Best explanation I have seen on facet issues and ablations. Thank you for taking the time to put this together. I would have you do an ablation on me in a heartbeat 👍
I just completed my second MBB. I walked out of recovery room and walked 1.25 miles with no pain. Waiting for PA for ablation. I plan on walking and doing crunches everyday to lose the weight I put on secondary to pain and strengthen my core. It is nice to hear the same steps of the procedure and expected outcome from you that confirms what my physician has explained to me. I am looking forward to being pain free after 1.5 years post laminectomy.
I’m having the first of these procedures on Tuesday and I am so grateful for the exquisite explanation as I was very apprehensive until I watched it. Thank you for this informative series!
I'm 69 and going to have a bilateral medial branch ablation at L4, L5, S1 on 6/18/24. The two diagnostic blocks gave me 80 to 90 percent relief. I'm looking forward to real back, buttock, and hamstring pain relief. If i have to have facet joints screwed for fusing, I'm hoping it's a few years out. I'll comment on my progress around 7/10/24. - Joe Frisina in PA
I'm 19 days post bi lateral medial branch ablations at L4,5, and S1. I feel that my relief is around 90% or better. Just some superficial sensations in my lower back and upper buttocks. My legs feel lighter, and it is easier to walk my 2 miles every other day. In between walking, my workouts at home are easier, too. I'm glad I had this done. - Joe Frisina
51 yrs old. I don't know what to do first. I can't even stand up straight. My muscles stay sore 24/7 and this going on for abt 3 or more years now. 09 full tear in left knee acl and va said at my age they opt not do surgery, left me like that, 2013 hurt my back real bad heard a pop resulted in Spondylothesis in lumbar and facet hypertrophy and spinal stenosis severe exit foraminal stenosis and one fully collapsed hip and other hip partially collapsed hip. I keep getting told no one does backs. The va hip surgeon said let's settle down the back and do full back work up first and va just sent me to another hip surgeon who doesn't do backs. And back in 2016 va sent me to a neurosurgeon and he recommended trigger point injections and I still haven't gotten them either. Thank you DAV for giving me the zinger so I have a way to walk my dogs. This all started with Cervical injury in 2000. I have no pain in Neck th9ugh thank you Lord literally. I don't even know where to start to even help myself. The va is so bad. I can't take the pain anymore. Otherwise I'm healthy. Does that sound crazy or what. Somebody Please help.
Your presentation on this subject is excellent. Thank you for taking the time to make these videos. They are really helpful. I suffer from low back pain and in 2020 the Orthopedist said it was my Facet Joints. I had a steroid injection which helped but the pain came back. Then the orthopedist said I had SI joint disfunction. The next injection did not address my pain. Fast forward to 2023, with daily stretching and PT i am much better but still suffer with muscle pain. I will be seeing a new Pain management Dr. who performs the oblation and rhizotomy. I'm ready for anything that will help.
Your presentation is amazing! My wife has lumbar stenosis and degenerative disc disease. She’s in great pain and barely walks. I now understand how important it is for her to become more mobile for her health. We live in Michigan near Ann Arbor. I would have thought neurosurgeons here would have the same information you have, but her surgeon and pain management doc have never discussed any of the ideas you have presented. Is there any neurosurgeon in our area who is as knowledgeable and experienced as you?
I really appreciate these videos IM 62 male ive had L5S1 and my neck fused 7 years ago now im going thru this. Almost 1.5 years of hell Luckily im in pain management now and can some relief with minimal opioids during the day.I do believe my body is very slowly healing itself cause recently the pain seems to be moving up from my lower extremities to the lower back area part of the day anyway and recently ive been able to take longer walks without having to stop and sit down 😁
58 y/o male here. had my first ablation 5 months ago and the pan is back to square 1. I have messaged my pain Dr today with your information. I hope he comes back with more than "well lets try it again and see what happens" Terrible painful process for only a few months of semi relief. Maybe 50% better for a fraction of that. Thank you!!
Very well done. I am a 61 female, lost almost 2” from 6’1, to 5’11. Dx spinal stenosis and degenerative disk disease and facet joint moderate arthritis. Bilateral hip arthritis is moderate. Had years of steroid injection in L5, then a new Dr said the bigger issue is the facets. Had two injections 11 yrs ago and was gold for years. Now, with weight gain, I’m pretty sore 80% of time. Social worker who walks, but now limited to distance as pain increases. This was so helpful to me as with most, who have significant back issues, I feel at a limit with pain and get fearful of what’s next, will it be more painful. THANK you for this video. I see interventional pain Drs soon in Idaho (live in small rural town in Oregon) and now feel like I have had a pre primer for the visit. Jane
Wow wow wow - how educational. Had an MRI yesterday, found out about my facet problem. This is so informative! My ex died years ago after a neck operation so of course I’ve been nervous of course. But I am in much better shape than him so will actively work on PT.
Very informative, thank you! I had the 2 diagnostic procedures done and had my first ablation 2 days ago (9/25/24) I could feel the burning of the nerves “slightly” was very numb but could tell it was happening. The first day, I was sore, aching and had a slight, deep throbbing but moved gingerly throughout the day. I could only stand for short periods of time as my lower back would get heavy and begin to ache. The following morning I was a little sore but as the day went on the soreness was lessening, I was amazed! I’ve had so many epidurals and facet blockers for so many years and was excited for this but also a little skeptical. It’s been 2/3 days and I can barely tell I’ve had it done and have only experienced very mild pain compared to what I’m used to! Bottom line, I do believe this has and will continue to help quite drastically! For how long is yet to be seen and felt 🤦♀️ Excited to finally feel free of pain and hope this continues for a long time! Good luck to everyone, if anything changes I’ll try to update. Thank you doctor for such a thorough explanation and helping to change so many peoples lives ❤️
Thank you so much for that detailed explanation of the syndrome and the treatment. I watched so many videos related to this topic, but your video connected all the pieces of the information together in my head. Thank you for that
I had the first round cortisone and steroid injection done this way 2 weeks ago , I could feel the difference within 30 minutes. Booked for another injection in 3 days, my neurosurgeon said it should keep me pain free for up to 18months. Fingers crossed. I have also started physiotherapy to strengthen back muscles.
Thank You so Much. You are the Only Person that explains this Process Thoroughly. I Now have a better Understanding of what is going on. I wish YOU could Fix me Up. As The Word Says: You shall hear the Truth and shall Know it
I just had my first Medial Branch Block on April 10th and I got great relief, I had to grade my pain when I got home, doing household chores, and grade my pain each hour ,for 7 hours, then give a percentage of total relief. So right after getting off the procedure table, I had NO PAIN, then when I got home, I stood at my kitchen sink and did dishes, which normally couldn't stand no longer than 2 mins and the pain would show up, then I would have to sit down, so I did the dishes this time , was standing there for about 8 to 15 mins, had zero pain. Then did some vacuuming, had no pain, standing while dusting, so was only giving a grade of 1/2 on the 3,4, and 5th hour, then on the 6th hour I grade my pain a 1, and the 7th and last hour I graded a 2, which before my procedure I graded my pain an 8 ! And so I gave the total percentage of relief I got from having this procedure, I gave it 90% relief that I received!! So my pain doctor has me scheduled for June 3rd to have my second Medial Branch Block! I can't wait!! It was not bad at all! Just felt a little sting for about 3 seconds each time they were getting ready to numb me. So I didn't jerk, move or make any sounds. So hopefully after this 2nd Medial Branch Block, he will want to do the Radio Frequency Block. Your video I enjoyed so much, it explained so much that has went on with my Lumbar Stenosis and what to look forward to going forward. I am a 67 yr young woman.. Keep up the good work Doc!! Sharon Carroll from Archdale, NC 🙂
Thank you for sharing I'm so glad to hear your review ,I have an appointment for MBB on May 2 coming up you and the Dr give me some strength to do it thank you very much 🙏
What a brilliant video! Two years agoI had a spinal fusion of L5-S1. And somehow the surgeon when he was inserting the pedicle screws into my spine, accidentally put one into my facet joint. I’ve been in so much pain since the surgery. Tomorrow I’m going to the hospital to have a CT guided steroid injection to the area around that damaged facet joint. Hopefully, it brings some relief. I do feel a lot more positive now after watching your video. I thank you for that
Thank you! I see my Dr next week Re ablation consultation. I believe I will be a better informed patient. The best part is it may lead to a longer life because I can be more active physically. (I was an active runner; today a quarter mile walk and I’m gassed.)
