Anyone Have Good Results with RF Rhizotomy??

[Jim Humphries, B.S., D.V.M.]

I had low back pain for many years. One of the pain generators was a congenital Spondy at L5 S1 and I was very lucky to have that successfully corrected surgically by an outstanding surgeon in Denver, Dr. George Frey.  He used a micro approach, i have an inch incision and fused quickly with no complications.  

However, the years of instability and degenerative disc disease lumbar spine have caused a very common secondary problem - Facet Arthritis.  These tiny joints on the back side of each vertebral segment become terribly irritated from unstable spinal column support over the years.  The result is Facet Arthritis.  The "angry" joints can be seen on MRI or CT scan.  Once this progresses to moderate or severe it is a very serious pain generator.  Well, I'm there.  

Just FYI, for someone who have never felt or properly experienced this pain, mine is diffuse low lumbar and not very location specific.  If I had to describe it (not knowing what it was) I'd call it severe muscle spasms.  However it has taken me years and meds and injections to realize for myself this is facet pain.  It has progressed to the point where I must do something.  I am taking far too many meds, too immobile mornings and evenings and frankly nothing but rest and hot packs will even help a little.  I will not say this is severe and I am not able to be on my feet or at my desk all day.  

I've gone through the proper medical protocol of facet injections, medial branch blocks etc. in order to reach the point of discussing this procedure.  Radio Frequency Rhizotomy or a better term is "burning of the nerve" that transmits this particular pain.  (Thank God there is one, and we can get to it!!)  Pretty simple really, they go in just like an injection, ID the nerve and then burn the hooey out of it using radio frequency heat!  That little persistent nerve has a tendency to grow back within 6 months to a year and it typically has to be done again.  

Hey, at this point I would let them dive in there and do anything to get me out of this pain.  I've heard it is not much fun as they cannot have you under sedation for the procedure, but I am okay with that.  Just stop this unrelenting pain!!  

Many people have this done.  I have mine schedule for the 24th of March.  

I'd like to hear from anyone who has had this procedure and what results you experienced for a few months or few years.  I am very hopeful this will let me get back to normal functioning (and attitude) and maybe even put a few miles on the motorcycle this summer.  

I appreciate anyone's experience and or advice for heading in to have this done.  

[Handel_with_care]

Hi Puggles, I just had my first of four scheduled lumbar RFAs a few hours ago on L1-3 on the left side.  Like you, I was nervous about it even though I had been doing a lot of research on it since it was first suggested to me in Spring, 2014 by my pain management team at the National Spine & Pain Center in suburban Washington, DC.

I even compiled a list of 30 questions and finally got an appointment directly with the doctor who would be performing this procedure.  Getting an appointment to meet with him directly took about a month of talking to office managers and higher-ups and left me completely frustrated, but I finally got one.

I feel this is a vital step for you as well to be an informed medical consumer and to have all the data you need to make an informed choice.  For instance, I found out that this doctor had never performed the procedure on someone who had an unsuccessful kyphoplasty performed for a compression fracture (L1) and that it was primarily suggested to me because of arthritis and other ancillary issues like stenosis, etc.

I had to have 4 test procedures first and those helped me to gauge how successful the RFAs would be and also satisfied Medicare guidelines.  Medicare will only allow a quarter of the lumber region (L1-3 left side first) to be done at one time.  

Since my entire lumbar area is in pain, it was difficult to gauge success in the test procedure for only one-quarter, but after 4 of these tests I felt there would be enough possibilitie--possibly 50%--of success and that was enough for Medicare to approve.

So since the risk of serious injury during the procedures is minimal and the doctor performing has never caused one, I decided finally to endure 4 procedures.  I must heartily agree with the prior poster who challenged his insurance carrier only paying for 2 levels at one time.  I would much rather have all 4 quadrants done at the same time, get through the initial pain all at one time, and get to the relief phase ASAP all at one time.

Since that's not possible with Medicare and these procedures must be scheduled two weeks apart and relief for the first procedure should begin just as I'm having the last procedure (two months), I will not get to a point of having all nerves healed until four months from today.

I've been told that for many patients their nerves grow back in 6 months.  If I'm a speedy healer, that means I would only have a 2 month benefit of having my total lumbar region pain-free after going through 4 months of pain more severe than the chronic pain I have had..

But I've also been told some patients have nerves that never grow back and that's what I'm hoping this provides me.  Also, optomistically thinking, while I was told the novacaine used for my procedure today would wear off two hours after my procedure today, it is now 3.5 hours later and I feel no more pain than I normally feel.

In fact, the actual procedure seemed to be less painful and speedier than the test procedures I have had.  

Now, as luck would have it, my normal monthly appointment with my pain management nurse practitioner for monthly prescriptions and urine tests was postponed until yesterday.  She asked me what was up.  I told her I was finally scheduled for my first procedure today and I was still very nervous.

So, she gave me a prescription for four Valium 10mg and told me to take one 30 minutes prior to the procedure and to take my normal Percocet 2 hours prior to the procedure which is technically the last time I was supposed to have anything to eat or drink.  I asked her if I could take a swallow of water with the Valium and she said that was ok too.

