Facet Joints in the Lumbar Spine. Ablations, blocks, injections. Are they safe? Do they work?
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- เผยแพร่เมื่อ 21 ก.ย. 2023
- Today I discuss facet joint nerve blocks and ablations and injections, and all of the available treatments for arthritis in the lumbar spine. They're critical joints in spinal anatomy, and the treatment of pain and dysfunction has been a topic for years. MIS minimally invasive surgery options exist, as well as ultra-minimally invasive options which are tried and true with minimal risk. Please feel free to ask questions in the comment section.
- วิทยาศาสตร์และเทคโนโลยี
Thank you for explaining 100x better than my dismissive orthopedic surgeon!
my pleasure!
You are a Good Man. Don't Stop helping the sick. The World Needs more people like You
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 👍
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 🙏🏽
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!!
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.
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.
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.
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
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
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 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 😁
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!
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
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.
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
Thanks. Very informative info.
Great video, thank you.
Wow. Thank you for this information
Glad it was helpful!
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…👍🙏💞👱🏻♀️
Thank you for yhis great explanation. Do you recommend trying a spinal cord stimulator for facet joint arthritis
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
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
Dude! That was epic! Really good, well presented info. Really put my mind at ease! Thanks
Glad you enjoyed it!
Recent MRI ruled out Stenosis. Pain also in left calf and ankle daily.
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
thank you.
Thank you so much! I am coming to see you soon!
Any time!
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.
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
Thank you!
You're welcome!
Excellent presentation! Have you had success with ablations for people who have fibromyalgia?
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
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
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
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
I’m in Australia and have had quite a few nerve blocks that worked really well which made me a good candidate for ablation but when it was done I got no relief and the pain was worse, which I don’t understand when the blocks gave me 90% relief. My Dr just said it doesn’t work for everyone.
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 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!
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?
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!
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.👍👍
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?
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!!!
Thanks alot. What about cancer risk from x-ray exposure when you require this procedure every year for the next 40-50 years?
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 🙂
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
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
😂😂😂😂 love the let’s get real, moment.
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.
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 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 .
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
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.
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.).
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 ?
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.
Isn't there a better way, maybe healing bone, finding ways to create cushions? This is terrifying
I’ve had 12 injections now and they don’t seem to help . Back pain sucks
Can this be done for my knees. I supposed to have bilateral knee replacement. But this sounds better for me. Of course it’s a work related injury. And I’m now 70. Been in constant pain since 2006. I had a laminectomy. Anterior posterior. And have a difficult time walking and I find my body curves forward as in kyphosis. So was wondering if this would work instead of knee replacement for me.
Yes you can! the results are usually better in the back, but like the facet joints: do a prognostic block of the genicular nerves and see what kind of relief you get.
Please inform me regards lumbar extension is that ok to do if you have bad l345 spinal stenosis ,
Buttocks pain left side only
Watch his SI joint video
These videos confuse me. This person has no name at all in his title He is not a surgeon who is he?