54 years old. severe Facet hypertrophy. L3 L4, (L4 L5 also with central annular tear), L5 S1 with broad based disc bulge, Degenerative disease/multilevel diffuse disc bulge. Moderate degeneration of T11 T12 , L1 L2, L2 L3. I am being scheduled to have these facet injections. One thing that I heard you mention that does not fit my issues is that sitting helps with no pain. I am not like that at all. If I stand I get pain after short time, if I walk on concrete with my work boots I get pain quickly or at a mall with my good runners on! If I push pelvis forward it hurts or looking upward. My only relief is laying down and keeping inflammation to minimum. If I sit for long I get same lower back pain as standing. I also have mild scoliosis happening. I have hurt my back countless times over my career, I move 700lb tanks by hand for over 10 years. I hope these injections help me! I want to have a decent retirement and not be a crippled old man, I worked too hard to have my golden years taken from me.
Excellent video. Thank you for explanation of facet joints and the different options to help alleviate pain. I’m 45, Canadian and I was in a car accident in November 2014. I was rear ended by a distracted driver. Before the accident I was very active. I loved to dance. Now, I have L5-S1 LEVEL: There is severe disc space narrowing with diffuse disc bulge and endplate osteophyte formation. There is also severe right-sided facet arthritis and mild left-sided facet arthritis. There is right- sided facet hypertrophy and ligamentum flavum hypertrophy. L3-L4 and L4-L5 levels are not as severe, but there is disc desiccation, arthritis and disc bulge. I have just done the steroid injection with success with pain free for 3 months. Now I’m waiting to do the ablation.
I have osteoarthritis hip replacement at the age of 52. Ablations shots, Ive had it all. Now I’m having lower back pain. Just had an MRI showing spinal stenosis
A very nuanced and thorough explanation. You have my thanks. I have intractable low back pain that prevents me from running, bending over without support, let alone lifting heavy and moving normally. I have DDD at L4-S1. I had a facet block last week that removed all of my pain for a day or two. I am going to get RF and see how long I get relief. This will be the second time around I get RF for facet pain, and if this time the relief does not last indefinitely then I will get surgery. I could get a fusion, but have been looking into disc replacement and I would prefer that option if it is suitable. I saw a surgeon that specializes in disc replacement and his perspective is that disc replacement will eliminate my facet pain because my facet pain, in his view, is due to poor dynamics as a result of significant disc height loss (more than 50%) at L5/S1. My facets are only mildly arthritic in imaging. I wonder if you think his point of view could be correct. Of course the safer route is fusion, but I would like to avoid that if I can.
I get very bad groin, lower back thighs Buttox can’t walk far now spondylitis told to L4/5 S1 tried injections rubbish had leminectomey 50 years ago now had very bad fall that is how this is worse.😅😊 retired law enforcement old 71 worried now waiting for operation but just worried of uncome😮 excellent video
Thanks a lot doctor for this information. I've been diagnosed with facet joint synovitis for a few years and i didnt really know all the options available and how long could it actually take to feel relieve with all of them. What if i put in the work on the gym? If i get stronger, build more muscle in my back and lower back and general build more muscle in my legs and body in general. Can this make it to the point of not being close to not need a fuse ever?
Hi Doctor thank you for your help. My son have one of those injection to block the pain after a synovial cyst in his L4. After a month he start to have itchy in his leg can be relative to the injection ?
Explained well. Had epidurals yrs ago & didn't work after an injury. Just had 2 sets of shots with a fluroscope. Some relief possibly but supposed to get an ablasion if I decide to but not sure if it will help. Temporary from what I am told. L4L5 are gone & have bone spurs. 2 other discs are bulging. Stenosis & degenerative disc disease. Family trait. Don't want to end up like my dad. Helping a neighbor pull bushes, he felt something pop in his back. 2 surgeries & never walked again.
I love following your journey and now I am your patient..💞🙏..I have been reading and following all of your extraordinary videos so thoroughly explained. I cannot wait until you attempt my back..I have 100% trust and faith in you and your knowledge and professionalism. I am enjoying learning everything about the spine, procedures and severity of it all..Thank you for all,of your passion and compassion for helping the quality of our lives…👱🏻♀️🤗💞🙏👍🥇🏩
What about if I already have A cage from L3-L5, and now I have have severe spinal stenosis in L2-L3 on center canal & on left & right facet joints. And mild to moderate facet arthrosis and a shallow disc bulge on L1-L2? Can I be a candidate for a endoscopic rhizotomy? Pain on L2-L3 runs down my left side to my arm, knee. And chin? I did physical therapy 6 weeks and got an epidural which lasted about 5 days & was given from 300-600 Gabapintin which does nothing but make me tired. The inside of left knee pain abated some but never really left. After four days it was all back. Although PT has helped a lot, the weak thighs and knee pain are still here. I continue to do all the same physical therapy exercises that were taught to me at PT at home. I even got a stationary glute bike, and still the inner sides on my knees can’t touch as the left knee throbs, cramps & locks up when I try to sleep on my side. I use to walk 5 miles a week now I am lucky if I do three. I went to an orthopedic surgeon Dr M Barnum he wants to remove my L3-L5 - cage & 8 screws, and replace them with 10 - screws 5 on each side screws. A laminectomy fusion with instrumentation. I’ve Had three spinal fusions. It’s physical trauma on a human being along with the mental trauma of losing my 21 yr old son. I am 65 yrs old, he spoke to me like it was a breeze, a walk in the park. I’d be out in 2-3 days , walking immediately yada, yada, yada, perhaps he missed the part where I told him I’ve been there, done that & it’s not a walk in the park. So I won’t be going to him ever again. He is at Advent Hospital here in Florida. I will now go see a neurosurgeon at Orlando Health Dr Virgillio Matheus on 11/21 to hear what he thinks my options are. Wish me luck! Thank you for explaining the process, the procedures, medical terminology and even the difference on the insurance financial aspects and making that clear I get it. I’ve been in the behavioral health medical field for 28 yrs and ran a center in NYU Langone so I know about some of the things you spoke about. I know you won’t be able to directly answer me, but I wanted to thank you for giving me the knowledge I needed to ask the right questions. On 11/21/23 Millie Crespo
Dear doctor, thank you sooo much for detailed explanation. Just wondering would hyaluronic injection or PRP help with facet joint syndrome/arthritis as it helped you for SI Joint problem
Had 6 lumbar ablations last week to help with pain. Also have 17 degree scoliosis L2-3 from car accident years ago. One doc doesn't want to operate, another devised a fusion plan anchoring in my pelvis up to the 3rd from bottom rib to straighten everything and alleviate the lumbar lower thoracic pain.(Also have cervical stenosis that affects my arms/hands; neither doc wants to go there right now.) Will these "screws" work for combined scoliosis/stenosis? Thank you. 1/11/24
Tysvm for making this video. U hav helped me sooooooo much thru this video & friends. I am so very sorry about your mom. I loved this video & God bless you 4 taking the time to do this 🙏🙏🙏
Outstanding video. I have been watching several of your videos. You have taught me so much and helped me be more comfortable with the science behind pain management. I am suffering from low back pain and through yoga I have developed sciatic nerve pain. I will be calling your office to set up a consultation. I live in Jacksonville but want to have “good hands” working on my back. What are your thoughts about the ultrasonic bone scalpel? A video on that technology would be appreciated. Thank you for the education.
@@joanverbarg2529I had the MILD done on me Dec 30th, 2022, I have Lumbar Stenosis LR 4 and L5. It didn't help me at all. Only relief I am getting is sitting down when I am up and the pain flares up, I have to sit down to get the pain to stop. I am thankful for my pain management doctor, we had had to go through all the steps since he did the MILD procedure, just to get where I am today, because like this doctor says, the insurance companies have a "protocol " you have to go through, try other things before you have the major one that WILL help your pain. So I am scheduled for May 29th to have my 2nd Medial Branch Block, the first one he did April 10th and it helped me TREMENDOUSLY! So I am looking forward to May 29th for my 2nd one and then hopefully the next step after that will be the Radio Frequency Block 🙂
I have been dealing with back pain for 20 years. I've had three MBB which lasted only a month. First time seeing a neurosurgeon and she has diagnosed my problem as facet joint arthritis, central canal is open. I also have a left "C" curve scoliosis in my lumbar spine complicating my facet joint instability. I'm hoping to get an appointment with a neurosurgeon specializing in deformity. I will certainly ask his opinion about the screw when/if I get that appointment. Thank you very much for this video.
