Lumbar Facet Joint Syndrome
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- Опубликовано: 27 сен 2024
- This video outlines the symptoms and treatment options for back pain caused by Lumbar Facet Joint Syndrome.
#lumbarfacetjointsyndrome #spinesurgery #rhizotomy #medianbranchblock #facetjointpain #thespineguy
Dr. Brian W. Su, MD
Spine Surgeon
Chief Development and Strategy Officer | California Orthopedics and Spine
Medical Director of Spine Surgery | Marin General Hospital
Director | Marin Healthcare District Board
Chairman | Marin Specialty Surgery Center
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Larkspur, CA 94939
7100 Redwood Blvd, Suite 200
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Disclaimer: This video is not intended to provide diagnosis, treatment or medical advice. Information obtained from this video should not be taken in lieu of your own medical provider's advice and treatment plan. Please consult directly with a physician or other healthcare professional regarding any diagnosis or treatment plan options. Content provided on this RUclips channel is for informational purposes only and should not be considered as a substitute for advice from a healthcare professional. The statements made about specific products throughout this video are not to diagnose , treat, cure or prevent disease.
I have been dealing with this stuff since the age of 19yrs old and I'm 46 now. Your explanation about the capsule was very informative. Having to do with the cartilage and tendons back there I've also got Ehlers Danlos Syndrome (hEDS) i would love to see some videos with Ehlers splashed in a bit in regards to how it may affect everything in the spine. Thank you!👍
Your explanation and warnings are extremely helpful. Thanks so much for making this a subject so understandable.
Dr. Su, I just want to thank you for your honesty! I always appreciate your videos.
Thank you for explaining it so well & making it easy to understand. Found out this s why I’ve been having back pain. Suffering 6-7 years with pain. Thanks for saying surgery won’t work.
Fantastic tutorial...excellent source of information 👏
Thank you so much Dr. Su! This video was extremely helpful and educational as well - and took my fear away!
Thank you so much my specialist was nowhere near as clear as you were in this video.. chronic back pain with this 38yrs had one numbing injection 💉 but they didn't explain very well so I didn't know what they were doing I thought it was going to help sort it out. Now I've just got crutches which helps so much
Wow everything you said was true! I had been diagnosed with lumbar facet joint syndrome since I was 19 and I’m 28 years old now. I literally went through all the phases of injections until I got a RFA. Surprisingly the RFA did the trick for a few years until now. I think I will get this procedure repeated with my pain doc. Very informative! Glad you gave me reassurance that surgery would not work. That’s always been in the back of my head wondering if that would be a permanent fix. I definitely won’t be doing that.
Thank you so very much for your content. It is awesome. I have spinal stenosis, spondylolisthesis and I have had RFA for facet joint syndrome. I do not have pain that runs down my leg, I have spine and buttock myofascial pain. Thank you again.
Thank you very much for this video Dr. Su. Last week I have been diagnosed with cervical facet joint syndrome by an orthopedic surgeon . I am 66 and have been an active long distance rider for 20 years. In the last 10 years I have been a victim of 3 accidents where car collided with my bike while riding in the bike lane. This caused fractures, whiplash and other. Each time I recovered over a period of 12 months and went back on the bicycle. As of August 2022 I started feeling strong pain in my neck and lumbar area accompanied by numbness of the groin, legs and feet at times. Also getting pins and needles in fingers, bicep/triceps pain. The pain so bad that it deprives me of sleep, makes it difficult to sit for prolonged periods, makes it hard to drive the car etc. I am being recommended pain management with all the thing you talked about in this video. I am taking Endep 10mg daily but this is not mitigating the pain very well. This causes me depression and anxiety. The pain management is weeks away due to all the paper work involved between specialists. Also these specialists are very booked out and have to wait. What do you recommend in the mean time while I am waiting for these procedures? Thanks.
I would have to look at the imaging. You can make a virtual appointment at California orthopedics and spine
@@DrBrianSuTheSpineGuy
Thanks for your reply. I forgot to mention that I am in Australia.
Best videos about back pain! Thanks for the information
Can not thank you enough for these detailed explanations and information ! Very very useful to learn and understand these( some cases our) condition including the potential handling of same.
Excellent explanation, thank you!
My MRI showed bilateral hypertrophy on every joint from T11 to S1.
At L1-2 there's ligamentum flavum infolding.
At L4-5 there's ligamentum flavum infolding but also encroachment of the right and partial encroachment of the left subarticular zones.
Can you do one about chronic pelvic pain syndorme.
The diagnostic injections are not that painful, the ablation needle/ hollow sleeve the rf tool goes inside of to do the procedure are painful and are painful for a period after from days to weeks before the ablation works. Some people say it's worse after the procedure for a period of time ( I agree with that, currently 2 days after). Hoping for relief after years of pain and multiple steroid injections.
