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