About

First Name
Jeff

City
Dix Hills

State/Province
NY

Country of Residence
United States of America

Postal/Zip Code
11746

Health Interests
Bone, joint, and muscle disorders, Cancer, Chronic pain, Heart and blood vessel disorders, Men's health issues

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Posts (14)

5 days ago · Lumbar Steroid Injection vs Facet Nerve Block in Bones, Joints & Muscles

Hi Babette. Sorry to hear you are in pain. I have had 67 epidural steroid injections & 11 nerve blocks.I've had very little success with any of them. I found an article (see below) that describes the difference between the 2. I hope the nerve block helps and that the article does the same.All the best

By Dr. Donald Corenman

What are Spinal Injections?

Injections in the cervical and lumbar spines have long been used to both diagnose and treat nerve irritation, canal stenosis and disc pain. These injections can be very helpful even in the long term to yield spine and extremity pain relief. Below, a detailed discussion is offered on epidural injections and selective nerve root blocks–diagnostic and therapeutic.
What is the difference between epidural steroid injections (ESI) and selective nerve root blocks (SNRB)?

The difference between epidural steroid injections (ESI) and selective nerve root blocks (SNRB) requires going back to anatomy. The dura is the membrane inside the spinal canal which makes up the long tube from the brain to the tailbone. This dural sac contains the nerves and the cerebrospinal fluid or CSF. The nerves then branch out from this sac like tree branches (one on each side) at every level to exit the spinal canal (see the anatomy section).

The Latin term “epi” means “above” so an epidural injection is an injection above the dura. This injection is normally placed around the center of the neck or back and the medication is deposited on top of the dura. The SNRB puts medication at the nerve root branch from the spine in the area called the foramen. With a small volume, only the exiting nerve root can be targeted. With a larger volume, the medication will enter the canal and cover more than one nerve root.
How Do You Choose Which One?

The choice of injection location depends upon the problem area suspected of causing pain. If the canal is stenotic (narrowed), a central injection or ESI would be used. If a nerve is suspected of causing pain, a SNRB would be used in the foramen that the nerve exits. Now to confuse the issue, you can introduce medication into the central canal through the foramen if you use enough volume. This would be called a trans-foraminal epidural steroid injection (TFESI). If disc pain is suspected, either route (ESI or TFESI) would be acceptable.
Diagnostic vs. Therapeutic

Epidural injections and selective nerve root blocks–diagnostic and therapeutic–which one to choose? There are two medications injected at the same time. One is a numbing agent and the other is a steroid. With both medications injected at the same time, the injection is called “diagnostic and therapeutic”. If just the numbing medication is injected, it would be called a diagnostic test. If only the steroid was injected- obviously the injection would be called a therapeutic injection.

The part of the test named “diagnostic” involves numbing the structure or structures thought to be involved in the pain generation. This can be a nerve root, a disc or the entire canal. This is just like a trip to the dentist. An injection into the jaw anesthetizes the sensory nerve and makes the jaw feel “numb and swollen”. After three hours, the feeling or sensation returns.

The same concept is used with the diagnostic injection into the structure thought to cause the pain. The first three hours after the injection will numb that area. If the region that is numbed is causing the symptoms, there should be relief of pain for about two to three hours while repeating the activity that causes pain (sitting, standing, walking bending or whatever action induces the pain). This of course means that if sedation is used during the injection-it must have worn off in a short period of time. If you are sedated for three hours and lie in the recovery room, the diagnostic portion of the injection will be lost and the injection will have to be repeated.
Pain Diary

The most important thing post injection is to get up and repeat the activity that causes the pain in the three hour diagnostic “golden window”. Do not just sit around after the injection! A pain diary needs to be kept both prior to the injection and after the injection. Please see the section on providing a pain diary to understand how to fill one out.
Steroids

The therapeutic portion of the injection is the steroid. The steroid medication is wonderful for nerve inflammation. Someone should develop a bumper sticker “Nerves Love Steroids”. These steroids are corticosteroids and not the anabolic type that body builders use to look like a puffed up balloon. The body manufactures about 8-10 mg/day of this in the adrenal glands.