I had lumbar fusion 2-5 four years ago. Have had many injections, RAF,spinal cord trial, Peripheral nerve stimulation, scramble therapy ,laser treatment all to no avail . Nothing has helped ! My lower back still hurts every single day. I do take tylenol and hydrocodone to ease my pain. According to my recent MRI I do have bilateral facet joint arthropathy .
Having an ablation done next week. Once it is done can I attempt to not be a lazy American and do PT exercises that may help it last longer or even eliminate the issues?
What would be the reason that a regular ablation is still considered above the endoscopic removal is the removal of the nerve is a longer relief up front? Insurance?
I'm getting closer and closer to requiring surgery. Who should be making these decisions on what should be done and who will perform the work should it be a neurosurgeon or an orthopedic surgeon if you have to have spine surgery. Do they go about the procedure the same way?
I have a trapped nerve in the lumber area, It was through an accident, been 2& half years now, still waiting for treatment. Choice is a screw in area or a nerve blocker. Now other hip hurting because taking all the pressure, I am having an exray in this area this week. I have decided to go for the nerve blocker, which is months away. How good is the nerve blocker .
Excellent videos! What if diagnosed with severe lumbar spinal stenosis, herniations on several levels, severe arthritis and degenerative disease on 5 levels. Plus 18° scoliosis from thoracic muscle spasms. The doctor wants to perform 4 lumbar medial branch blocks. Would this be necessary with all the other issues going on? Also, I have severe cervical stenosis with arthritis. Im 62 yrs old and in intolerable pain. I'm at a loss as to what to do. No quality of life. Past history 2005 had laminectomy L3,4 and failed back surgery. 2010 had spinal blocks under x-ray, which did not work. PT, tens unit, medications helped tremendously from 2005 to 2023, but my Dr. Moved and now unable to find a Dr to prescribe even with MRIs and past history medical records. Im on ice packs constantly. Every doctor tells me something different. Where do I begin. Thank you!
I had the FRA done June 27th of this year and didn't get any relief to this day September 10th, 2024. I went for a follow-up about a month after, told the physician assistant that I was still having the lower back pain. I told her I didn't know if it was going to take longer for me to feel any relief or not. All she said was, " we will have you come back in 6 months ". So I go back and see my doctor in January 2025. I hopecmy doctor suggest doing the indoscopic RFA. I have Aetna/Medicare, so not sure if they will allow me to do the indoscopic RFA or not.
Hello Dr. I am a 67 year old man that worked as a boiler installer for 25 years, that was heavy work. One day while bending over and lifting about 25 pound weight, then the sharpest pain ever shot thru me and I was unable to move for a few hours. after many months of this test and that procedure and PT. I am still left with lots of pain, little sleep and many grumpy moods. Its been almost 31 years now and I am on some pain meds, topical ointments and exercise. I have had 11 ESI, a discectomy, trigger point inj's. so many of those that it must be in the hundreds. 5 nerve blocks, and several tens unit. every therapy has had some relief but non provided any long term relief The Dr. now has me set up for a nerve ablation. Do you see that as a wise move at this point? Thank you for any advice you may have. Tim Seel
Are you familiar with the new procedure INTRACEPT PROCEDURE and what are your thoughts. Is it permanent or does it need to be repeated over time? I have spinal stenosis and my doctor who retired recommended this procedure. He stated it was permanent once and done, however; in looking up this procedure I’ve heard otherwise.
Great video! Dr mcroberts- I had a collapsed disc at L5/1.. they did a disco gram test and I tested positive for pain at the bottom two discs. “Oooouuuchhhh!” The 5/1 disc had so many tears that the Dye for the live X-rays all leaked into the body cavity. (At the 3/4 lvl it formed a nice elliptical blob ) very thorough doctor. Substantial annular tear posterior at 4/5 disc. Facet injections did nothing. Ok it’s disc pain. Nothing helps. So I have an ALIF 5/1 rods / screws- astronomical improvement. Still sitting pain. Over time gets worse and worse despite constant PT, walking and aquatics. Saw another surgeon and he doesn’t think I healed well. This was confirmed upon revision surgery. (Non union) Laminectomy 5-4-1 fusion 4/5 revision at 5/1. Much more painful this time being posterior.. had complications ,6-7cm hematoma. Unimaginable pain . But … eventually I improved. Now to my question- Why would the second set of nerve blocks (no steroid -only anesthetic )provide SUBSTANTIAL relief, but the actual nerve ablation was mostly ineffective?? Is it possible that the anesthetic was reaching something else besides the facets ,that was grossly irritated ? I also don’t see why I’d develop arthritis one year after surgery, unless it has something to do with the hardware. Mostly I’m terrified of yet another failed surgery .. or at least partially so. Any thoughts?
I have significant degeneration in my sacroiliac joints and facets. I have had cortisone injections in each sacroiliac joint. I have previously had to quit my work as a Cook as my mobility is severely paired. I have little to no pain while sitting or lying down. What can I do to improve my quality of life and help me become mobile again. I am 59 year old female and live in Australia??
Great video and information. Thank you. I've had extensive and prolonged pain and discomfort for an extensive period of time. My history is far toooo long to list here - ha! I had a significant cycling crash in 2021 that took my back pain to an entirely new level and consistency. Last April I also had a microdiscectomy to reduce a herniated disc that smashed my femoral nerve. That was successful (unrelated) I have had bilateral RFA of the SI joint and L5/S1 Facet Joints. RFA had zero effectiveness, but the tests were very effective. 50 days ago had bilateral facet injections and in the last 3yrs that's been, by far, the most effective treatment. Pain is slowly returning. I know the nerves can't be seen, so the placement is not perfect with respect to an RFA and some times the nerves are missed. If another round of injections are favorable, but short lived, would a Rhizotomy be the next appropriate treatment? Appreciate you time and thank you again for a great video. Chris
Thank you so much for your detailed explanation of the branch blocks and the ablation. I am going this coming Tuesday for the 2nd set of the bilateral media branch blocks. The first round provided at least a 90% improvement in my pain as soon as I stood up from the gurney. I found the branch block to be very painful, so I am pretty apprehensive about going yet again. You said the ablation was only slightly more uncomfortable, but it really scares me at the thought of not being under sedation for the ablation, especially since the branch blocks were so painful. Why can't a patient be under some sort of sedation such as an amnesiac drug? Is it absolutely necessary that the patient be awake?
Thank you for an excellent informative lecture! I have been in such pain lower back and constant pain in left buttocks 24 hrs per day for 3 years. Use ice and heating pad 24/7 for 3 years. Have had 3 MRI, 6 mos. PT, steroids shots, more PT, Xrays....no help but increase pain in buttocks. I had been walking for many years minimum 2 miles per day 6 days of the week. My work involved sitting and walking. Had 3 steroid shots: L3/4 ; L5; pimaformis muscle. Did not work. Had to quit my 2 mile walks 3 years ago. Tried 1/4 mile but so painful 2 hours later. Forced myself but have had to stop last 2 years. Doctor’s didn’t follow me after. Pandemic occurred. I schedule video visit with my spinal surgeon. He did another MRI. Said things about the same: mild degenerative disc disease. Told me it may be sacroiliac joint. Now, when I get up in the morning, I can hardly walk.. legs hard to move. Gets better 2 hours. Pain all day in left buttocks. Lower back pain. Cannot stand in one place more than a few minutes. Go grocery shopping and do light chores but have to sit on ice and heating pad. Went to another spinal surgeon. So I did all.... X-rays show “Severe Facet Degeneration of mid and lower lumbar”. PT I could hardly do (4 weeks)because the exercises were to tighten glut muscles in butt and aggravated too much the Pain in left buttocks. MRI not much different from previous. XRays were what showed a drastic difference in facet joints degeneration. So now I need to make an appointment with the surgeon since I have done what he asked. Do you think I have 2 things going on here, or 1. Just arthritis of lower spine and/or sacroiliac joint. Please kindly advise what I should ask surgeon, and do I am over 60.
I’m in the same situation as you; but I had ablation twice and it’s works! I like it better than epidural. Some days I’m in pain, but I feel much better. I’m thinking in doing the laser surgery.
Awesome video! One question: At 16:48 into the video, you describe that a steroid is often included with the numbing medication and injected "right next to the arthritic joint". Bit puzzled by that. I assume the inflammation is within the facet joint. How does the steroid reach the inflamed area. Is it adsorbed through the synovial sac? I also understand that there is a procedure where a steroid is injected directly into the facet joint. The needle pierces the synovial sac and the steroid is injected. Is my understanding correct and is that a procedure that you also perform? Thanks!!!
