RF Ablation and Precision SCS

[daveinaustin]

For those around for awhile know that I've had two fusion procedures over the past two years (L5-S1 followed by L4-L5). Recovery was going well until L4-L5 succesfully fused.

I've had unsuccessful steroid injections (several major muscle groups, bilateral transforaminal injection, and billateral facet joint L3-S1).

My doctors conferred, and believe the "framework" is good and this is an "electrical" problem. One that has me up to 6 Norcos as day, and barely able to stand after the workday is over. Thank God my management team is understanding, I am can somehow still work and support my family.

The next step is RF Ablation. They will do the right side (L3-S1) this Thursday and the left side in 12 days afterwards. Hopefully, this will help. The contingency (if insurance approves) is the Precision SCS, where they implant a pain-making device that by-passes the "electrical system" to the spinal cord.

Insurance is a friggen pain. Maybe if they would have approved of the ProDisc, I wouldn't be in this mess today! But, that's worthless conjection and frustration.

I don't like the ablation or SCS ideas since they mask pain instead of solving the root cause. However, it's the best they can do for now.

I'm kind of scared. The optimistic side says this is much better than taking a ton of Norcos. The other is worried about "what if this doesn't help."

If you have a prayer or happy thought, I could use it for this Thursday! :-)

-Dave

[JaclynR]

Hello Dave and welcome!

Iam also new on here Iam about 3 weeks post op ADR ProDisc L5/S1.

Anyways I wanted to let you know that my father who is 54 has one of those electrical stimulaters that you are talking about and he had it before and after his 4 level fusions and it really saved him from having to take so many pain medications. Especially for him because he has Hep-C so taking all the medications he was on just to function wasnt an option after a few years due to liver failure.
Anyhow he has had that stimulater for a few years and he said at first it took a little while to get used to but after he really got it down as far as learning how his body responded to it he really got a lot of pain relief..If you have any questions about it I might know or I can always ask him.. I know he was really worried at first about getting it put in but he has no regrets doing it.. and I guess you can always have it taken out if it doesnt work out for you..I know before they implanted it they had him wear a temp. one to see if it works and after they confirmed that it worked for him he had the procedure done to implant it completely..he wears a tiny fanny pack thing aroung his pants and under his shirt so you cant see it and thats where he holds the control for it.. hope this helps a little.. at least to know your not the only one going through this and we are all here for you ...please update us and let us know how everything works out for you.. Take care!

Jaclyn

[phylly]

Dave,
I just had a two level fusion L4-S1. It has only been 2+ months and I still have some sciatic pain. Before the fusion I had a RF ablation. My understanding was that once you successfully fuse the facets do not move anymore. Is this untrue? Why are you having the ablation?

Jaclyn,
Thanks for the info on the SCS. It is something I also worry about needing someday and I am glad to hear a success story.
Phylly

[daveinaustin]

Phylly,

Excellent question. I believe it depends on whether you have anterior vs. posterior fusion. I believe there is slightly more flexibility from ALIFs.

Good luck with your recovery. Apparently, it is common to still have sciatic pain up to a year or more after the procedure. Personally, my leg/foot pain "ebbed and flowed" throughout each recovery. It was gone the first week after each procedure. But returned several weeks later. The strongest sciatic pain was about 60 days after each procedure. But now, I have a just a little bit of periodic pain/numbness in my leg.

JaclynR,

Thanks for the information on the electrical stimulator. Hopefully, it won't come to that level, but the information about your father helped to relieve anxiety.

-Dave

[Harrison]

Phylly, you raise a good point. I believe one assumption is that fusing will prevent movement of the (possibly arthritic and/or inflamed) facets, thereby eliminating pain. But if the degeneration or disease is still present in the facets after fusion, the pain may not go away. This is why alternative therapies have helped some patients (cold laser, antimicrobial, etc.).

Jacylyn, sorry to hear about your dad. That’s rough. How does the Hep C fit in with the chronology of his spine problems? I am not saying they are related – just curious.

Dave, I know you know this, but you may find some related topics on this issue that may help; and there are over 100 if you search for “ablation or rhizotomy.” Were any of these topics helpful?

And good luck this Thursday!!!

[JaclynR]

Hello Harrison

I might not fully understand the question but will do my best to answer. Since he has had Hep C.( whiich has been about 20 years) he has also had a severe bad problem (he has broken back 3 different times) needing heavy pain medication daily. Well unfortunetly any type of medication especially something like a pain medciation needed on a daily basis is very bad for his liver.. he can go into live failure..on top of that he has be a recovery alochol and drug addict for the last 30 years on and off so the alochol/drugs/prescritipon narcotics that he would abuse only made the situation worse..on top of all that there a a number of medication he CANNOT take due to liver damage and unfortunately even if the doctor didnt prescribe it to him he would still get it..does this answer your questions at all? If not please clerify.. Have a great week!!

