2 doctors weighed in:

Can you recommend anything other than surgery? I began having lower back pain 6 yrs ago, ended up having 3 injections for fractured facets, arthritic changes and 2 bulging discs. 2 years ago, i had another 3 injections for the same problem. The dr told me

2 doctors weighed in
Dr. Krishn Sharma
Orthopedic Surgery - Spine

In brief: I'm

I'm sorry you're having trouble getting relief of your pain.
Based on your description, you have facet mediated pain most likely from facet arthropathy (arthritis). It sounds as though you have exhausted many of the non-operative options available for your problem. Some other options (you may or may not have tried already) include acupuncture, physical therapy, oral medications, and lumbar traction. None of these methods are a "cure-all" but they may give you enough relief to make the situation tolerable and avoid surgery. If you fail all of these measures and continue to have pain that interferes with your quality of life you might consider surgery. There are some newer techniques that have not stood the test of time (facet joint replacement) but the gold standard is lumbar fusion. It is reliable surgery in the properly indicated patient. You would need to discuss the risks, benefits, and alternatives with your surgeon, but don't expect 100% relief of pain. If you can accept 75% improvement in your pain condition, that would be a reasonable expectation. Good luck, hope you find relief.

In brief: I'm

I'm sorry you're having trouble getting relief of your pain.
Based on your description, you have facet mediated pain most likely from facet arthropathy (arthritis). It sounds as though you have exhausted many of the non-operative options available for your problem. Some other options (you may or may not have tried already) include acupuncture, physical therapy, oral medications, and lumbar traction. None of these methods are a "cure-all" but they may give you enough relief to make the situation tolerable and avoid surgery. If you fail all of these measures and continue to have pain that interferes with your quality of life you might consider surgery. There are some newer techniques that have not stood the test of time (facet joint replacement) but the gold standard is lumbar fusion. It is reliable surgery in the properly indicated patient. You would need to discuss the risks, benefits, and alternatives with your surgeon, but don't expect 100% relief of pain. If you can accept 75% improvement in your pain condition, that would be a reasonable expectation. Good luck, hope you find relief.
Dr. Krishn Sharma
Dr. Krishn Sharma
Thank
Dr. Carl Spivak
Orthopedic Surgery - Spine

In brief: Facet

Facet joints are a common cause of pain.
Patients who fail conservative treatment may benefit from x-ray directed facet joint injections or burning the facet nerve (radio frequency ablation of the medial branch nerve). Unfortunately these treatments only last 3 to 6 months on average. As a consequence many people consider surgery. Traditionally patients required fusion surgery. Fusion surgery usually involves large skin incision, significant muscle retraction and damage, bone removal and the placement of metal screws and rods. Collateral tissue damage from the surgery may result in more pain, back muscle weakness, instability and scar tissue leading to future difficulties. Fortunately this surgery can now be done minimally invasive through 1 inch incision. The surgery is done through a tube in between back muscles to decrease muscle damage and weakness caused by muscle retraction. The most recent advance in spine surgery is the development of endoscopic spine surgery. Endoscopic spine surgery is state-of—the-art minimally invasive spine surgery. A micro video camera is inserted through a very small incision to the damaged facet joints. The camera projects the images onto a video screen so the surgeon can easily visualize find the painful facet nerve. Tiny instruments are inserted through the camera to cut the pain nerve under direct visualization. Back pain usually rapidly improves. This is called endoscopic rhizotomy. The advantages of endoscopic rhizotomy include: no general anesthesia very small incisions less post operative pain faster recovery.

In brief: Facet

Facet joints are a common cause of pain.
Patients who fail conservative treatment may benefit from x-ray directed facet joint injections or burning the facet nerve (radio frequency ablation of the medial branch nerve). Unfortunately these treatments only last 3 to 6 months on average. As a consequence many people consider surgery. Traditionally patients required fusion surgery. Fusion surgery usually involves large skin incision, significant muscle retraction and damage, bone removal and the placement of metal screws and rods. Collateral tissue damage from the surgery may result in more pain, back muscle weakness, instability and scar tissue leading to future difficulties. Fortunately this surgery can now be done minimally invasive through 1 inch incision. The surgery is done through a tube in between back muscles to decrease muscle damage and weakness caused by muscle retraction. The most recent advance in spine surgery is the development of endoscopic spine surgery. Endoscopic spine surgery is state-of—the-art minimally invasive spine surgery. A micro video camera is inserted through a very small incision to the damaged facet joints. The camera projects the images onto a video screen so the surgeon can easily visualize find the painful facet nerve. Tiny instruments are inserted through the camera to cut the pain nerve under direct visualization. Back pain usually rapidly improves. This is called endoscopic rhizotomy. The advantages of endoscopic rhizotomy include: no general anesthesia very small incisions less post operative pain faster recovery.
Dr. Carl Spivak
Dr. Carl Spivak
Thank
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