ADR facet issues/failure? Need help!

[laid up doc]

you certainly could have facet joint aggravation w/o significant MRI changes... what they would see on MRI is bony change if it's an arthropathy (what you really don't want) or even some fluid if it's just inflamed (wouldn't necessarily see it, and if they did it could resolve).

i think part of the problem is that patients are so heterogeneous before AND after ADR surgery, that most dr's take a very conservative approach. it's harder to pinpoint the source of pain b/c one big source - a disc - is gone. so at least you know it isn't the replaced disc...

you're then left w/ muscle issues, facet issues, and another disc, for the most part. make sure you're seeing a good PT who sees a lot of spine and does manual work. look for letters after their name like OCS (orthopedic certified specialist), and ask your pain doc for recommendations.

in my experience, seeing a mediocre PT is extraordinarily frustrating. a good spine PT is often better than your doc at pinpointing where your pain is coming from, and can help tremendously with biomechanical issues that we ALL have (spineys or not!!).

good luck to you.

[annapurna]

To answer the question about prolotherapy: First, over the years we've realized that we're blessed with a world class prolotherapist, Dr. Harry Adelson, who not only travels the world to treat but also to teach prolo. His main office is a couple of hours away. We're also occasionally flying to Chicago to see the other main name in prolo, Dr. Hauser. At that skill level, prolo is a very good addition to any surgical procedure to try to reestablish the soft tissue support after surgery. I've used it to try healing partially torn ligaments and we're using it to treat Laura's unstable left knee. It doesn't do much of anything for boney changes and can't reverse a degenerated disk but it's a good adjunct after those problems have either been addressed or eliminated as concerns.

The MRI might possibly show cartilage loss or changes, depending on how well they worked to get a good image. If you can see anything at the ADR level, you might try posting a snapshot of that level here and see if anyone has any comments. If you can't see anything, they may not have been able to see it themselves. Not attacking all docs, but we've encountered dry labbed MRI and x-ray reports previously. You should get a copy of the images and flip through them just to see how much really was obscured.

[laid up doc]

i have encountered radiology negative macro type reads w/ such obvious omissions that it's horrifying... ergo i over-read anything for which i am especially suspicious.

nb: mri's are not my forte unless they're for particular things, though my spine doc taught me a good bit about spines... it's best to read through the whole series not just look at one shot. the different weighted images and STIR and whatnot, and different cuts, can make or break whether something is visible. lord knows i have gone dizzy at times reading medical journals about the physics of mri's and why things look the way they do...

[lkastl]

Hi

Regarding Prolotherapy, I have tried it in the past as I was trying to sort out my pain generators after ADR. I had prolo on my right SI joint at that time, and I may go back now to see if this recurrent of pain is SI rather than facet. When I asked my doc today he said "could be". )gee thanks, think maybe we could try and figure it out?)

I do think the prolo it helped, but it did take a lot of time, a lot of sessions and a lot of $$. And in the end it may have been just time and mother nature that helped the pain resolve . That being said, I may be going back. I am also fortunate to have one of the top prolo docs near me.

As far as the MRI goes, I do have the CD. Have no idea how to look at it, nor any idea how to go about posting it here. That is beyond my limited computer skills

[lkastl]

Thought I would update this thread. Today I got medial branch blocks on 3 levels on both sides. This was purely diagnostic. They numb up the nerves going to the facets to see if your pain improves while the anesthetic is working for the 2-4 hours before it wears off. Well, much but not all of my pain improved during the test period. I think this is a positive sign and will be going back to the doc on May 8 to talk about rhizotomy. Will post results. Sigh

[Slackwater]

Originally Posted by lkastl

Thought I would update this thread. Today I got medial branch blocks on 3 levels on both sides. This was purely diagnostic. They numb up the nerves going to the facets to see if your pain improves while the anesthetic is working for the 2-4 hours before it wears off. Well, much but not all of my pain improved during the test period. I think this is a positive sign and will be going back to the doc on May 8 to talk about rhizotomy. Will post results. Sigh

There are a lot of factors. The diagnostic is good. Best wishes from this side, S->