There are multiple actions of steroids that benefit nerves. The main action of the steroid is to prevent the chemical cascade that causes inflammation. A cascade is an amplification system to get a small matter big attention. For example- a small inflammatory source (a cut or abrasion) will cause multiple amplifications in a cascade. The first step magnifies the response 100 times; the next step multiplies that step 100 more times and so on. There may be 7-8 steps for this cascade to continue. Breaking this cascade is the specialty of the steroid.

What the steroid prevents is swelling, breakdown and tissue destruction of the injured area (which is what inflammation really is). Normally the chemical cascade “calls” in white blood cells (WBCs) to do their work. When the white blood cells (WBCs) migrate to this area, they release their contents which cause more swelling and even some tissue destruction (normally designed to “clean up” the injured area but in this case, causes more nerve injury). Swelling occurs when the under the influence of the chemical mediators of inflammation- small blood vessel walls in the vicinity become more “leaky” and tissue fluid floods into the area. The WBCs literally dissolve and eat (phagocytize) the dead and dying tissue. This is great for healing a tendon or skin abrasion but not so good for the nerve root.

The steroid also seems to “toughen” the nerve root. The lack of swelling and irritation reduces the size of the herniation but also probably makes the root less susceptible to compression. Remember that the disc herniation material is toxic to nerves. The steroid stabilizes the membrane that surrounds the root itself- making it less susceptible to chemical contamination.

Of course, there are potential risks of steroids and they need to be discussed with your physician but the global benefits of the steroid injection cannot be underestimated. Many times, it is the only substance that can give such immediate relief and continue that relief for a longer period of time. Steroid should be thought of as a management tool for the spinal generated pain. The procedure should be simple for a skilled and meticulous physician.

Wed, Sep 4 10:23am · Sacroilliac Joint Pain & Fusion in Spine Health

Hi Justin. Thanks for re-posting. It is a lot of surgeries. My surgeon is a spinal disorder surgeon @ The Hospital for Special Surgery. He has done all the fusions with the exception of the first 1. He is very confident that this is the correct way to go. "Fusing vertebrae together alters the spine's flexibility, which can place more stress on the SI joint." per The Mayo Clinic.Based on the X-Rays & CT, the SI Joints are torn so there is too much movement. My son, a PS resident @ The Mayo says they do a lot of SI Joint fusions but I think he is talking about the MIS procedure not open surgery. Of all the people in these pages, I can't believe no one has had this procedure. Again, I appreciate your help. 🙂

Wed, Sep 4 9:42am · Sacroilliac Joint Pain & Fusion in Spine Health

Hi. I am a 62-year-old male living on Long Island, NY. I have currently been having in pain in my lower lumbar, groin & hips for months and it has escalated to the point I can hardly walk my dog. Had an X ray taken and sent to my doc. He said my Sacroiliac (SI) Joints are no good. I had 3 ESI’s & then RFA, none of which worked at all. Followed by another series of 3 more ESI’s. These did not help at all. My surgeon called me in for a chat to discuss surgery. I have finally scheduled Bilateral SI Joint Fusion using the Posterior Midline Approach. This is an open surgery, evidently this is a seldom used surgery as Minimally Invasive Surgery is the procedure of choice. If anyone has had SI Joint surgery, please let me know about the surgery, postop, rehab & if it helped.
My History – I suffered a fracture & spondylolisthesis @ L5/S1 in a trauma in 1998 & had fusion in 1999. After the surgery the pain never went away & at times was worse. I started pain management in 2001. They gave me different meds that didn't work until I was on the maximum dose of both Oxycontin & Oxycodone. When that wasn't helping, they added Fentanyl patches until I was maxed out on that. Lived like that until 2008. In 2006 I had a spinal cord stimulator (SCS) implanted. I lived this way until 2008 when my family decided I couldn't live like this anymore. Went to The Hospital for Special Surgery (HSS) in June 2008. They did an exploratory. They discovered that the fusion failed, even though numerous surgeons told me all was fine. My exploratory turned into a 6-hour PLIF. Ten days later I had ALIF. They also removed the SCS. It was discovered that I suffer from a severe case of osteoporosis (-3.2). Rehab was tough. Felt better but not great. Was still on all the meds. I retired from my job on disability as I could no longer work. In April 2011, I started having severe pain. Back to HSS. An MRI was done and the diagnosis was a fracture @ L4/L5. Back in the OR & another fusion. In November 2011, the pain was worse. It was discovered that the fusion failed so I had a revision. Fifteen days later I experienced the worst pain so far. It was a cyst @ L4/L5. Emergency surgery. In January 2013, it was discovered the fusion @ L4/L5 failed again. Another revision. Did relatively well but still lots of pain until November 2014 when L3/L4 went. Had a good 2015 but in February 2016 L1/L2/L3 went. They fused T12 to L3. In December 2016, guess what, L1/L2 failed and another revision. Moving on to September 2018 when C3 to C7 went. Had 4 level Anterior Cervical Discectomy (ACDF). In addition, I have had 2 heart attacks and a mini stroke which is why I need to be able to walk every day. I have a Service Dog, Bentley, to help pick up the numerous things I drop (due to cervical fractures I have neuropathy), retrieve things and the best part, he keeps me smiling.
Thanks. 😊
PS – I got off all of meds at the end 2017 when I fell & broke my nose.