Instead of the burning the nerve why can’t this nerve be cut permanently so that the rhizomoty doesn’t have to be performed multiple times?? Thank you for this video! Very educational!!
Burning the nerve does the same thing as cutting it
THANK YOU...THANK YOU....THANK YOU....
Thank you for caring enough to make these clear understanding videos for the suffering, Dr. Su.
I’m 67 female with pain throughout my cervical with narrowing at C 4-5, thoracic facet joint syndrome and lumbar radiculopathy, facet joint syndrome, osteoarthritis and sciatica in lower lumbar.
My physiatrist asked me where I want to start for pain management and I chose my thoracic area as it felt like a knife stuck under my right shoulder blade for 5 years now. She did the first set of lidocaine injections three weeks ago and the T9 spot sent lightening bolts all the way to my right rib and down to my feet. I was numb all day in the T9-11 and that was wonderful relief. I had my second set yesterday in the same areas and did not feel the same numbness or relief as the first time but it did numb a smaller area for a few hours. What would cause the second round to be less of an area relieved? Did she not hit the same spot? I’m going next for nerve ablation in same area. Then to my lumbar and neck area for the ablation.
I forgot to add that I had a facet joint block last October which helped me feel less rigid for a few weeks but the pain didn’t lessen, I have also received an hyaluronic acid infiltration in my right hip which hasn’t helped me with the pain. I only have the pain unit to help me with pain management; I’m not a candidate for back surgery as you have explained in your videos. I am not a candidate for labrum repair surgery as I am 59. I wish I knew which symptoms were for what, thanks if you get to see my comment. Best regards from Madrid.
Thank you for this highly informative presentation.
Great video dr Su!
The purpose of that nerve is to provide pain so that you don’t damage the joint further, and allow the body time to repair it.
Hey Doc, what would the long term consequence of ablation be in relation to the above?
Take all the time you need.
Taking sensation away from the nerve does not increase degeneration of the nerve. The nerve also does grow back and sometimes patients require repeated ablations
Thanks so much for all the info. I now understand what is going on and can proceed with treatment.
Thanks for an excellent explanation.
SI Joint pain, my tail bone Sacrum pain that's in my groin and privates, affecting urination. Pain travels to my thighs, top hip pain, and buttocks pain as well. I have Herniated disc and bulging disc as well, WHY after TWO years has no one has figured out what to do? This pain which is hard to sit, stand for long periods of time, sometimes if I can't sit or stand, laying down legs elevated helps.. temporary until my lower back and buttocks start to hurt again, and then do the process all over again, sit or stand until pain comes back.. 24/7 I do not sleep much, when my meds wear off, my pain will wake me up. meds take sometimes 2 hours to kick in to give me 5 to 6 hours of relief.. this is my Cycle of Unacceptable Pain sir.. Please help, any advice of procedure, Type of MRI, CAT scan, Ultrasound needed to help find the cause.. HELP! My pain Mgmt isn't helping. Don't need Virtual reality Therapy, which doesn't work for me,Pills to mask the pain, and the NICE Iceless Cold Compression device made it worst, the cold touching my Sacrum, increased the PAIN... my problem is in my Sacrum or my SI Joints and no one is listening to me.
You trayed diagnostic injections? How is it going?
Sciatic nerve? I read that in some situations sciatic nerve issues can include discomfort/pain in the thigh and genital areas.
My Dr has diagnosed me with ischelgluteal bursitis for that "can't sit comfortably" pain , along with medial branch facet nerve issues. Got MB RF nerve ablation, but it does nothing for the Bursitis that will be dealt with separately. Sometimes we have more than one concurrent problem, although we think it's all coming from one spot.
I’m in the same boat , I was hurt at work in 2021 . Herniated a disk and I have more bulges . Your pain and everything else sounds so familiar . I’ve had over 20
Injections on my spine . Nothing works . I’m not
Doing any injections anymore .
What medicine do you take for the pain? I am just like you. I have 2 disc bulges and facet joint hypertrophy. Most doctors seem to think my pain is probably caused from the disc bulges but I’m not so sure because I have every symptom of facet syndrome. I can only walk or stand for two to five minutes and then I have to sit but I don’t have pain when sitting
Finally understand going on both legs hurt and feet spinal stenosis I was told I have faucet joint so why doc not doing things helps
I got good insurance Aetna gold
Thank you so much. Very informative 👏
Great video!
Congratulations!🎊
Dr Su in addition to facet joint arthritis I also have a facet cyst 10 mm on L4-5 which is pressing on the nerve and a lot of pain on my left leg , pls advise what can be done to shrink or remove the cyst .. thank you so much
Great video Thank you
can you do content on endoscopic rhizotomy v fluoroscope rhizotomy and where to access endoscopic as it latest longer ?
