Ablation for lower back pain L4-5 S1

How do doctors determine what nerve to block

The block is usually the medial nerve which is the nerve that sends pain to the brain. They use X-ray during the proceedure and are able to see the nerve. Hope this is helpful to you.
https://www.spine-health.com/treatment/injections/medial-branch-nerve-blocks

BTW, your doctor should explain in depth and answer any questions you may have.

I had it done for the 4th year in a row,but this time about 3 weeks after i am weak in both legs.I don't know if its that or my nerves are pinched.Dr. wanted to refer me to his Surgeon but i said no.Don't want no back surgery.Pain management Dr. sent me to get mri and said my nerves were more pinched than before 4 years ago.

I had the same problem and the Mayo did a OLIF and a L5-S1 TLIF. I feel great 10 weeks out now. Almost to the 3 months. I am down to having a sore back that is getting better each week. I wouldn't be scare of back surgery as long as you do your homework on the surgeon.

I also had diagnostic nerve blocks for lumbar stenosis. The injections were horribly painful. I was yelling in pain and the doctor never stopped stabbing me! I won't go near a spinal injection ever again. As for ablation, the same doctor tried to schedule one for me without ever discussing it with me. I refused. After what I went through with the nerve blocks I am certainly not about to let someone electrocute me with needles that heat up to 124 degrees centigrade to cause 2nd degree burns! That's how an ablation destroys perfectly healthy nerves. Look it up online. The procedure does nothing to help the diseased skeleton. Then the nerves often grow back. A significant percentage of people get short term or no relief from nerve blocks and ablations. The studies are out there on the Internet from reputable hospitals and professional medical journals. There are older studies that give better rates of success, but those are based on the doctors' responses. The newer study based on patient responses gives much lower success rates. The doctor who tried to pressure me into an ablation admitted in person to me that they can't even see the nerves they are trying to deaden or destroy! I came to the conclusion that spine doctors who do a lot of blocks and ablations are incompetent sadists in love with a quick procedure that makes them lots of money. What ethical person would risk paralyzing a person by using destructive techniques performed blindly that can't be relied on to work? The doctor I had lied to me and told me he had done hundreds of blocks and no one had ever had a problem with pain. He also called the procedure "minor" and promised that I would be "relaxed and comfortable"! Ha! He used a benzodiazepine sedative, which does NOT stop pain. It puts the patient into a temporary state of mental illness called dissociation. The patient still feels the pain, but the doctor is counting on the other effect of benzodiazepines: amnesia. In other words they make you helpless and confused so you can't say stop. It's a deceit, and they know they can do it and get away with it because it's your word against theirs afterwards, and since you had the drug they can just say you remembered wrong. The drug did nothing but paralyze me while I was wide awake. I could not defend myself or even speak. Never again!

Wow, I am so sorry you had those bad experiences. I have had numerous nerve blocks and ablations and they were nothing like that. Mine we all done with conscious sedation, either Versed or propofol. The only pain I felt was a small prick for the numbing medication he used to prevent pain from the big needle. They were all done under fluoroscopy where the doctor can see exactly where he is going and what nerve he is targeting. Maybe you need to find a more qualified doctor.

I agree they will not cure anything but they can make you comfortable until surgery becomes absolutely necessary.

I am relieved that you had good experiences. Versed was the same medicine my rotten doctor used on me. Still not ever doing that again. Thank you for your nice message.

I had the ablation on my lumbar and on my cervical. The lumbar lasted about a month for me before the pain came back. The cervical lasted about 6 months. They did a ViaDisk procedure on my L5/S1 where they injected live cadaver cells into the center of the disk hopefully causing the disk to regenerate itself. After that, my pain went from bad to unbelievable. The doctor said it was from the nerve being disrupted by the procedure and did some more shots to settle it down. No luck. They are now doing an MRI to see what the next steps might be. It could be fusion or a spinal cord stimulator. But something has to be done! I am in so much pain that I can’t walk any distance or do anything that requires movement. Bear in mind that I am fused from C3 to T1 and all but one of my lumbar are fused. I have severe spinal stenosis.
Good luck. I know that lots of people have had good luck with labations.

They initially try and locate which vertebral body is physically causing the pain. With the aid of evidence from the MRI and some palpation they make their best determination. The anesthetic nerve blocks serve as diagnostic. The anesthetic wears off quickly, so if immediately the pain is gone, voila. Then it is up to the steroid and sometimes the steroid cannot sufficiently reduce the inflammation.
Usually they like to do at least one block before proceeding to radiofrequency. But if the steroid works for several months, the block can be repeated.
Sometimes they surmise incorrectly, sometimes it is difficult to locate the nerve on fluoroscopy and they can miss the nerve.