Sun, Aug 25 12:42pm · Chronic Back Pain for Years in Spine Health

Hi. I am a 62-year-old male living on Long Island, NY. I suffered a fracture & spondylolisthesis @ L5/S1 in 1998 & had fusion in 1999. After the surgery the pain never went away & at times was worse. I started pain management in 2001. They gave me different meds that didn't work until I was on the maximum dose of both Oxycontin & Oxycodone. When that wasn't helping, they added Fentanyl patches until I was maxed out on that. Lived like that until 2008. In 2006 I had a spinal cord stimulator (SCS) implanted. I lived this way until 2008 when my family decided I couldn't live like this anymore. Went to The Hospital for Special Surgery (HSS) in June 2008. They did an exploratory. They discovered that the fusion failed, even though numerous surgeons told me all was fine. My exploratory turned into a 6-hour PLIF. Ten days later I had ALIF. They also removed the SCS. It was discovered that I suffer from a severe case of osteoporosis (-3.2). Rehab was tough. Felt better but not great. Was still on all the meds. I retired from my job on disability as I could no longer work. In April 2011, I started having severe pain. Back to HSS. A MRI was done and the diagnosis was a fracture @ L4/L5. Back in the OR & another fusion. In November 2011, the pain was worse. It was discovered that the fusion failed so I had a revision. Fifteen days later I experienced the worst pain so far. It was a cyst @ L4/L5. Emergency surgery. In January 2013, it was discovered the fusion @ L4/L5 failed again. Another revision. Did relatively well but still lots of pain until November 2014 when L3/L4 went. Had a good 2015 but in February 2016 L1/L2/L3 went. They fused T12 to L3. In December 2016, guess what, L1/L2 failed and another revision. Moving on to September 2018 when C3 to C7 went. Had 4 level Anterior Cervical Discectomy (ACDF). Please don't question my surgeon's abilities as he is one of the top spinal surgeons dealing with diseased spines and IT IS HSS! I have had 2nd, 3rd, 4th and even 5th opinions from some of the top spine surgeons in the US including The Mayo Clinic. This brings me to the present day. I have been having in pain in my lower lumbar, groin and hips for months and it has escalated to the point where I have trouble walking. Had an X ray taken and sent to my doc. He said my Sacroiliac (SI) Joints (cartilage & ligaments torn due to excessive motion) and right hip are completely shot. I did an Epidural Steroid Injection (ESI) & then Radio Frequency (RF) nerve ablation. Followed by (after the proper waiting time) a series of 3 more ESI’s over 6 weeks as I need a week in between to go back on my blood thinners. The shots did not help at all (this is a complete negative test for SIJ instability). My surgeon called me in for a chat this past week. The result being I have scheduled Bilateral Open SIJ fusion. Evidently this is a rarely used surgery as Minimally Invasive Surgery is the procedure of choice. He feels with all the damage,Open is the way to go. In addition, I have had 2 heart attacks and a mini stroke which is why I need to be able to walk every day. I have a Service Dog (yes, a real one) to help pick up the numerous things I drop (due to cervical fractures), retrieve things, help me balance, and the best part, he keeps me smiling. As this disease eats my bones, I will eventually need a bigger dog to help with my balance & then later down the road, to pull me in a wheelchair.
My advice to all in pain:
1) Pain is here forever
2) Opioids will rarely help the pain
3) Go to the best surgeon even if you need to travel
4) Get a 2nd & 3rd opinion as this surgery will affect your life
5) Do any and everything possible not to have a fusion unless it is a must
6) If nothing helps, try marijuana (in legal states) as I have found that this is my best pain relief
7) Most of all, find happiness in anything.
Thanks for reading. I feel better already.