Yes
Helpful! 💯
Thanks You.
Subbed
Great.
is 30 minutes enough for a spinal consultation with a consultant? Some private drs here charge £220 for 15 mins and £250 for 30 mins
Hi Doctor, thanks to your videos I am understanding my diagnosis much better.I have been diagnosed with DDD, facet joint osteoarthritis in L4,L5 and S1. I also have torn labrum and condropathy coxofemoral in both hips, with a para labral cyst in my right one.
My question is, I can’t sit or stand for long and I know that is due to the lower back issue. But, I am currently unable to walk far and unable to go upstairs, the pain is paralysing and my buttocks and groin burn, I have to stay still until it wears off. is this due to the hips or the lower back? I appreciate any information on this. I’ve been told that it’s all connected but that isn’t helpful for my day to day care and exercise routine. I am an ex professional dancer so this is extremely frustrating 😢
I would have to look at the imaging. You can call California orthopedics and spine for a virtual appointment with me
Unfortunately I had fusion I had issues with a torn disc and enlarged facet joint putting pressure on my nerves fusion helped but of course I still have pain.
What stem cell injections???
Would that be helpful??
There is no evidence that it works for facet joint syndrome.
Thank you so much for your reply.
I am 56 yr old woman
Been active my whole life.
Performance arts.
I have scoliosis level three was a lower lumbar but the spondylolisthesis at level 45 and I do believe the facet joint syndrome is causing rotation in all lumbar and sacral joints most recently I always had pain and lower back but now I’m in horrendous pain down my tents or fascia lata and iliotibial track. I’m also massage therapist over 30 years, I have had ablations which I haven’t seem to do much for me. The surgeon wants to fuse eight of my vertebrae because he’s worried about Jason syndrome. He wants to go in through the back for 10 hours two days later going through the front for 10 hours and then he told me he thought it wouldn’t so I wouldn’t survive.
Then he changed his mind, saying he would have a vascular surgeon there, but he would rather that I try to manage not having any surgery at all. I agreed with him. . I am in New Jersey
God help me…lol
Oh yeah, I also have spondylosis, and spinal stenosis . The doctor would not sign off papers for me to have disability of any kind and I can’t stand or sit or walk for any distance or time like you explained it’s very hard to see on the MRI and no one will put me on my side for x-rays I just can’t seem to get any help that I need, unfortunately I am on Medicaid because I can’t work anymore. I failed to mention that the surgeon wanted to fuse eight of my vertebrae. I am so impressed with you. I can’t express it anymore. In this note! I love the fact that you talk to us patience with technical terms, and show on the skeleton whatever everything is because it’s so complicated for people to understand but I really really do understand everything that you’re talking about. I’ve been suffering since I’ve been nine years old, but it’s gotten to the point where recently I was riding my bike and was knocked off the bike not going tremendously fast someone’s dog ran into my front tire as I was riding with my dog on the other side anyway, I laid down the bicycle like a motorcycle, and I slid for a few feet, but I landed on my hip and ever since then I cannot take one step without excruciating pain down my entire left side of my back down my entire left side of my leg and my spine just rotates. I try to put it back in with constant yoga constantly during the day but it pops right back out. Is there anyway I could fly out there and see you with Medicaid, I have doubts because Medicaid sucks but I do think there might be a way that I can get a doctor to sign off but then you don’t make any money so any kind of reply to any of these questions I would greatly appreciate I just think you’re the best and the greatest and I am so grateful for your videos and I am feel like there’s hope. I really am tearful, extremely tearful right now with that there may be hope for me I used to be a bikini model and a dancer and now I’m afraid I will have no range of motion and never be able to dance again I’m very emotional thank you so much I pray for your response.