Doctor, I’ve decided to start with physio first and haven’t done RFA yet. It has been 3 months since it is painful to stand, however I’m ok with tolerating this pain (I reduce standing where possible, to have less flare ups and exercises don’t hurt my facets) as I want to see the actual improvement in my pain and standing pain free by working on my muscles and understand that this is a long process. However I started to think if that pain and current inflammation after standing will cause more damage and I should do RFA and then continue with exercises and work outs. Could you please advise on what would be better? I wanted to start with FRA later, when pain is stronger (I’m 35 y.o.).
I live just north of Tampa. I’ve had injections, blocks and ablation done. I cannot find anyone in my area that performs any type of MILD procedures. I have my MRIs and would love to have them evaluated. Thanks
I was diagnosed with facet joint disease and went through the testing and received ablation on L5,L5S1 It relieved the pain I had while sleeping but now I have pain in my hip while sitting. I never had pain while walking. I was while sleeping or sitting? So explained that is probably something else? On the MRI it mentions some mild stenosis in different areas?
Hi doctor I watched one of your previous videos. I'm scheduled tomorrow for a nerve block at SI As i've had chronic sex ziatica, pain for the last seven months in the middle of my buttocks, it is Is burning pain pain Which I'm unable to get relief frob. Even with pain medication. I've had three Is back fusions add chronic s I problems. This doctor is a pain doctor and anesthesiologist, but he I'm sure of where to put it and we've had a lot of back-and-forth, as I've been suffering now for many months.Eddie way any suggestions? I am going to get a second opinion with a nearl surgeon orthopedist orthopedist and since he did not do an .MRI But chose ACT scan. I don't know how accurate his diagnosis is. I am very hard to diagnose as i've had so many procedures with all the metal in my back And chronic SI problems. I see a chiropractor 1-2 times a week. To level out my sacrum. That is another kind of pain which he did do an epidural, and it did help the middle of my back when the sacrum Tilts forward. Anyway I would appreciate any suggestions thank you
Great content, thank you! I had my first block 'test' 2 weeks ago and got lots of relief for the rest of the day so success #1. (Going back in 2 weeks for test #2.) I have pain that radiates down into my buttock and into the back of my thigh which you said was more likely stenosis but the facet nerve blocks worked so I'm even more confused now, lol. There's also pain in my hip on the side that's not affected by the (sciatica?); nothing shows up on X-rays, CTs or MRIs so I'm wondering if that could be related to me compensating for the back pain when I walk or move. Really wish they'd hurry up and 'discover' comparable treatment for knee pain, although I know mine is due to an assortment of issues in there - torn meniscus, bits and bobs floating around inside the joint, etc. - as I have probably two knee replacements in my future (that doctor appointment is tomorrow).
Hello Doctor Your channel is so good and informative. I have watched many videos. Your explanations are terrific. I was diagnosed with a large synocial cyst at T12 causing nerve pain. I am in the insurance waiting game of conservative treatment for 4 weeks before they will consider an epidural. In your experience what is the treatment for nerve pain from a cyst like this.
Sadly, rarely does insurance allow for standard of care medicine. There is no conservative treatment for an epidural facet cyst, other than an epidural steroid injection. these rarely go away on their own. there are methods to percutaneously lyse the cyst, but hard to find spinal interventionalists with this knowledge and experience. often surgery is required. but usually with good results. the best of luck!
I’m fused C3-C6 and suspect my facets are inflamed through that area with the dizziness and pain at the base of my neck that radiates upwards and definitely would want the Longterm benefits of the endoscopic ryhzotomy as opposed to the short term ablations especially with the shorter recovery times and a better quality of life.
Love your videos…I’m about to get my first approximately 6 injections lumbar spine. I’m also have stenosis and spondylosis. After sitting etc. Takes me a bit to straighten up. Also I had severe ciatica issues, I was prescribed steroid pack, It worked ! Months later I’m having occasional foot numbness again and when working an occasional sharp stab to my hip area same side.. You mentioned adding a bit of steroid with initial facet numbing. Do you think the added steroid would help with ciatica as well as helping facet stuff. The Dr. did not mention anything about steroid addition. (He may be planning it but I don’t know) wondering if I should text that question to the Dr.? Any thoughts would be much appreciated.. Ps: I’m a healthy active 64 yr old. Thx Doc.👍👍
Question--- what if flexion and extension cause pain and rate of "episodes" or " tweaks" to lower back become more frequent; even happening whilst in a course of PT? Do we proceed to some sort of needle adventure??
I’m so miserable I have severe osteoarthritis, I had brunch block yesterday and it failed, this has been going on for 30 years, after test after test, 2 tkr and one that failed and my ankle fused, I’ve got oa all over don’t know what to do
Dear Dr. Porter McRoberts, I have watched several of your videos, ie Spinal Stenosis and the one dealing with Facets, etc. I am very impressed with your expertise and the clarity with which you explain your subject matter. I have low back pain, exactly as you described, very painful when standing, and less so when sitting or lying down and unfortunately also a malunion of my right hand/wrist and shoulder, which I sustained in a fall and which was not dealt with correctly at the time. Unfortunately, I live in New York and cannot make it down to Fort Lauderdale. I also have Parkinsons, with a tremor in my right hand. My preference would be to consult with you, but that is not possible for me at the moment. However, I wonder if there is someone you would be able to refer or recommend in New York, who I might be able to try to see. Thank you in anticipation. Sincerely, JP
Maybe I missed it in this great video, but can one who sees relief from an MBB especially one that includes a steroid simply continue steroid injections for relief assuming they are happy with the length of relief and not progress to an RFA? Is there a risk to this strategy? Thanks for your videos they are very well done.
This is not a bad option. There are of-course consequences to prolonged exposure to steroid in the spine, however, this much be balanced against the risk of reduced activity secondary to spinal pain, and of course MBAs are not themselves without risk. There is minimal data looking at the long term consequences of repeat MBB with steroid, but some patients do rely on them alone as the bulwark of their therapy. Discuss it with your MD. I have one patient who I see every 4 years or so for a MBB. In this instance, it seems clearly like reasonable risk for such a great reward to me.
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Thank you so much. I feel better now. I'm not as scared now. I have to go get the nerve blocks soon in my lower back. Thanks for your explanation.
Any treatment any improvement
Best explanation I have seen on facet issues and ablations. Thank you for taking the time to put this together. I would have you do an ablation on me in a heartbeat 👍
You are a Good Man. Don't Stop helping the sick. The World Needs more people like You
Thank you for explaining 100x better than my dismissive orthopedic surgeon!
my pleasure!
I just completed my second MBB. I walked out of recovery room and walked 1.25 miles with no pain. Waiting for PA for ablation. I plan on walking and doing crunches everyday to lose the weight I put on secondary to pain and strengthen my core. It is nice to hear the same steps of the procedure and expected outcome from you that confirms what my physician has explained to me. I am looking forward to being pain free after 1.5 years post laminectomy.
I had RFA on my L3/4 L4/5 and L5/S1 . I only had relieved pain for 3 moths then constrain pain come back
Phenomenonally helpful explanation. I'm inspired to do the PT exercise. If only all Physicians spoke with such clarity.
I’m having the first of these procedures on Tuesday and I am so grateful for the exquisite explanation as I was very apprehensive until I watched it. Thank you for this informative series!
Glad it was helpful!
Hi Dr McRoberts. HG here. Looking forward to my knee ablation in 2 weeks....then my cervical. Loved listening to your explanation...not so nervous now
Best video about facet joint pain on yt
I'm 69 and going to have a bilateral medial branch ablation at L4, L5, S1 on 6/18/24. The two diagnostic blocks gave me 80 to 90 percent relief. I'm looking forward to real back, buttock, and hamstring pain relief. If i have to have facet joints screwed for fusing, I'm hoping it's a few years out. I'll comment on my progress around 7/10/24. - Joe Frisina in PA
I'm 19 days post bi lateral medial branch ablations at L4,5, and S1. I feel that my relief is around 90% or better. Just some superficial sensations in my lower back and upper buttocks. My legs feel lighter, and it is easier to walk my 2 miles every other day. In between walking, my workouts at home are easier, too. I'm glad I had this done. - Joe Frisina
51 yrs old. I don't know what to do first. I can't even stand up straight. My muscles stay sore 24/7 and this going on for abt 3 or more years now. 09 full tear in left knee acl and va said at my age they opt not do surgery, left me like that, 2013 hurt my back real bad heard a pop resulted in Spondylothesis in lumbar and facet hypertrophy and spinal stenosis severe exit foraminal stenosis and one fully collapsed hip and other hip partially collapsed hip. I keep getting told no one does backs. The va hip surgeon said let's settle down the back and do full back work up first and va just sent me to another hip surgeon who doesn't do backs. And back in 2016 va sent me to a neurosurgeon and he recommended trigger point injections and I still haven't gotten them either. Thank you DAV for giving me the zinger so I have a way to walk my dogs. This all started with Cervical injury in 2000. I have no pain in Neck th9ugh thank you Lord literally. I don't even know where to start to even help myself. The va is so bad. I can't take the pain anymore. Otherwise I'm healthy. Does that sound crazy or what. Somebody Please help.
