Hello to the forum

[Eskimo]

The effect is variable with some responders and non-responders to the anesthetic. Those who respond to the numbing will respond to the RF as well.

I used to work with a guy up here who was one of the pioneers of the procedure for the SI joints.

[annapurna]

Originally Posted by Eskimo

Unfortunately, there is no such thing as a "muscle relaxant" in reality. This entire class of medications all work mostly at the CNS level as global depressants. I'm not sure it would answer the question anyway as muscles often become irritable as a consequence of underlying injured joint tissue, IMO.

I only seem to have time to post when I'm too tired to do this justice so please excuse my brevity. Your background is much more extensive about why the drugs work so I'll defer to you on that. We have seen, though, situations where a muscle spasm becomes self-perpetuating in the absence of injury or damage. That is the condition I suggested drugs to control. A short pulse relieves the spasm long enough to permit the area to "reset" as it were. If the spasm continues then underlying causes have to be looked for.

I believe that it was Charles in Charge that said the MRIs don't work with many ADR. That isn't entirely true. Certainly any titanium ADR can be imaged to some extent but even the older ones such as a Charite can be looked around in an MRI. It is possible for a radiologist to electronically move the artifact caused by the metal away from the facet and an accurate image of the facets to be produced. Laura's even had good enough images to assess the thickness of cartilage on the facet joints. It will be a rare radiologist willing to go to the effort but it is possible.

Another possibility is tugging at the facet capsules rather than arthritic facets. The increased mobility can cause the facet capsules rather than the facet joints to become irritated with limited ability to figure out the cause.

[Eskimo]

Originally Posted by annapurna

I only seem to have time to post when I'm too tired to do this justice so please excuse my brevity. Your background is much more extensive about why the drugs work so I'll defer to you on that. We have seen, though, situations where a muscle spasm becomes self-perpetuating in the absence of injury or damage. That is the condition I suggested drugs to control. A short pulse relieves the spasm long enough to permit the area to "reset" as it were. If the spasm continues then underlying causes have to be looked for.

I believe that it was Charles in Charge that said the MRIs don't work with many ADR. That isn't entirely true. Certainly any titanium ADR can be imaged to some extent but even the older ones such as a Charite can be looked around in an MRI. It is possible for a radiologist to electronically move the artifact caused by the metal away from the facet and an accurate image of the facets to be produced. Laura's even had good enough images to assess the thickness of cartilage on the facet joints. It will be a rare radiologist willing to go to the effort but it is possible.

Another possibility is tugging at the facet capsules rather than arthritic facets. The increased mobility can cause the facet capsules rather than the facet joints to become irritated with limited ability to figure out the cause.

In terms of the muscle relaxants, it is a bit of a misnomer. The only true muscle relaxant out there right now is dantrolene but no one uses it due to liver toxicity issues. All the others are CNS depressants: valium and ativan are probably the most well-known. The ones the general public gets are more commonly methocarbamol and flexeril but none of them really work on muscles. I do think they can be useful as pain relievers in LBP but I don't think they are doing what people think they are doing. I've used flexeril in the past myself and consider it an okay drug. I haven't used it with this most recent flare as most of the thoracic paraspinal tightness that was plaguing me settled down after a couple of weeks.

The issues regarding diagnostic certain of facet triggers of pain are definitely complicated even amongst those without ADR and who facet arthritis.

My own experience has been the lateralized pain, facet arthritic changes on radiology and concordant pain responses from triple block protocols will result in a successful RF. However, the exact cause of the pain is still controversial. I do believe ADR and the resultant re-alignment could definitely result in facet hypermobility and possibly irritate the facet capsule and ligaments. I guess I'd just suppose that if the MBB did take away the pain, they must be providing the sensation to whatever structure is acting as the pain generator and that this response should be replicated by a properly done RF.

My issue is mostly that my lumbar pain right now is central and provoked by sitting and bending forward which still makes me quite suspicious of the L3/4 disc. I'll give it another month and physio before consider the blocks of my L5/S1 facets.

[CharlesinCharge]

I was speaking only of the Maverick disc when I said an MRI would not give a good image, as it is made of 100% steel metal alloy (no titanium). I had one done, and it was very blurry and completely useless (even with contrast). With other aritificial discs that have less metal content an MRI might give you a clear enough picture, but not with the Maverick.

[annapurna]

First, point of clarification, no one uses steel in surgical devices unless they're real desperate. Typically, you'll see nickel-cobalt alloys in surgical applications. Titanium alloys are replacing it but they aren't the easiest of materials to deal with.

The radiologist who ordered your MRI or translated your doctor's order into instructions for the tech ran a standard scan. Any metal is going to lead to problems in a standard scan. Titanium less so, nickel-cobalt more so, old style stainless steels much more so. If the radiologist can be bribed or begged into spending the necessary time, the artifact caused by the metal can be shifted slightly, about far enough away from an ADR to see the facets. That's true of all ADRs, including the Maverick. It isn't true, however, of all radiologists I'd guess.

[Eskimo]

Originally Posted by annapurna

First, point of clarification, no one uses steel in surgical devices unless they're real desperate. Typically, you'll see nickel-cobalt alloys in surgical applications. Titanium alloys are replacing it but they aren't the easiest of materials to deal with.

The radiologist who ordered your MRI or translated your doctor's order into instructions for the tech ran a standard scan. Any metal is going to lead to problems in a standard scan. Titanium less so, nickel-cobalt more so, old style stainless steels much more so. If the radiologist can be bribed or begged into spending the necessary time, the artifact caused by the metal can be shifted slightly, about far enough away from an ADR to see the facets. That's true of all ADRs, including the Maverick. It isn't true, however, of all radiologists I'd guess.

I have the AMavs and my understanding is the portion that abuts the vertebral endplate is a titanium based alloy and the portion that articulates is made out of a cobalt alloy. This allows good bony integration with the titanium and limits ionic debris with the cobalt.