i am scheduled for ths
e Boston scope study at weil cornel where they insert clips to separate the vertabrate to repose pressure on the nerve. cant find videos on the subject
Nutrition, more magnesium? Cartilage can be healed and repaired with proper nutrition
Hi could you advise whether or not to do sets of squats if you have facet joint OA at L5-S1(severe) and L4-L5 (medium)? Thanks
I was told via mri. I have “exuberant facet joint hypotrophy L3-L4 with moderate stenosis of the lateral recesses and initial mass effect over the transversing bilateral L4 nerve roots. And L4-L5 minimal posterior diffuse disc bulge and exuberant facet hypertrophy resulting in moderate central spinal canal stenosis and narrowing of the bilateral lateral recesses. Moderate crowding of causal equina initial mass effect over the transversing bilateral nerve roots. Moderate narrowing of the left neural foramen no compromise of the exiting nerve root. L5-S1 moderate to severe spinal stenosis secondary to the combination of the posterior diffuse disc bulge, hypertrophy of facets and developmentally small spinal canal. Left paracentral and lateral broad base disc bulge with severe narrowing of the left neural foramen. Mass effect over exiting left L5 nerve root. No compromise on right. I’ve watched most of your videos on facet and spinal stenosis. As of today I have had diagnostic facet injections and the second round of them. 3 on each side x 2. Guess they were prepping for RFA. Saw an Ortho back surgeon he address L2 L3 jnterlaminal epidural injection. After consulting with my pain Dr (the one doing the injections) today he did not understand why L2L3. Read through mri report again and what the ortho put in my report. Ultimately pain Dr recommended L4L5 based on the mri. Ortho Dr also commented on why I got facet injections. Again pain Dr Dr McConn from Syracuse reiterated the exuberant facet issues. I do not want surgery if it can be avoided. Today was the inter-laminal epidural nerve block. Been icing on and off. Lidocaine has worn off so I know it will get worse before it gets better. Do you have any words of wisdom for me? Thank you in advance
It's hard to say without seeing the imaging
I have acute pain in lumbar extension and off to one side right side, and yet I have leg weakness and tingling sensation down to the base of the foot across all my leg, and stifness in the lock back, so I am clueless
Can you do a video like this for cervical facet arthropathy? Also what thoughts do you have on laser procedures to debride the arthritic osteophytes on the facets within the joint capsule?
Watch the cervical facet joint syndrome video. There have been no procedures shown to be useful surgically for facet joint arthritis
Thanks a lot for this great video, Dr. Su!!! 🙏 In the video you said that it’s difficult to diagnose lumbar facet joint syndrome by merely looking at an MRI, however, today, I got an MRI and the doctor diagnosed a lumbar facet join syndrome as the cause of my chronic lower back pain (I have pain since 2017 after a landing from a jump during a Basketball game). He said that the cause of the joint pain is a degenerated disc between L5 and S1. The degenerated disc was very visible on the MRI (darker than the other discs). This causes also a bulging disc which, however, isn’t the source of my back pain he said. He also saw signs of arthritis in the facet joint on the MRI. Is that really true?
I’m only 34 years old, male, very athletic, never smoked, and I exercise since age 16.
What would you recommend to do next? From your video, I understand that getting injections could be another test to confirm the diagnosis.
Thank you so much for your time and help 🙏
Almost everybody has some degree of lumbar facet join arthritis on their MRI the trick is whether or not it's causing the pain and sort that out by using injections.
@@DrBrianSuTheSpineGuy Thank you so much for taking the time to reply to my question! 🙏 It’s much appreciated. You’re doing a wonderful service to humanity here!
@@DrBrianSuTheSpineGuyHow do we diagnose this doc on the basis of just the symptoms if we don't want to take the injections?
Would a rhizotomy relieve radiating leg pain in the thighs, glute, and running down the back of your legs? Thanks.
Sometimes it can
I think this is what I have. I have tenderness on the right side near the spine, tingling into my foot for 3 months and the pain is so bad in the evening. Anti inflammatory medications have helped but not made the symptoms completely disappear. As soon as I stop using the meds it comes back. The pain moves around the lower right back and into the outer thigh. I have not been offered the numbing medication test, just going straight for steroid injections. Maybe it’s different over in the U.K.? I m on private health care as the NHS told me there was nothing wrong with me apart from sciatica.
The numbing test is for radiofrequency ablation (burning the nerves), not for steroid injections. I've had both.
Did you find out what it was and have you got any relief?
Doctor Su, for years I thought my lower back pain was from my L5 disc bulge. I've tried everything to address my pain. Nothing has helped. My spine surgeon doesn't want to operate. After watching your video, I am now wondering if my pain is due to facet syndrome?
I can do a zoom appointment with you if you call California orthopedics and spine
Great explanation.
One question;
After having 3 artificial disc replacements from S1 to L3, my facet joints are killing me with pain and yearly rizolisis do not work anymore. I’m 58.
If fusion is out of the question, what else is there for me?
Thanking you in advance.
Any advice, Dr.?
Any advice, Dr.?
Dr. Su, do think artificial facet joint replacement is a suitable alternative to fusing the facet joint? thank you
Those have not really panned out for the lumbar spine
@@DrBrianSuTheSpineGuy but why? im prepared to pay the 60k if it will work, why wont it work in the lumbar spine. on that note why not surgery either ?. im 30 and struggling to walk some days
So with severe bilateral facet joint arthopathy (dx'd on MRI), what are the options? I don't want to get injections all the time. I'm only 61, but with years of horseback riding. I've heard about a facet joint replacement. I just want the problem solved, not band-aids.
