Spine-Pain

Post lumbar spinal fusion surgery, my myelogram with CT scan indicates post operative scarring. Earlier this month, I received an invasive procedure called caudal lysis of adhesion. I received three days moderate chronic spinal pain relief, but no pain relief from my chronic legs nerve pain as wells as burning pain and numbness in my feet. Over the past two years, I have received three post lumbar spinal fusion surgery nerve root block injections. I received only 3 days moderate chronic spinal pain relief from each of these injections.

It is my understanding to be effective spinal injections should provide pain relief for six months or more.

I found the following online article.

Lumbar epidural lysis: a cranio-caudal lateral intralaminar approach

The standard approach for epidural lysis is reaching to the problematic area through the caudal canal. If the symptoms do not cease and no improvement is seen, a cranio-caudal approach can be tried. In a patient with back pain due to failed back surgery syndrome for six months, epidurography was performed using caudal approach under fluoroscopy in the first intervention. A catheter was progressed to fibrotic tissue for epidural lysis. But the pain regression was not satisfactory at the L4 dermatome. After 3 weeks, a second intervention was planned with the lateral cranio-caudal approach at the L3-4 level and a catheter was placed around the fibrotic tissue and lysis was applied. The patient’s back pain totally disappeared and neurological symptoms started to decrease at the end of the first week. We suggest that, for patients with low back pain due to failed back surgery syndrome, a cranio-caudal approach may be applied after caudal epidural lysis.

http://www.ingentaconnect.com/content/maney/tpc/
2005/00000017/00000002/art00017

There is no definitive research to dictate how many epidural steroid injections should be administered or how frequently they should be given. In general, the consensus is to perform up to three epidural injections per year, which is about the frequency that many arthritis patients receive cortisone shots for shoulder and knee pain. Different strategies are used:

Some doctors will space the injections out evenly over a year.

Others take a different approach and administer two or three epidural steroid injections at 2-4 week intervals, if the first shot results in significant pain relief.

There is no general consensus in the medical community as to whether or not a series of three injections should be performed. If a patient does not experience any back pain or leg pain relief from the first epidural injection, further injections may not be beneficial

http://www.spine-health.com/topics/conserv/epidural/feature/ep04.html

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If the patient’s symptoms are not improved by one or two epidural injections, it is unlikely that any further injections would be helpful. However, if the injections do help, up to three injections per year appears to be reasonably safe to undergo.

http://espine.info/spineinstitute/template.1.php3?page=Injections

Injections are done with the help of fluoroscopic guidance. The fluoroscope is an x-ray machine that allows the doctor to actually see an x-ray image while doing the procedure. This allows the doctor to watch where the needle goes as it is inserted. This makes the injection much safer and much more accurate. Once the needle is in the right location, a small amount of radiographic dye is injected.

Lumbar facet joint (LFJ) arthrography with intraarticular injections of long-acting steroids and local anesthetics is routinely used for therapeutic purposes in selected patients for relief of low back pain. The procedure may also be used for diagnostic reasons to establish the source of such pain.

Lumbar facet joint (LFJ) arthrography is performed mainly for therapeutic purposes for relief of low back pain with intraarticular injection of a steroid and a local anesthetic. The procedure may also be used for diagnostic purposes to establish the cause of lumbar pain.

http://radiographics.rsnajnls.org/cgi/content/full/19/1/93

The facet joints are paired joints in the back that have opposing surfaces of cartilage (cushioning tissue between the bones) and a surrounding capsule. Twisting injuries can cause damage to one or both facet joints, and cartilage degeneration associated with aging may also cause pain.

In a facet block procedure, a physician uses fluoroscopy (live x-ray) to guide the needle into the facet joint capsule to inject lidocaine (a numbing agent) and/or a steroid (an anti-inflammatory medication). If the patient’s pain goes away after the injection, it can be inferred that the pain generator is the specific facet joint capsule that has just been injected.

If the facet block procedure is effective in alleviating the patient’s low back pain, it is often considered reasonable for the procedure to be done up to three times per year. There are very few risks associated with this technique.

http://www.spine-health.com/topics/conserv/overview/inj/inj03.html