Will be praying for you. 🙏🏽
@kingdavid3154 thank you. I can surely use that. Sincerely one day at a time sweet Jesus. We got this.
@@c.tucker95 Amén 🙏🏽
Maybe a cortisone shot?? I don’t know, that is what I am looking for at this point for my Facet Joints.
Your presentation on this subject is excellent. Thank you for taking the time to make these videos. They are really helpful. I suffer from low back pain and in 2020 the Orthopedist said it was my Facet Joints. I had a steroid injection which helped but the pain came back. Then the orthopedist said I had SI joint disfunction. The next injection did not address my pain. Fast forward to 2023, with daily stretching and PT i am much better but still suffer with muscle pain. I will be seeing a new Pain management Dr. who performs the oblation and rhizotomy. I'm ready for anything that will help.
Your presentation is amazing! My wife has lumbar stenosis and degenerative disc disease. She’s in great pain and barely walks. I now understand how important it is for her to become more mobile for her health. We live in Michigan near Ann Arbor. I would have thought neurosurgeons here would have the same information you have, but her surgeon and pain management doc have never discussed any of the ideas you have presented. Is there any neurosurgeon in our area who is as knowledgeable and experienced as you?
There is no education in medical school of how to talk to people. THat is the real problem
How is your wife doing? I found a Dr office in Midland, MI. I'm getting this procedure July 17. 2024
I really appreciate these videos IM 62 male ive had L5S1 and my neck fused 7 years ago now im going thru this. Almost 1.5 years of hell Luckily im in pain management now and can some relief with minimal opioids during the day.I do believe my body is very slowly healing itself cause recently the pain seems to be moving up from my lower extremities to the lower back area part of the day anyway and recently ive been able to take longer walks without having to stop and sit down 😁
58 y/o male here. had my first ablation 5 months ago and the pan is back to square 1. I have messaged my pain Dr today with your information. I hope he comes back with more than "well lets try it again and see what happens" Terrible painful process for only a few months of semi relief. Maybe 50% better for a fraction of that. Thank you!!
Terrible painful process? He said it was minimal at best?
FOS… it hurts
Very well done. I am a 61 female, lost almost 2” from 6’1, to 5’11. Dx spinal stenosis and degenerative disk disease and facet joint moderate arthritis. Bilateral hip arthritis is moderate. Had years of steroid injection in L5, then a new Dr said the bigger issue is the facets. Had two injections 11 yrs ago and was gold for years. Now, with weight gain, I’m pretty sore 80% of time. Social worker who walks, but now limited to distance as pain increases. This was so helpful to me as with most, who have significant back issues, I feel at a limit with pain and get fearful of what’s next, will it be more painful. THANK you for this video. I see interventional pain Drs soon in Idaho (live in small rural town in Oregon) and now feel like I have had a pre primer for the visit. Jane
Wow wow wow - how educational. Had an MRI yesterday, found out about my facet problem. This is so informative! My ex died years ago after a neck operation so of course I’ve been nervous of course. But I am in much better shape than him so will actively work on PT.
Very informative, thank you!
I had the 2 diagnostic procedures done and had my first ablation 2 days ago (9/25/24)
I could feel the burning of the nerves “slightly” was very numb but could tell it was happening. The first day, I was sore, aching and had a slight, deep throbbing but moved gingerly throughout the day. I could only stand for short periods of time as my lower back would get heavy and begin to ache.
The following morning I was a little sore but as the day went on the soreness was lessening, I was amazed! I’ve had so many epidurals and facet blockers for so many years and was excited for this but also a little skeptical.
It’s been 2/3 days and I can barely tell I’ve had it done and have only experienced very mild pain compared to what I’m used to! Bottom line, I do believe this has and will continue to help quite drastically! For how long is yet to be seen and felt 🤦♀️
Excited to finally feel free of pain and hope this continues for a long time! Good luck to everyone, if anything changes I’ll try to update.
Thank you doctor for such a thorough explanation and helping to change so many peoples lives ❤️
Thank you so much for that detailed explanation of the syndrome and the treatment. I watched so many videos related to this topic, but your video connected all the pieces of the information together in my head. Thank you for that
I had the first round cortisone and steroid injection done this way 2 weeks ago , I could feel the difference within 30 minutes. Booked for another injection in 3 days, my neurosurgeon said it should keep me pain free for up to 18months. Fingers crossed. I have also started physiotherapy to strengthen back muscles.
Thank You so Much. You are the Only Person that explains this Process Thoroughly.
I Now have a better Understanding of what is going on. I wish YOU could Fix me Up. As The Word Says: You shall hear the Truth and shall Know it
Absolutely, the best explanation I have ever heard. Thank you so much.
I just had my first Medial Branch Block on April 10th and I got great relief, I had to grade my pain when I got home, doing household chores, and grade my pain each hour ,for 7 hours, then give a percentage of total relief. So right after getting off the procedure table, I had NO PAIN, then when I got home, I stood at my kitchen sink and did dishes, which normally couldn't stand no longer than 2 mins and the pain would show up, then I would have to sit down, so I did the dishes this time , was standing there for about 8 to 15 mins, had zero pain. Then did some vacuuming, had no pain, standing while dusting, so was only giving a grade of 1/2 on the 3,4, and 5th hour, then on the 6th hour I grade my pain a 1, and the 7th and last hour I graded a 2, which before my procedure I graded my pain an 8 ! And so I gave the total percentage of relief I got from having this procedure, I gave it 90% relief that I received!! So my pain doctor has me scheduled for June 3rd to have my second Medial Branch Block! I can't wait!! It was not bad at all! Just felt a little sting for about 3 seconds each time they were getting ready to numb me. So I didn't jerk, move or make any sounds. So hopefully after this 2nd Medial Branch Block, he will want to do the Radio Frequency Block. Your video I enjoyed so much, it explained so much that has went on with my Lumbar Stenosis and what to look forward to going forward. I am a 67 yr young woman..
Keep up the good work Doc!!
Sharon Carroll from Archdale, NC 🙂
Thank you for sharing I'm so glad to hear your review ,I have an appointment for MBB on May 2 coming up you and the Dr give me some strength to do it thank you very much 🙏
@@roseetienne222Good luck and hope it helps you as it did me!
What a brilliant video! Two years agoI had a spinal fusion of L5-S1. And somehow the surgeon when he was inserting the pedicle screws into my spine, accidentally put one into my facet joint. I’ve been in so much pain since the surgery. Tomorrow I’m going to the hospital to have a CT guided steroid injection to the area around that damaged facet joint. Hopefully, it brings some relief. I do feel a lot more positive now after watching your video. I thank you for that
Thank you! I see my Dr next week Re ablation consultation. I believe I will be a better informed patient. The best part is it may lead to a longer life because I can be more active physically. (I was an active runner; today a quarter mile walk and I’m gassed.)
Dude! That was epic! Really good, well presented info. Really put my mind at ease! Thanks
Glad you enjoyed it!
Super informative and extremely well presented.
How amazing! I wish I could see you for my condition. Thank you so much. You explain it so well!
Thanks for sharing your knowledge and honesty I have a great deal of respect for Dr McRoberts I am under his treatments
I am under his wing as well…👍🙏💞👱🏻♀️
Excellent explanation. It has helped me understand what is causing my back pain and treatment options for faucets pain.