Sat, Aug 24 3:30pm · Sacroilliac Joint Pain & Fusion in Spine Health

Sorry about that. I am scheduled to have open bilateral SIJ fusion in a few weeks. I was wondering if anyone has had this surgery. If so, please let me know what the surgery, post-op & recovery was like. I am really nervous as my surgeon (@ HSS) has told me it will be worse than any other of my 11 spine fusions as he is doing 2 different areas. HELP. 🙂

Fri, Aug 23 2:45pm · Feeling at my wits end with Chronic Pain and Fibromyalgia in Chronic Pain

Hi.No problem. That article relates to minimally invasive. I'm looking for bilateral OPEN joint fusion. Very difficult to find as it is out of the mainstream these days, but due to my entire lumbar being fused, my surgeon wants to do open & both sides at the same time. Says it will be best for me structurally not necessarily pain wise or post-op rehab though.

Fri, Aug 23 10:42am · Feeling at my wits end with Chronic Pain and Fibromyalgia in Chronic Pain

Thanks. Open bilateral SIJ fusion scheduled for 10/4. Need to heat from Mohs & repair surgeries.

Fri, Aug 23 10:39am · Chronic Pain members - Welcome, please introduce yourself in Chronic Pain

Hi. I am a 62-year-old male living on Long Island, NY. I suffered a fracture & spondylolisthesis @ L5/S1 in 1998 & had fusion in 1999. After the surgery the pain never went away & at times was worse. I started pain management in 2001. They gave me different meds that didn't work until I was on the maximum dose of both Oxycontin & Oxycodone. When that wasn't helping, they added Fentanyl patches until I was maxed out on that. Lived like that until 2008. In 2006 I had a spinal cord stimulator (SCS) implanted. I lived this way until 2008 when my family decided I couldn't live like this anymore. Went to The Hospital for Special Surgery (HSS) in June 2008. They did an exploratory. They discovered that the fusion failed, even though numerous surgeons told me all was fine. My exploratory turned into a 6-hour PLIF. Ten days later I had ALIF. They also removed the SCS. It was discovered that I suffer from a severe case of osteoporosis (-3.2). Rehab was tough. Felt better but not great. Was still on all the meds. I retired from my job on disability as I could no longer work. In April 2011, I started having severe pain. Back to HSS. A MRI was done and the diagnosis was a fracture @ L4/L5. Back in the OR & another fusion. In November 2011, the pain was worse. It was discovered that the fusion failed so I had a revision. Fifteen days later I experienced the worst pain so far. It was a cyst @ L4/L5. Emergency surgery. In January 2013, it was discovered the fusion @ L4/L5 failed again. Another revision. Did relatively well but still lots of pain until November 2014 when L3/L4 went. Had a good 2015 but in February 2016 L1/L2/L3 went. They fused T12 to L3. In December 2016, guess what, L1/L2 failed and another revision. Moving on to September 2018 when C3 to C7 went. Had 4 level Anterior Cervical Discectomy (ACDF). Please don't question my surgeon's abilities as he is one of the top spinal surgeons dealing with diseased spines and IT IS HSS! I have had 2nd, 3rd, 4th and even 5th opinions from some of the top spine surgeons in the US including The Mayo Clinic. This brings me to the present day. I have been having in pain in my lower lumbar and hips for months and it has escalated to the point I can’t walk my dog. Had an X ray taken and sent to my doc. He said my Sacroiliac (SI) Joints and right hip are completely shot. I did an Epidural Steroid Injection (ESI) & then RF nerve ablation. Followed by (after the proper waiting time) a series of 3 more ESI’s over 6 weeks as I need a week in between to go back on my blood thinners. The shots did not help at all. help. My surgeon has asked me to come in for a chat this week. We all know that when a surgeon calls you in, he’s gonna tell you that you need surgery! In addition, I have had 2 heart attacks and a mini stroke which is why I need to be able to walk every day. I have a Service Dog (yes, a real 1) to help pick up the numerous things I drop (due to cervical fractures), retrieve things and the best part, he keeps me smiling. As this disease eats my bones, I will eventually need a bigger dog to help with my balance & then later down the road, to pull me in a wheelchair.