Difficult for me to say without seeing the images. You can always make a virtual appointment with me.
Is facet hypertrophy different than facet syndrome?
Hypertrophy basically means overgrowth from arthritis
I HAD SURGERY AND STILL HAVE PAIN. I HAD/HAVE? SPINAL STENOSIS ALSO. I HAD A LAMINECTOMY, L4 AND 5. I ALSO HAD BEFORE AND STILL HAVE LEFT FOOT NUMBNESS/DEAD FOOT BEFORE AND AFTER SURGERY ON LEFT SIDE, SAME SIDE AS PAIN IN BACK STILL. CAN YOU HELP?
I would have to look at the imaging studies.
Is this related to synovial cysts?
Please watch the lumbar synovial cyst playlist
@@DrBrianSuTheSpineGuy thank you
Dr. Su, Is there a risk of scar tissue forming if you have to repeat the Rhizotomy procedures over time?
We generally don't see that. You should consult your spine pain doctor
@@DrBrianSuTheSpineGuy Thank you!
I had these pain blocks done... not worth it.
What about synovial cysts on lumbar facet joints? I am told that is the source of the pain running down my left leg
I have to do an episode on synovial cysts. They are benign but they can cause pain because they usually compress the nerve at the level of the facet. It can be treated with either facet aspiration or rupture.
Are Spinal Cord Stimulators effective for relief?
They can be and you should see a pain management doctor to get evaluated
I believe my pain management doctor wants to do a test nerve block injection for arthritis in my lumbar spine. Are you saying that an RFA will not help arthritic pain in the lumbar area? I need to clarify whether my doctor thinks I have a facet joint problem. Thank you for your help.
RFA can help if it is a fisset problem that is arthritic but in my experience arthritic joints do better with intra-articular injections
I have had two medial branch blocks in the past month with no indication of pain relief. I’m scheduled for a 3rd one next week. #1 was L3-L4, #2 was L5-S1, and the next will be tried at L1/2-L3. I’m disappointed with results, so I’m losing confidence. I was told that an epidural would not help me. I’m 73 and overweight with a small disc bulge between L3 and L4. Have been doing PT on land and in water…the water has especially helped some and I also have a good deal of arthritis in my joints and spine. Wondering if I should get a second opinion?? Thx.
It is always good to get second opinions. You can do so locally with your spine surgeon or find someone that you trust and do a zoom visit
@@DrBrianSuTheSpineGuy thank you.
Hi doctor, I just turned 30 and I’ve been diagnosed, last week, with Facet syndrome of the cervical and lumbar area. Some months ago I’ve been diagnosed with Lyme disease (first symptoms summer 2021-bites 2020). The pain I mainly feel is in my buttocks, leaving many times my left leg numb. Could my Facet syndrome be related to the Lyme? I know from the facet syndrome that the pain should not radiate to the feet. I also have shivers on the muscles. Thank you
The facet syndrome is not related to Lyme disease but Lyme disease can cause the symptoms you are feeling. You should see a rheumatologist.
@@DrBrianSuTheSpineGuy thank you doctor for your suggestion.
I have burning pain in the sacrum due to l4l5 and l5s1 facet joint arthritis, can't walk, bend and sit. The irritation is causing lots of weakness in my legs and PT doesn't help much. Does it mean I have to accept the situation and be bedridden for the rest of my life? I read somewhere that surgery is only indicated where there is severe instability. Would you agree with that?
I would have to look at the images. You can make a zoom appt with me by calling cal Ortho and spine.
I have mild facet arthritis and mild bulges at L4, L5-S1. Could the bulges plus facet arthritis cause localized soreness that's worth with extension? Prolonged flexion also makes my back sore. Thanks! I'm hoping that maybe fixing the bulges also helps the facets.
Yes it could
@@DrBrianSuTheSpineGuy Thanks for replying. I'm scheduled for a nerve block to see if the facets are the primary issue. Your video helped motivate to take the next step.
There are specialists out there that do artificial facet joint replacement. (Removing arthritic facet joints and replacing). Would that not remove all pain from the patient suffering any facet joint related conditions?
Fusion has not been shown to reliably treat lumbar facet joint pain. Lumbar facet replacement while interesting has also not been shown to be clinically successful.
Is it recommended to use lumbar pillow when sleeping and cushion pillow when sitting? Hope this querry be addressed. Thanks im advance
Yes, absolutely
@@DrBrianSuTheSpineGuy Hi Doc. Is there a specific design for the said pillows? I have searched in an online platform here in Philippines, it has so many designs.. Could you please have a content of the recommended design of lumbar pillows and seat cushion?
my first block (injecting cortisone into the facet) L5/L4 lastet only 2 weeks. My surgeon said it can take effect after 2 weeks, but for me it was immediate total pain relief, then back after 2 weeks. I did a second block now that is lasting a bit longer, but I did L5 and L5/L4. should i consider ablation? I heard there was a more permanent solution than ablation.