54 years old. severe Facet hypertrophy. L3 L4, (L4 L5 also with central annular tear), L5 S1 with broad based disc bulge, Degenerative disease/multilevel diffuse disc bulge. Moderate degeneration of T11 T12 , L1 L2, L2 L3. I am being scheduled to have these facet injections. One thing that I heard you mention that does not fit my issues is that sitting helps with no pain. I am not like that at all. If I stand I get pain after short time, if I walk on concrete with my work boots I get pain quickly or at a mall with my good runners on! If I push pelvis forward it hurts or looking upward. My only relief is laying down and keeping inflammation to minimum. If I sit for long I get same lower back pain as standing. I also have mild scoliosis happening. I have hurt my back countless times over my career, I move 700lb tanks by hand for over 10 years. I hope these injections help me! I want to have a decent retirement and not be a crippled old man, I worked too hard to have my golden years taken from me.
Excellent video. Thank you for explanation of facet joints and the different options to help alleviate pain. I’m 45, Canadian and I was in a car accident in November 2014. I was rear ended by a distracted driver. Before the accident I was very active. I loved to dance. Now, I have
L5-S1 LEVEL: There is severe disc space narrowing with diffuse disc bulge and endplate osteophyte formation. There is also severe right-sided facet arthritis and mild left-sided facet arthritis. There is right- sided facet hypertrophy and ligamentum flavum hypertrophy.
L3-L4 and L4-L5 levels are not as severe, but there is disc desiccation, arthritis and disc bulge.
I have just done the steroid injection with success with pain free for 3 months. Now I’m waiting to do the ablation.
I have osteoarthritis hip replacement at the age of 52. Ablations shots, Ive had it all. Now I’m having lower back pain. Just had an MRI showing spinal stenosis
A very nuanced and thorough explanation. You have my thanks.
I have intractable low back pain that prevents me from running, bending over without support, let alone lifting heavy and moving normally. I have DDD at L4-S1.
I had a facet block last week that removed all of my pain for a day or two. I am going to get RF and see how long I get relief. This will be the second time around I get RF for facet pain, and if this time the relief does not last indefinitely then I will get surgery. I could get a fusion, but have been looking into disc replacement and I would prefer that option if it is suitable.
I saw a surgeon that specializes in disc replacement and his perspective is that disc replacement will eliminate my facet pain because my facet pain, in his view, is due to poor dynamics as a result of significant disc height loss (more than 50%) at L5/S1. My facets are only mildly arthritic in imaging. I wonder if you think his point of view could be correct.
Of course the safer route is fusion, but I would like to avoid that if I can.
Thank you for the enlightning information in this video. My understanding is quite a bit better now.
I get very bad groin, lower back thighs Buttox can’t walk far now spondylitis told to L4/5 S1 tried injections rubbish had leminectomey 50 years ago now had very bad fall that is how this is worse.😅😊 retired law enforcement old 71 worried now waiting for operation but just worried of uncome😮 excellent video
Thanks a lot doctor for this information. I've been diagnosed with facet joint synovitis for a few years and i didnt really know all the options available and how long could it actually take to feel relieve with all of them.
What if i put in the work on the gym? If i get stronger, build more muscle in my back and lower back and general build more muscle in my legs and body in general. Can this make it to the point of not being close to not need a fuse ever?
Earmuffs for the insurance companies at 17:00 ;) Great explanation of the MBB -> RFA process, Dr. McRoberts!
Hi Doctor thank you for your help. My son have one of those injection to block the pain after a synovial cyst in his L4. After a month he start to have itchy in his leg can be relative to the injection ?
Explained well. Had epidurals yrs ago & didn't work after an injury. Just had 2 sets of shots with a fluroscope. Some relief possibly but supposed to get an ablasion if I decide to but not sure if it will help. Temporary from what I am told. L4L5 are gone & have bone spurs. 2 other discs are bulging. Stenosis & degenerative disc disease. Family trait. Don't want to end up like my dad. Helping a neighbor pull bushes, he felt something pop in his back. 2 surgeries & never walked again.
Thank you for the fabulous explanation. Ive got Bertolottis Syndrome and due to have blocks shortly. Im not as apprehensive now
Can this be done after a fusion due to the hardware and heat?
Thank you for your great talk! I learned a lot and will be viewing your other lectures
I love following your journey and now I am your patient..💞🙏..I have been reading and following all of your extraordinary videos so thoroughly explained. I cannot wait until you attempt my back..I have 100% trust and faith in you and your knowledge and professionalism. I am enjoying learning everything about the spine, procedures and severity of it all..Thank you for all,of your passion and compassion for helping the quality of our lives…👱🏻♀️🤗💞🙏👍🥇🏩
Wow, thank you
@@wportermcroberts
Can a branch radial nerve trigger symptoms in the dermitoms in the foot or is it more so disc issue
What about if I already have A cage from L3-L5, and now I have have severe spinal stenosis in L2-L3 on center canal & on left & right facet joints. And mild to moderate facet arthrosis and a shallow disc bulge on L1-L2? Can I be a candidate for a endoscopic rhizotomy? Pain on L2-L3 runs down my left side to my arm, knee. And chin? I did physical therapy 6 weeks and got an epidural which lasted about 5 days & was given from 300-600 Gabapintin which does nothing but make me tired. The inside of left knee pain abated some but never really left. After four days it was all back. Although PT has helped a lot, the weak thighs and knee pain are still here. I continue to do all the same physical therapy exercises that were taught to me at PT at home. I even got a stationary glute bike, and still the inner sides on my knees can’t touch as the left knee throbs, cramps & locks up when I try to sleep on my side. I use to walk 5 miles a week now I am lucky if I do three. I went to an orthopedic surgeon Dr M Barnum he wants to remove my L3-L5 - cage & 8 screws, and replace them with 10 - screws 5 on each side screws. A laminectomy fusion with instrumentation. I’ve Had three spinal fusions. It’s physical trauma on a human being along with the mental trauma of losing my 21 yr old son. I am 65 yrs old, he spoke to me like it was a breeze, a walk in the park. I’d be out in 2-3 days , walking immediately yada, yada, yada, perhaps he missed the part where I told him I’ve been there, done that & it’s not a walk in the park. So I won’t be going to him ever again. He is at Advent Hospital here in Florida. I will now go see a neurosurgeon at Orlando Health Dr Virgillio Matheus on 11/21 to hear what he thinks my options are. Wish me luck! Thank you for explaining the process, the procedures, medical terminology and even the difference on the insurance financial aspects and making that clear I get it. I’ve been in the behavioral health medical field for 28 yrs and ran a center in NYU Langone so I know about some of the things you spoke about. I know you won’t be able to directly answer me, but I wanted to thank you for giving me the knowledge I needed to ask the right questions. On 11/21/23 Millie Crespo
QUESTION Can any of these procedures mentioned be done for the Thoracic Area of the spine?
yes indeed. the thoracic spine is additionally amenable to facet denervation
Dear doctor, thank you sooo much for detailed explanation. Just wondering would hyaluronic injection or PRP help with facet joint syndrome/arthritis as it helped you for SI Joint problem
Had 6 lumbar ablations last week to help with pain. Also have 17 degree scoliosis L2-3 from car accident years ago. One doc doesn't want to operate, another devised a fusion plan anchoring in my pelvis up to the 3rd from bottom rib to straighten everything and alleviate the lumbar lower thoracic pain.(Also have cervical stenosis that affects my arms/hands; neither doc wants to go there right now.) Will these "screws" work for combined scoliosis/stenosis? Thank you. 1/11/24
Tysvm for making this video. U hav helped me sooooooo much thru this video & friends. I am so very sorry about your mom. I loved this video & God bless you 4 taking the time to do this 🙏🙏🙏
You are so welcome
Outstanding video. I have been watching several of your videos. You have taught me so much and helped me be more comfortable with the science behind pain management. I am suffering from low back pain and through yoga I have developed sciatic nerve pain. I will be calling your office to set up a consultation. I live in Jacksonville but want to have “good hands” working on my back. What are your thoughts about the ultrasonic bone scalpel? A video on that technology would be appreciated. Thank you for the education.
happy to help. thank you
I need to know more about”MILD”!
1:03
@@joanverbarg2529I had the MILD done on me Dec 30th, 2022, I have Lumbar Stenosis LR 4 and L5. It didn't help me at all. Only relief I am getting is sitting down when I am up and the pain flares up, I have to sit down to get the pain to stop. I am thankful for my pain management doctor, we had had to go through all the steps since he did the MILD procedure, just to get where I am today, because like this doctor says, the insurance companies have a "protocol " you have to go through, try other things before you have the major one that WILL help your pain. So I am scheduled for May 29th to have my 2nd Medial Branch Block, the first one he did April 10th and it helped me TREMENDOUSLY! So I am looking forward to May 29th for my 2nd one and then hopefully the next step after that will be the Radio Frequency Block 🙂
Thank you for yhis great explanation. Do you recommend trying a spinal cord stimulator for facet joint arthritis
I have been dealing with back pain for 20 years. I've had three MBB which lasted only a month. First time seeing a neurosurgeon and she has diagnosed my problem as facet joint arthritis, central canal is open. I also have a left "C" curve scoliosis in my lumbar spine complicating my facet joint instability. I'm hoping to get an appointment with a neurosurgeon specializing in deformity. I will certainly ask his opinion about the screw when/if I get that appointment. Thank you very much for this video.