[steelskyway]

Dave,
I will be watching your posts closely. I find it interesting how they conservative treatments progress. Stopping the movement of the vertebrae may not change the loading on the facets or may increase them at some other level.

Maybe that is why they have started at L3 above the fusion site.

My thoughts and prayers are with you. The struggle to be pain free sometimes seems elusive to modern science.

Paul

[daveinaustin]

Thanks for the suggesions and prayers.

As Harrison knows, I have done substantial research along my journey. It's one of my innate Engineering traits, which drives my doctors crazy with all my conjectures/suggestions!.

Whenever I thought I'd be on the tract for an alternate treatment I've been wrong! My team keeps on saying that I overanalyze everything, and am currently running 0 for 20! :-) For better or worse, the doctor tries some of my suggestions (most recently, the bilateral transforaminal and full bilateral facet injections).

However, this time, I promised my team that I would let the doctor do HIS job, and that I would rely on his expertize (afterall, that's why I chose the best doctors I could find in Central Texas and received a 2nd opinion from Dr. Zigler in Plano)! I hate that we cannot determine the pain's root cause, but my doctor chose the RF ablation vs. pulsed RF or rhizotomy (from my research, the ablation seems to be the right choice).

This treatment still masks the root cause. But, there's a part of me that's optimisitic that by the time the body "re-synapses" to the nerve root, the fusion will be complete, and I will be out of pain.

However, I will have a CT scan next week, between the 12 day break between burning the right side and left side, to see if there could be a next step before the SCS contingency.

Potentially, I'd like to determine if a Foraminotomy could be in order before the SCS, but my team will tease me that I'd probably be 0 for 21!

=====================

The RF ablation (L2-S1, right side of spine) was fast, and the doctor believes was successful. I'll know in three days if it helps, and will have the left side done on my birthday.

Unfortunately, one of the nerves was close to the nerve root, so I keep falling over if I try to walk! He was kind of expecting the local to impact my proprioception.

I called the Dr. three hours after the procedure and he said everything was fine, and that it will take about 18 hours until I can walk again. I'm glad I kept the walker after the spinal fusion. It helps me remain a bit mobile and stable.

[mark-perth]

Hi Dave

I just wanted to let you know that I have had radio frequency ablation done more times than I can remember, ive been hospitalised more than 20 times for it with sometimes having 10 burns done in one session and wouldnt hesitate in having it done again. I found it took 2 days to help as it would take 2 days for the pain from the needle to go away. I have read only of a few negative problems with it and have only had one time when there was a problem during the proceedure when a nerve was hit but was fine afterwards. I have found that if the P/S is experienced then the results can often be great with only a few days pain from it at the most. The best thing is that it is not permanent so the feeling will return soon enough and hopefully get you thru this hard time. I too was concerned with masking the pain and possibly be doing damage when you cant feel anything. My P/S now also gives a drug after to wipe your memory so you dont remember what happened.

Do you know if they are doing a medial branch block to the dorsal rami or is it into the facet joint itself?

I have also had done radio frequency ablation to my left and right L2 nerves with seem to control quite a bit of the pain the travels thru the lower discs.

I have had both the pulsed and heated version and and prefer the heated version as well as I found it worked over a larger area. My P/S now always uses the pulse first as its more localized and if it needs to be done over a larger area he will use the heat the next time.

With regards to the spinal nerve stimulator, are you aware that you CANNOT have an MRI scan after it is implanted?
But that being said I too may need to get one and have heard that they do a great job of reducing pain so wouldnt let that stop me getting one if I have too but would probably prefer to try a morphine pump first myself.

Best of luck with it and if I can help you in anyway please let me know.
Mark

[daveinaustin]

Mark,

Thanks for your advise. I had L2-S1 medial branch nerve RFN (right side) last week and the left side next Tuesday. Hopefully after both sides are complete, it will reduce or eliminate the 5 Norcos/day. I hate to complain, but it's a battle just trying to make it through the day at work. So, the relief would be very welcome!

Based upon your comment that the Precision SCS will prevent future MRIs, I hope my doctors can determine the root cause of the pain before this contingency plan. I had a CT Scan yesterday. Hopefully, it will help with the root cause determination. Perhaps a Myelogram could help provide insight.

BTW, it was interesting to learn about your experience with the Pulsed RF ablation. I've recently read an article on it from the Mayo Clinic, and it sounds like a promising direction. For now, we'll just burn those nerves and hope the back will properly heal before needing further treatment!

-Dave