Ablation is the right move
why cant a fusion stop facet joint pain arent you stopping the movement of the facet joints? i read in korea that they are performing "facet fusions" that they put 4 screws into the facet without fusing your disc with bone graph? also i feel like i have a tickle if i bounce up and down, is that normal for this type of pain? how much for a consultation? really sorry for all the questions , you have been more informative then my neuro surgeon he just told me its l1 left facet joint pain and i should visit a pain clinic without explaining anything
You would think that doing a fusion would help facet joint pain because you stop the motion which is the pain generator. In reality they're probably is some component of back pain that could be relieved with lumbar facet fusions but that's not really been shown in the literature.
@@DrBrianSuTheSpineGuy can you show me the literature? i want to make a educated decision on what im going todo with my back.......big fan of your videos you make them easy to understand and very informative
@@DrBrianSuTheSpineGuy Hi , thank you for responding to me last time , update on me is i almost made a full recovery last year zero pain on my joints untill last week were i lifted a bag of motar and really popped my back and an at square one feeling defeated.
just wanted to ask have your herd about the TOPS facet system? any info if they good or bad ? and would this be a pernament fix to facet joint pain? In your optinion is this system just a hoax?
@@jackattack9799 May i know what are the symptoms you experiencing currently because of the facet joint issues? Thanks
Very localized pain at L1 left facet joint
If one has a spinal fusion L3 L5 with pedicle screws, can RFA be done at facets L5 S1 without overheating the pedicle screws ?? Thanks .
Yes that is not a problem. As a disclaimer consult your spine surgery
@@DrBrianSuTheSpineGuy Thank you very much.
Hello Doctor I have a Question, to get an Ablation on a nerv in the neck C5 I'm 40 years old. Can I get an Ablation?is there an age requirement?
There's no age limitation
Thanks for answering
Doctor I have been going through nerv pain for 2 years now MRI only showing facet in. C5 going bad I took emg test came out negative, I think facet hole pinching nerv. How I have had 4 epidural in neck they stopped working. How can I tell if an ablation will work to see if that will take the nerve pain will away? And I was wondering if a surgery were they go and open the canal open with a shave the bone open the hole.?
If fluid in the capsule is lost, can it rehydrate?
It cannot rehydrate.
@@DrBrianSuTheSpineGuy Thank you for the reply. I have had the same disk herniate twice but it healed both times on its own. I am concerned however that the disk has consequently lost inherent stability and is now creating a chronic over-stressing of the facet joint to compensate. Have you heard of this scenario, and if so do you think physical therapy can be enough to reverse damage?
Hi Dr Su,I've been struggling with sever lumbar pain for about a year now. I have had several x-rays and a MRI. Was first diagnosed as spinal stenosis and got a epidural. That did not help. Today I just got back from same office and was told it was Arthropathy of lumbar facet joint. M47. 816: Spondylosis without myelopathy or radiculopathy. lumbar region.
I have low level pain and stiffness especially in the morning. I also have very severe pain usually from getting up from a sitting position, getting in and out of a car and at times as I go to lie down. It's like if a extended ladder slipped a rung and crashed to the next rung. It's excruciating and is happening several times a day now. I can pinpoint exactly where the pain is. I have no radiating leg or buttock's pain. Any chance you would explain to me what is going on?
I would have to look at the imaging. You can make a virtual appointment with me at California orthopedics and spine
@DrBrianSuTheSpineGuy Thanks for the reply. My provider has a patient portal, but my MRI and x-rays are not accessible to me from there. I messaged them and asked for digital copies of each. Hopefully, it won't be an ordeal to get.
Hello Doctor! I started to have back pain a year ago. The pain came gradually, but it has become worse with time. The pain fluctuates depending of how much I do. Sitting and standing for long periods gets bad, but laying down takes it away. The pain is always in the same place. I can feel it when I apply pressure in the L5 facet joint. I feel it locally and radiates to my lateral knee when I press the joint down. Lower back extension is not well tolerated the bad days. I had an steroid injection in the facet joint and it helped big time. I had an MRI done and revealed mild foraminal stenosis and facet arthropathy. I don’t know what to make of that, I know you mentioned facet arthropathy can’t be diagnosed with an MRI. I am only 35 and before this situation I was an extremely active individual.