This was extremely informative, thanks!
I had lumbar fusion 2-5 four years ago. Have had many injections, RAF,spinal cord trial, Peripheral nerve stimulation, scramble therapy ,laser treatment all to no avail . Nothing has helped ! My lower back still hurts every single day. I do take tylenol and hydrocodone to ease my pain. According to my recent MRI I do have bilateral facet joint arthropathy .
Having an ablation done next week. Once it is done can I attempt to not be a lazy American and do PT exercises that may help it last longer or even eliminate the issues?
I tell my patients to wait a week or two before resuming full activities.
Very kind doctor. Wish I could change the fat to muscle around the joints, I’m sure that would help. Can’t seem to work through the pain.
I’m very grateful for the explanation
What would be the reason that a regular ablation is still considered above the endoscopic removal is the removal of the nerve is a longer relief up front? Insurance?
Would a block of the facet joint help with psoriatic arthritis of the lumbar spine? I suppose it would take 4 to 5 blocks to get all of these joints.
Excellent presentation! Have you had success with ablations for people who have fibromyalgia?
I'm getting closer and closer to requiring surgery. Who should be making these decisions on what should be done and who will perform the work should it be a neurosurgeon or an orthopedic surgeon if you have to have spine surgery. Do they go about the procedure the same way?
I have a trapped nerve in the lumber area, It was through an accident, been 2& half years now, still waiting for treatment. Choice is a screw in area or a nerve blocker. Now other hip hurting because taking all the pressure, I am having an exray in this area this week. I have decided to go for the nerve blocker, which is months away. How good is the nerve blocker .
Recent MRI ruled out Stenosis. Pain also in left calf and ankle daily.
Excellent videos!
What if diagnosed with severe lumbar spinal stenosis, herniations on several levels, severe arthritis and degenerative disease on 5 levels. Plus 18° scoliosis from thoracic muscle spasms. The doctor wants to perform 4 lumbar medial branch blocks. Would this be necessary with all the other issues going on? Also, I have severe cervical stenosis with arthritis. Im 62 yrs old and in intolerable pain. I'm at a loss as to what to do. No quality of life. Past history 2005 had laminectomy L3,4 and failed back surgery. 2010 had spinal blocks under x-ray, which did not work. PT, tens unit, medications helped tremendously from 2005 to 2023, but my Dr. Moved and now unable to find a Dr to prescribe even with MRIs and past history medical records. Im on ice packs constantly. Every doctor tells me something different. Where do I begin. Thank you!
I had the FRA done June 27th of this year and didn't get any relief to this day September 10th, 2024. I went for a follow-up about a month after, told the physician assistant that I was still having the lower back pain. I told her I didn't know if it was going to take longer for me to feel any relief or not. All she said was, " we will have you come back in 6 months ". So I go back and see my doctor in January 2025. I hopecmy doctor suggest doing the indoscopic RFA. I have Aetna/Medicare, so not sure if they will allow me to do the indoscopic RFA or not.
Hello Dr. I am a 67 year old man that worked as a boiler installer for 25 years, that was heavy work. One day while bending over and lifting about 25 pound weight, then the sharpest pain ever shot thru me and I was unable to move for a few hours. after many months of this test and that procedure and PT. I am still left with lots of pain, little sleep and many grumpy moods. Its been almost 31 years now and I am on some pain meds, topical ointments and exercise. I have had 11 ESI, a discectomy, trigger point inj's. so many of those that it must be in the hundreds. 5 nerve blocks, and several tens unit. every therapy has had some relief but non provided any long term relief The Dr. now has me set up for a nerve ablation. Do you see that as a wise move at this point? Thank you for any advice you may have. Tim Seel
Are you familiar with the new procedure INTRACEPT PROCEDURE and what are your thoughts. Is it permanent or does it need to be repeated over time? I have spinal stenosis and my doctor who retired recommended this procedure. He stated it was permanent once and done, however; in looking up this procedure I’ve heard otherwise.
My pain doc now started recommending this now . Risk ?
"Off loading" and 'articulation" are unfamiliar terms for most. It might help a lot to define the terms.
Great video!
Dr mcroberts- I had a collapsed disc at L5/1.. they did a disco gram test and I tested positive for pain at the bottom two discs. “Oooouuuchhhh!” The 5/1 disc had so many tears that the Dye for the live X-rays all leaked into the body cavity. (At the 3/4 lvl it formed a nice elliptical blob ) very thorough doctor. Substantial annular tear posterior at 4/5 disc.
Facet injections did nothing. Ok it’s disc pain. Nothing helps. So I have an ALIF 5/1 rods / screws- astronomical improvement. Still sitting pain. Over time gets worse and worse despite constant PT, walking and aquatics. Saw another surgeon and he doesn’t think I healed well. This was confirmed upon revision surgery. (Non union) Laminectomy 5-4-1 fusion 4/5 revision at 5/1. Much more painful this time being posterior..
had complications ,6-7cm hematoma. Unimaginable pain .
But … eventually I improved.
Now to my question- Why would the second set of nerve blocks (no steroid -only anesthetic )provide SUBSTANTIAL relief, but the actual nerve ablation was mostly ineffective?? Is it possible that the anesthetic was reaching something else besides the facets ,that was grossly irritated ? I also don’t see why I’d develop arthritis one year after surgery, unless it has something to do with the hardware. Mostly I’m terrified of yet another failed surgery .. or at least partially so.
Any thoughts?
@@sebastianbillings7807 Do consider the sacroiliac joint.
@@wportermcroberts 🤔
I have significant degeneration in my sacroiliac joints and facets. I have had cortisone injections in each sacroiliac joint. I have previously had to quit my work as a Cook as my mobility is severely paired. I have little to no pain while sitting or lying down. What can I do to improve my quality of life and help me become mobile again. I am 59 year old female and live in Australia??
Went to Costco . Surprised on the number of people walking with walkers.
Great video and information. Thank you. I've had extensive and prolonged pain and discomfort for an extensive period of time. My history is far toooo long to list here - ha! I had a significant cycling crash in 2021 that took my back pain to an entirely new level and consistency. Last April I also had a microdiscectomy to reduce a herniated disc that smashed my femoral nerve. That was successful (unrelated) I have had bilateral RFA of the SI joint and L5/S1 Facet Joints. RFA had zero effectiveness, but the tests were very effective. 50 days ago had bilateral facet injections and in the last 3yrs that's been, by far, the most effective treatment. Pain is slowly returning. I know the nerves can't be seen, so the placement is not perfect with respect to an RFA and some times the nerves are missed. If another round of injections are favorable, but short lived, would a Rhizotomy be the next appropriate treatment? Appreciate you time and thank you again for a great video. Chris
Do we exercise our back
Thanks alot. What about cancer risk from x-ray exposure when you require this procedure every year for the next 40-50 years?
Excellent explanations, thanks.
Great explanation!!
Thank you so much for your detailed explanation of the branch blocks and the ablation. I am going this coming Tuesday for the 2nd set of the bilateral media branch blocks. The first round provided at least a 90% improvement in my pain as soon as I stood up from the gurney. I found the branch block to be very painful, so I am pretty apprehensive about going yet again. You said the ablation was only slightly more uncomfortable, but it really scares me at the thought of not being under sedation for the ablation, especially since the branch blocks were so painful. Why can't a patient be under some sort of sedation such as an amnesiac drug? Is it absolutely necessary that the patient be awake?
