted by SandyW

And yes Terry I'll try to be more patient since I'm 69 yrs. young and only 1yr post op from 4 cervical ADR's, 15 mos post-op from knee surgery, 9 mos from gall bladder surgery, 4 mos cataract surgery. Know these are mickey mouse surgeries, but all take a toll.

Sandy Wade

Oh My God Sandy; You've gone through hell and back in the last couple of years. I hope the facet blocks work as they will help you be more pain free while your body continues to heal. I had them every three months for the first year and then needed none for a year. I had my last injections in December so it has been over 4 months ago. I still feel good.

Terry Newton

[Justin]

Originally Posted by SandyW

And yes Terry I'll try to be more patient since I'm 69 yrs. young and only 1yr post op from 4 cervical ADR's, 15 mos post-op from knee surgery, 9 mos from gall bladder surgery, 4 mos cataract surgery. Know these are mickey mouse surgeries, but all take a toll.

Sandy Wade

Sandy, I'm going to echo what Terry said: you've been through hell. The facet injection sounds like a good next step. Did the sports med therapist offer to manually work on your tight muscles or give you exercises that you can do on your own? Muscular dysfunction can be significant after surgery and can take quite a while to "work out."

I would not question your surgery, as you had to do something in the face of spinal cord impingement. It's hard not to second guess yourself. Here's to hoping this is just a prolonged bump in the road and that it will be a distant memory soon. Good luck!

[Cindylou]

I could not agree more with the above responses Sandy. Hard not to second guess, but big waste of time and energy. Don't go there. The nerve block will prove valuable indeed. All is certainly not lost. You had major, major surgery that definitely produces musculature ironing out, over time. Yes, facets are the elephant in the room, but the fact that you had Dr. B do such an invasive surgery is very encouraging indeed. You had the master of multi-levels, so take great hope in that. Are the trigger injections helping? Regular massage therapy maybe?? Hang in there. Let us know how the nerve block goes.

My best,

Cindylou