I do have couple questions. Is it normal for the glute max and medius on the affected side to become extremely weak due to facet joint arthropathy? Also, can it cause leg weakness including weak ankle and toe dorsiflexion? I have noticed this problems in my leg and it seems more resemblant of stenosis. Hell it could be both. I would appreciate your input. Thanks
You should have an electromyogram to look at the nerve conductivity. You may want to try an epidural steroid injection to see if it is chemical radiculitis.
@@DrBrianSuTheSpineGuy The EMG was exactly what I was thinking of doing next. I will check into it. Thanks you!
Hi guys! Exactly same case, my right quad and butt got smaller. I did the EMG, everything came out ok. Now I don’t know if try injections or RFA. What should be my next step?
I have the same, my right glute is much smaller and some of the glute muscles fire only very sporadically. Sometimes they don't work for few days and then I move certain way and then it gets almost normal
I was having trouble reading my mri it'd been about 4 years but it said spinal stenosis and l2-3 l 3 and l4-5? And facet hypertrophy with Ligamentous
And a bulging disc at 5. I was wondering, I've had this for about 7 years and the pain has gone from a daily 3/5 to constant 4/5 and 5/5 pretty much every other day from sciatica. I was just wanted to know if surgery can help
Like I said I got and mri 4 years ago when I wax 22 this all started at 19. I was born with a narrow spinal column. I've had this chronic pain for 7 years now. I'm pretty much bed bound and require a cane most days at this point and I wish someone would help me get a new mri. I'm worried I could end up paralyzed
Great Work, Thank you so much 👏🏻🙏🏻😄
Excellent description and analogy of "what to see and expect in an MRI." Never knew about the results you see after age 50 (I'm 81) are not as alarming as they may sound. good to know as I see spinal orthopedic surgeon week. Right now the chief surgeon at MGH says that I have stenosis at L5-S1 which I can see on various images and explained to me. I have all the severe pain in my buttocks and down my right leg (1 to 10 pain scale does not cut it.....it goes to about a 20!). I have had the steroid injection this week, about 5 days ago. This is 4th one after about 2 years. Now that pain level is so high, brought me to tears along with trip to ER. So chief spinal surgeon wants me to see an Orthopedic spinal surgeon because I have a prosthesis in right hip about 2.5 years ago and he is not sure that at end of prosthesis it may not be secure and possible be moving, which could be another issue, but will know better next week, maybe also need a bone scan to determine.
So I am so anxious to get this fixed, steroid does not appear to help , pain level is up to a 5 already, nerve meds don't help (gabapentinn), 500mg Tylenol 3x a day help a little.
My life now is that I am completely immobile and want to get back to normal life. PS: I was playing golf on July 10th, had a great round and July 12th the pain hit.
Thanks for your excellent videos on issues of spine and their interpretation.
I have had bilateral steroid Injections,no pain relief at all,i had Nerve ablation for 10 hours of pain relief, i have now had Lumbar back pain for 15 years every single day,i have to stop walking at least every 20-30 yards
I was diagnosed with suspicious par stress fracture at L5 on right side according to my lumber MRI REPORTS. After 3 months of rest it is healed completely according to my current lumber ct scan reports. Overall reports are normal including all the disc height , canal, as well as no facet joint arthopathy is not there. But the problem now is that i have right side lower back pain when i over extend my spine. (while doing any bodybuilding back muscle posing ) specially it feels like the pain is in the bone or joint. Please help sir i am very much tensed about it. I used to do bodybuilding and want to continue with it 🙏🏻
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One thing i would like to mention is that the pain was gone after 3 month of inactivity at my lower back but i did extreme yoga streching and after than i am experiencing lower back pain again on my right side while extension but also i did my lumber ct scan after this only. So no abnormalities revealed please do reply 🙏🏻
It sounds like it may be the lumbar facet joint. You should look on my video called lumbar facet joint syndrome. As a disclaimer you should always consult your spine surgeon.
New subscriber 😊 Just got diagnosed with lower lumbar facet arthropathy & moderate disc height loss at l5-s1, have an appointment in july with Chiropractor im very nervous upset and hoping this can be resolved soon 🙏 To everyone dealing with these terrible back issues your all in my thoughts and prayers 🙏❤
chiro cant i believe they just take our money
@@dantae666 After going to a few appointments I decided to just treat this myself because its way to expensive and nothing is really done ✔
What if you have facet joint syndrome and all lumbar discs herniated and touching exiting nerves with DDD? Surgical consult or suffer.
You should have at least a consult.
Finally someone that explained everything perfectly
Very great explanation thank you .
Hi Dr. Su, you are such a great doctor. Thank you so much for your explanation. I have been diagnosed with facet joint syndrome and disc height loss. Pregabalin made me so dizzy I could not take it and stopped taking. For a while it was good and did not have pain even my physical therapist was so surprised by quick improvement. But it came back again, and it got worse. I am going to see a doctor next week. But I am very much worried about the future. Am I not going to be able to stand on my feet more than 1 hour? what would you recommend?
