Another L4-L5-S1 story

[AZMtnman]

Update 2023:
(I had a whole post and my session timed out and I lost it, so "take 2")

I've been out of the loop here but glad to see this helpful community is still around. I thought I'd reply to help others see how things change over time and this really is a long journey.

To recap, my primary problem was periodic (3-4x/year) disc ruptures followed by intense, debilitating pain for a week or 2 each time. I decided to delay surgery (either ADR or fusion) as long as I could. So I kind of checked out of these forums and tried my best to get on with life.

On the "good" side, the intense pain I used to get has subsided and I haven't experienced the old cycle of "annular tear/protein release/nerve inflammation that lasts a week or 2" for a few years now. I think my disc is pretty much a dried up raisin at this stage so there's no more juicy protein center to leak out anymore. This is interesting because it shows that my old problems were really almost entirely inflammation from the protein and not direct impingement of nerves.

On the bad side, that's been replaced by a progressively constant duller pain, with occasional but shorter lasting sharp pain if I move wrong, and lack of mobility/activity. I'm scheduling another round of imaging to confirm but current indications look like my problems are almost entirely L5/S1 facet joint at this stage. So NJ Gene had great advice in 2015, just a few years early for where I was at on my journey.

I'll likely be pursuing facet joint injections & nerve ablation, hoping to keep delaying surgery. Surgery is the only real "fix", but if I can reduce the pain & restore some mobility, I hope to be able to keep living the life I want without surgery for a bit longer.

[Harrison]

Wow, thanks for posting. It was eight years ago when you first posted! I hope you figure out the next steps, and work towards a solution.

[AZMtnman]

yeah, I had a couple really bad episodes 8 years ago, but for multiple reasons decided to try to hold off on surgery. Recent years have been "better" in that my pain isn't completely debilitating, but worse in that it is more chronic. I guess it reached the point where status quo just isn't working anymore.

Reading your link about the M6 durability kind of reinforces some of the reasons that I held out. I hesitate to say that, because I mean no judgement to anyone who opted for them - we all have very individual experiences and decision criteria. But at the age I was 8 years ago, I was more worried about device longevity. (I'm still a bit worried, but have 8 fewer years on the clock to worry about now.)

Any major developments that I've missed? I'm digging into the research again. Maybe I just haven't found them yet, but to be honest, I expected to see more recent studies.

[Harrison]

AZMtnman, I've not kept up with the ADR technology like I once did - 15 years ago. Even though I started this site in 2004, I've moved on to other things in my life. It's a long story!

Anyway, keep us posted. What's the latest in your research or searching for doctors?

[AZMtnman]

My local doc isn't a fan of ADR. If I get to that point and want to pursue ADR I'll likely need to find another practice. But a fresh MRI doesn't really show much worse degradation of disc height or bulge from 8 years ago so it's likely my current problems are facet-based.

Next step is injection therapy. It's probably going to be some months of trying different injections to see what works and for how long. And if that doesn't help they would likely recommend facet surgery before fusion or ADR.

[AZMtnman]

Checking in to say "hi".

I'm currently looking into Intracept, which for those not familiar is a form of RFA for the basivertebral nerves. It's been around for 5-6 years but seems like it's only becoming more common in the last 2-3. If you have modic changes in your vertebral end plates, you may be a good candidate to try.

The diagnostic injections were amazing for me. I felt 10 years younger - for a day, of course. But the facet RFA did nothing for my pain. So the current theory is that my pain is vertebrogenic and not facet based. One good thing with Intracept is that it is a one-time procedure. Unlike the facet nerves, the basivertebral nerves don't seem to regenerate.

It's been a crazy 9 months of appointments: MRI, follow up, intro to the pain doc, diagnostic injection 1, follow up, diagnostic injection 2, another follow up, etc.... I'm hoping to just get to some form of closure, hopefully with less pain. Fingers crossed.

[Harrison]

Hey Mountain Man! Thanks for posting. Anything new in terms of your options now?