Thank you for an excellent informative lecture! I have been in such pain lower back and constant pain in left buttocks 24 hrs per day for 3 years. Use ice and heating pad 24/7 for 3 years. Have had 3 MRI, 6 mos. PT, steroids shots, more PT, Xrays....no help but increase pain in buttocks. I had been walking for many years minimum 2 miles per day 6 days of the week. My work involved sitting and walking. Had 3 steroid shots: L3/4 ; L5; pimaformis muscle. Did not work. Had to quit my 2 mile walks 3 years ago. Tried 1/4 mile but so painful 2 hours later. Forced myself but have had to stop last 2 years. Doctor’s didn’t follow me after. Pandemic occurred. I schedule video visit with my spinal surgeon. He did another MRI. Said things about the same: mild degenerative disc disease. Told me it may be sacroiliac joint. Now, when I get up in the morning, I can hardly walk.. legs hard to move. Gets better 2 hours. Pain all day in left buttocks. Lower back pain. Cannot stand in one place more than a few minutes. Go grocery shopping and do light chores but have to sit on ice and heating pad. Went to another spinal surgeon. So I did all.... X-rays show “Severe Facet Degeneration of mid and lower lumbar”. PT I could hardly do (4 weeks)because the exercises were to tighten glut muscles in butt and aggravated too much the Pain in left buttocks. MRI not much different from previous. XRays were what showed a drastic difference in facet joints degeneration. So now I need to make an appointment with the surgeon since I have done what he asked. Do you think I have 2 things going on here, or 1. Just arthritis of lower spine and/or sacroiliac joint. Please kindly advise what I should ask surgeon, and do I am over 60.
I’m in the same situation as you; but I had ablation twice and it’s works! I like it better than epidural. Some days I’m in pain, but I feel much better. I’m thinking in doing the laser surgery.
I also had a blation therapy done twice years ago to my facet. Joints and recently to the SI joints. I had absolutely no relief the second time.
Awesome video! One question:
At 16:48 into the video, you describe that a steroid is often included with the numbing medication and injected "right next to the arthritic joint". Bit puzzled by that. I assume the inflammation is within the facet joint. How does the steroid reach the inflamed area. Is it adsorbed through the synovial sac?
I also understand that there is a procedure where a steroid is injected directly into the facet joint. The needle pierces the synovial sac and the steroid is injected. Is my understanding correct and is that a procedure that you also perform?
Thanks!!!
Doctor, I’ve decided to start with physio first and haven’t done RFA yet. It has been 3 months since it is painful to stand, however I’m ok with tolerating this pain (I reduce standing where possible, to have less flare ups and exercises don’t hurt my facets) as I want to see the actual improvement in my pain and standing pain free by working on my muscles and understand that this is a long process. However I started to think if that pain and current inflammation after standing will cause more damage and I should do RFA and then continue with exercises and work outs. Could you please advise on what would be better? I wanted to start with FRA later, when pain is stronger (I’m 35 y.o.).
I like the facet joint titanium screw as treatment. Longer lasting
I live just north of Tampa. I’ve had injections, blocks and ablation done. I cannot find anyone in my area that performs any type of MILD procedures. I have my MRIs and would love to have them evaluated. Thanks
Thank you for the great video!
I was diagnosed with facet joint disease and went through the testing and received ablation on L5,L5S1 It relieved the pain I had while sleeping but now I have pain in my hip while sitting. I never had pain while walking. I was while sleeping or sitting? So explained that is probably something else? On the MRI it mentions some mild stenosis in different areas?
Wow. Thank you for this information
Glad it was helpful!
Hi doctor I watched one of your previous videos. I'm scheduled tomorrow for a nerve block at SI As i've had chronic sex ziatica, pain for the last seven months in the middle of my buttocks, it is Is burning pain pain Which I'm unable to get relief frob. Even with pain medication. I've had three Is back fusions add chronic s I problems. This doctor is a pain doctor and anesthesiologist, but he I'm sure of where to put it and we've had a lot of back-and-forth, as I've been suffering now for many months.Eddie way any suggestions? I am going to get a second opinion with a nearl surgeon orthopedist orthopedist and since he did not do an .MRI But chose ACT scan. I don't know how accurate his diagnosis is. I am very hard to diagnose as i've had so many procedures with all the metal in my back And chronic SI problems. I see a chiropractor 1-2 times a week. To level out my sacrum. That is another kind of pain which he did do an epidural, and it did help the middle of my back when the sacrum Tilts forward. Anyway I would appreciate any suggestions thank you
Great content, thank you! I had my first block 'test' 2 weeks ago and got lots of relief for the rest of the day so success #1. (Going back in 2 weeks for test #2.) I have pain that radiates down into my buttock and into the back of my thigh which you said was more likely stenosis but the facet nerve blocks worked so I'm even more confused now, lol. There's also pain in my hip on the side that's not affected by the (sciatica?); nothing shows up on X-rays, CTs or MRIs so I'm wondering if that could be related to me compensating for the back pain when I walk or move.
Really wish they'd hurry up and 'discover' comparable treatment for knee pain, although I know mine is due to an assortment of issues in there - torn meniscus, bits and bobs floating around inside the joint, etc. - as I have probably two knee replacements in my future (that doctor appointment is tomorrow).
Hello Doctor
Your channel is so good and informative. I have watched many videos. Your explanations are terrific. I was diagnosed with a large synocial cyst at T12 causing nerve pain. I am in the insurance waiting game of conservative treatment for 4 weeks before they will consider an epidural. In your experience what is the treatment for nerve pain from a cyst like this.
Sadly, rarely does insurance allow for standard of care medicine. There is no conservative treatment for an epidural facet cyst, other than an epidural steroid injection. these rarely go away on their own. there are methods to percutaneously lyse the cyst, but hard to find spinal interventionalists with this knowledge and experience. often surgery is required. but usually with good results. the best of luck!
I’m fused C3-C6 and suspect my facets are inflamed through that area with the dizziness and pain at the base of my neck that radiates upwards and definitely would want the Longterm benefits of the endoscopic ryhzotomy as opposed to the short term ablations especially with the shorter recovery times and a better quality of life.
Love your videos…I’m about to get my first approximately 6 injections lumbar spine. I’m also have stenosis and spondylosis. After sitting etc. Takes me a bit to straighten up. Also I had severe ciatica issues, I was prescribed steroid pack, It worked ! Months later I’m having occasional foot numbness again and when working an occasional sharp stab to my hip area same side..
You mentioned adding a bit of steroid with initial facet numbing. Do you think the added steroid would help with ciatica as well as helping facet stuff. The Dr. did not mention anything about steroid addition. (He may be planning it but I don’t know) wondering if I should text that question to the Dr.? Any thoughts would be much appreciated.. Ps: I’m a healthy active 64 yr old. Thx Doc.👍👍
Question--- what if flexion and extension cause pain and rate of "episodes" or " tweaks" to lower back become more frequent; even happening whilst in a course of PT? Do we proceed to some sort of needle adventure??
Great question. Not necessarily yet: get a full set of flexion and extension X-rays, and then also likely too MRI.
I’m so miserable I have severe osteoarthritis, I had brunch block yesterday and it failed, this has been going on for 30 years, after test after test, 2 tkr and one that failed and my ankle fused, I’ve got oa all over don’t know what to do
My PT used the word "gristle over."
Thanks. Very informative info.
Dear Dr. Porter McRoberts,
I have watched several of your videos, ie Spinal Stenosis and the one dealing with Facets, etc. I am very impressed with your expertise and the clarity with which you explain your subject matter.
I have low back pain, exactly as you described, very painful when standing, and less so when sitting or lying down and unfortunately also a malunion of my right hand/wrist and shoulder, which I sustained in a fall and which was not dealt with correctly at the time.
Unfortunately, I live in New York and cannot make it down to Fort Lauderdale. I also have Parkinsons, with a tremor in my right hand. My preference would be to consult with you, but that is not possible for me at the moment. However, I wonder if there is someone you would be able to refer or recommend in New York, who I might be able to try to see. Thank you in anticipation. Sincerely, JP
Great video, thank you.
😂😂😂😂 love the let’s get real, moment.
Maybe I missed it in this great video, but can one who sees relief from an MBB especially one that includes a steroid simply continue steroid injections for relief assuming they are happy with the length of relief and not progress to an RFA? Is there a risk to this strategy? Thanks for your videos they are very well done.
This is not a bad option. There are of-course consequences to prolonged exposure to steroid in the spine, however, this much be balanced against the risk of reduced activity secondary to spinal pain, and of course MBAs are not themselves without risk. There is minimal data looking at the long term consequences of repeat MBB with steroid, but some patients do rely on them alone as the bulwark of their therapy. Discuss it with your MD. I have one patient who I see every 4 years or so for a MBB. In this instance, it seems clearly like reasonable risk for such a great reward to me.
@@wportermcroberts yep thx. I will talk to my docs.
Please inform me regards lumbar extension is that ok to do if you have bad l345 spinal stenosis ,