When the surgical assistant came into the pre-op room to take me in for the procedure, I had nodded off already.  I was very relaxed and not at all nervous and even joked with the staff during the procedure.  I felt fine during my stay in the post-op room and even though I had a friend to drive me home, I felt I could easily drive, say, to New York from Washington with no problem.

This makes me feel very positive about my experience so far.  Although I had intentionally made no appointments for me for tomorrow, I don't see me having any problems in doing some work or in driving this week starting right now if I had an appointment.

So my suggestion to you is to 1) be a pain-in-the-*** and eventually get an appointment directly with the doctor who would be performing the procedure and have questions written ready to go and when he gets snotty with you for wasting his high-priest-of-medicine time, just maintain your professionalism and get your answers; 2) have 2 test procedures on the same area to satisfy insurance requirements and to really gauge your discomfort; and 3) have your pain management doc or assistant give you a prescription for Valium 10mg to take 30 minutes prior to the procedure and take it with one swallow of water.  

Hope my positive experience so far helps you with your preliminary online research.

[puggles]

I am scheduled to have RF next week. After reading all of this I am scared to death. I have had three back surgeries and basically its this or another surgery. I have had more injections then I could ever count. I had an accident in  my home when I was 33 and my life has been nothing but hell since then.  No one and I mean no one understand what it is to live with this pain, unless you go through it. Please let me know if it's worth it. I've had mylogram's, discograms, you name it. My doc told me I had to be awake for it. I've just had it with pain and surgeries....needles, doctors. Please if anyone can help me out I'd appreciate it. This rollarcoaster is just getting very old after ten years. Blessings to you all. Leah

[Shadowlucky]

let me know how it goes for you

[Shadowlucky]

that's just it, the rhizotemy does only treat the symptoms, so this means that although it will help the pain, it is not a cure.  :(  what to do, what to do.  I am at my wits end and getting worse everyday.  Ready for retirement but have 4 1/2 more years.  I don't think I can make it.  Thought about trying the disability route.  If I can't get my long term disability and/ss disability, I guess there's always collecting cans and selling worms.  So much pain and can't do the job anymore.  sigh  now trying to figure out how to apply and get accepted before I starve to death and lose everything I own.  Life's a beach and then you die!  lol  

[Mariathelion9]

Oh government run insurance will be better! After 20 years of chronic pain, I finally went back to the VA for my healthcare. Sure it took 3 months to get a specialist appointment, but once there, the ball got rolling. The surgeon said my back was too subluxated to do laminectomies, so I asked about those new minimally invasive procedure? He thought about it a minute and said, "Yeah, okay. Let do that first." So a couple of days later I got a call from the patient outservice coordinator. I got to pick the pain clinic I wanted to go to. I already had researched UCSD as they have one of the most innovative and technologically current methods of minimally invasive surgeries (the birthplace I believe). In a few days I had my appointment.

My DR (Polston) and his colleague examinined me and felt it was NOT my disks at all, but the facet joints at the L3-4-5 & S-1. They did the medial block. If >50% pain relief, I'd be a candidate for RF. My immediate relief was 100%.  2/8/13(FRI). He told me if they don't call to schedule me to make an appointment on Tuesday myself so I can be seen next Thursday or Friday. (2/16 or 2/17). After 20 years of TRICARE insurance AND out of pocket expense (chiropractic) running into the thousands and my life & livelihood stolen from me by this pain, I LOVE Government medicine.

The best med service is usually a place like UCSD, where they have all the funding for the latest in technology and innovation, and the brightest students & docs. They are also NOT FOR PROFIT.  So the patient is #1 and the measure of your success, NOT the bottom line.

I am looking forward to not having this pain anymore even if it's just for a year. I am 52 and my QOLfor the past 20yrs has been so dismal. I lost two careers (ARMY & teaching) and have not been able to work at all for the past two years. I used to be very active (dancing, surfing, hiking, skiing). I haven't been able to do any more than watch TV and I've gained 12 pounds. I had a heart bypass in 2009, and maintaining my weight is crucial to my health. I can't even walk my dogs. (they got fat too!) They have turned on each other from the lack of stimulation & the outdoors they had become accustomed to.

I was ready for full on surgery 10 years ago but the docs refused. They all had to have a 80% certainty it would work. Didn't matter what my pain level was. Dozens of psychotic and narcotic meds later nothing ever really helped. Only trazadone for sleep and alcohol ineebriation during the day on the worst days. Narcotics OXCONTIN & vicodin off and on so as not to get addicted.

Te RF has given me hope, but it only treats the symptoms and not the cause. Anyone know if there is a "cure" for facet joint disease?

[MDWall]

I had The RFA a little over a week ago, spinal stenosis has been wreaking havock for almost 2 yrs now. I even had surgery, ( lamenectomy ) and still no relief. After reading about a lot of people's experiences with the RFA, at least I still have hope that it will give me some relief.
  From what I've been told, if the RFA is not successful, the only other alternative is a multi level fusion. I really don't want to have to go that route, as I'm only 47 and would really like to be able to go back to work for another 20 years or so.
I do hope you've found relief, as well as everyone else here, who's dealing with cronic pain.