My wife has had a XLIF @ L3-L4 in 2009 and a Fusion @ C5-C6-C7 in 2011. The pain radiated fron her left side of body previous to both procedures but approximately 2 weeks ago she started having excruciating pain (Sciatica) on her right side from the top of her buttock to her feet. She also has degenerative disc desease with RA. We went to the local ER and had a CT done at the site it showed no damage. A MRI was done we took copies the Sugeon for them to check out and get back to us, 3 days ago and waiting. My wife has been through PT, Chiropractor,Therapist, Phsycharist (Spelling),Pain management etc.. I found an article about Laser Facet Rhizomy and am hoping that that could some help...my wife at her wits end as she has been battling the pain for four years...
The laser facet rhizotomy is done for conditions arising from the facet joints, which are located in the posterior elements of the vertebrae. Most patients with facet joint problems have pain in the lower back (neck if it is the facet joints in the cervical spine).
This procedure usually does not do much for radiculopathy, or radiating pain down the legs.
To see if the patient is a candidate for the procedure, the surgeon will sometimes inject the area around the facet joints with a local anesthetic. If this takes most of the pain away, then a rhizotomy will probably help.
The rhizotomy basically destroys the tiny nerves which innervate the facet joint capsule. By destroying these small nerves to the degenerative facet joints, it decreases the pain.
Again, this is done for pain arising from the facet joints, which usually is manifested by back pain. Radiculopathy, which comes from compression of the nerve roots, causing the radiating pain down the extremities, will usually not respond to this treatment.
You should speak with a spine surgeon who does the technique. He/she would be able to tell you if your wife was a candidate.
Thank you for your insight, it has been very frustrating to watch my wife suffer these last four years. She has had steroid injections in both her discs and facets with no apparent relief of pain. Her first procedure a XLIF did help with lessening the pain intensity at the surgical site and left side leg (sciatia)pain. She is opiate tolerate since she has been on opiod treatment for 4 years which has only added additional treatment complications with her pain med management going from a agressive approach, her first DR. and then her second provider a PA who is conservative, she recently had an onslaught of intense sciatia pain on her right side and I gave her additional pain meds to try and make her comfortable and of course we exhausted her supply eight days early and she was dismissed from her care after informing the PA. The PA wrote her last refill prescriptions to be filled 8 days from that day and offered no additional meds for those 8 days so now she is bed ridden and I am trying to get her to go to the ER but she steadfastly refuses.... so the saga continues.. sorry for venting...
Got MRI Report- impression: Status post left lateral L4-5 spinal fusion without significant L4-5 stenosis. Mild central spinal stenosis at the L3-4 level secondary to degenerative spondylosis and facet artropathy.
"Status post left lateral L4-5 spinal fusion without significant L4-5 stenosis."
>> There are post surgical changes at the L4-5 level consisting of a spinal fusion. The spinal canal at this level does not have significant narrowing (stenosis).
"Mild central spinal stenosis at the L3-4 level secondary to degenerative spondylosis and facet artropathy."
>> At the L3-4 level, there is mild narrowing of the spinal canal, which is coming from a couple of places. Spondylosis is the generalized degenerative processes seen in the anterior elements of the vertebra. These usually consist of some osteophytes (bone spurring) around the endplates of the vertebrae. The endplates are the top and bottoms of the vertebral bodies. Spondylosis is more of a descriptive term than a diagnosis. It is the fact that it is mildly narrowing the central spinal canal that is the important part.
..The canal is also being narrowed by degeneration of the facet joints in the posterior aspect of the vertebrae. When the facet joints degenerate, they overgrow or hypertrophy. This overgrowth can cause the spinal canal to be narrowed.
This study is another example of why all studies have to be correlated with the patient's history, symptoms, and physical exam. From just the study, a surgeon may say, "well that's not so bad". But, when taken in light of the symptoms the patient is having, there's a big difference.
Spinal stenosis can give you back pain, radiating pain into the pelvic girdle, and sometimes pain down the legs. This tends to be worse with walking and many times the pain is relieved with bending forward, putting the hands on the knees. It can also cause muscle weakness, as the narrowing progresses.
The facet joint degeneration (DJD) can also cause lower back pain. This pain is usually worse with extending the spine (leaning backwards).
Unfortunately, there is no mention as to whether or not there is any involvement of the neural foramina or nerve roots. The neural foramina are the holes through which the nerve roots exit the spinal canal. Foramina just means hole.
Impingement of the nerve roots could give you radiculopathy, or pain running down the lower extremities.
If the opioids help, they are an option. Long term opioid therapy has been used for centuries, and has many benefits as well as risks. As long as the dependency is controlled, it is the tolerance that becomes the biggest problem. With continued use, the dose has to be continually raised to maintain the proper pain control. And of course, with the perceptions of society now days, you have to deal with that. The looks, the snide remarks, the hassels, can all take their toll. But, again, as long as it works, it is a good pain management tool.
Also, since she has some degeneration of the facet joints, RFA may be an option. It would mainly address some of the back pain. Of course, it would not eliminate all of it. It is not a large procedure, especially when compared to a spinal fusion. So, it may be worth a shot.
You might want to discuss it as an option with the pain management physician or her spine surgeon. Good luck.