Thank you for the detailed explanation. That's what doctors think I have and it's unbearable. Everyday all day long pain unless I'm completely off my back. high doses of Narcotics are the only thing that are helping but they suck for obvious reasons. I pray my body can heal itself. I'm also going to do the steroids and we already did the block but we have to repeat it
Just wondering about steroid injections with facet joint. I always thought the body produces pain to tell us to limit or stop what we are doing that causes it.
If you get injections that allow movement by masking the pain can you cause further damage because the pain is no longer there and you resume actions that are not good for the joint like lifting heavy objects?
Great information, thanks
That's not necessarily the case that pain means there is irreversible damage.
I had the median branch block and it was SO painful and caused my back to spasm keeping me in absolute agony for a whole weekend. I never wanted it to begin with but the surgeon insisted. Since then I have had the facet joint injection and it feels great. I was in physical therapy for a year before these interventions but it stopped helping when i stopped going. Now I’m in the gym trying to get stronger and i will def use the relief i got from the steroid injection to train seriously. Thank you for the recommendation on chiropractic care /release. That is priceless info and I will definitely check that out.
How long do your injections last?
It was stated on my recent MRI report that I have multiple vertebral body hemangiomas present from T12 into the sacrum. Can you explain what that means or have a video? My pain clinic Dr just wanted to address the narrowing of my facet joints around the nerves.
Thank you!
They are benign bone tumors. They do not cause pain typically. As a disclaimer please consult your surgeon.
just great thanks
Thank you for the video that explains the lumbar anatomy. It is good to see it from an MRI perspective and also appreciate you giving relief about the scary big MRI report!
My EMG/NVC in the past were normal.. This new Neurologist wants another one done.. I've heard if a procedure called a Scintigraphy(Bone Scan) this showed the implant in my thigh; the TIP from my Total hip replacement in 2017 loosening, My one doctor didn't think it was a problem, probably it shift, as it was healing.. I don't think so.. The Bone Scan went DIRECTLY to this SPOT as a problem! Can't they Dr. Su, do a Scintigraphy of my Sacrum and Nerves, and SI Joints?
We typically do not do bone scans for nerves
@@DrBrianSuTheSpineGuy Okay, thanks for letting me know Dr. Su. Any Suggestions of what kind of procedure, and what kind of MRI should be ordered for my specific Sacrum/SI Joint Pain.. I am seeing a Neurologist. Should I see a Neuro Surgeon Dr. Su? I think someone like you and in your field, will eventually find my problem. Any Suggestions of what might be causing my pain Dr. Su?
Gread video! if you have time could please make a video about spinous process syndrome ?
That's a great suggestion.
One of the best videos I’ve seen. Clear explanation and drawings as well really helped explain what a facet is.
Can't believe a proper MD recommending chiro, which is a scandalous pseudo-science.
Dr Brian, in the UK, I had initial block which was very successful and I was virtually pain free for a few minutes, however just over 3 weeks ago I had a denervation procedure on two of the lumber facet joint nerves and since then the referred buttock and back of leg pain which I had before, became far worse, plus I have this awful pain most of the time. Now in April I had high hopes of getting back to tennis, however I don't see this happening for a long time, if ever.
Dr. Su , As always you have enlightened me with knowledge of the faucet joints. I am having pain in my right front thigh for sometime now, down to just above my knee 8 out of 10 pain . Once again you have helped me with the correct answer. Thank You, Sincerely, Ray Donahue
Hi Dr, can physical therapy alleviate symptoms for multilevel mild to moderate facet joint arthropathy in the lumbar spine? Wondering if I can still live a normal pain free life. Early 30s.
Yes, physical therapy can be very helpful.
@@DrBrianSuTheSpineGuy Thank you Dr 🙏
How are you doing now? Did PT help?
@tim A how’s it going???
Thanks for simplifying this enough in layman's terms. I wish you did work comp in Missouri
The best explanation of Lumbar face joint, thank you very much, you are helping many people!
I ALSO HAD A FACET JOINT INJECTION THERE JUST BEFORE I GOT DEAD FOOT.
Doctor I had a lesion from doing judo/martial arts years ago. it sometimes activates a deep pain when I do work in squatting position for long periods and try to get up or just doing work that requires certain lumbar inclination like weeding out a patio, etc. don't know exactly what's happening behind curtains but it's unbearable pain in the l2-l3, I feel like some nerve gets "punched" by the discs or something. What do you recommend?
You can make a virtual appointment with me by calling Marin health spine institute