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Trying to decide between SCS or RFA for facet arthropathy

Started by rynezuzi on 10/26/2018 10:19pm

So here is some background info on what I have been experiencing:

About a year ago, I experienced a work related injury to my back. After several failed attempts at medication (muscle relaxers) from my PCP, she referred me to an ortho specialist. Upon seeing the ortho doc, I had an MRI done which per the radiologist report, didn't show anything that could be causing the back pain besides something that indicated DDD at the L4-L5 level. So the ortho doc did a lumbar ESI, which caused severe pain. For several months, i was averaging a 6-7 on a scale of 1-10, with some incidences of an 8 or 9.

At one point, i was sick of getting the run around from the hospital system so I went to another provider. Upon that provider viewing the MRI imaging, he saw an annular tear at the L4-L5 level, and stated that that was what was causing my back pain. (Around this time, i also started seeing a pain management doc to get started on new meds as the ones that i was being prescribed were not helping. He prescribed gabapentin and celebrex, which have been helping at reducing the pain to 3-4). He suggested doing another injection, but with my horrible experience the first time, i was hesitant. Finally, around the end of March 2018, i decided to give the ESI another shot. This time it worked :) ! My new ortho doc stated that per the imaging done with the first injection, it didn't look like the "hit the right area."

Well, the next 4 months were great. I was averaging 1-2 on a scale of 1-10. I was in heaven. But, when August comes around, i start experiencing pain again, averaging a 4-5, sometimes a 6. I go back to my new ortho doc and he suggests having another injection. I agree. At the end of August, i get my now 3rd injection. As the next two weeks go by, i am experiencing no relief. I finally go back in to my ortho doc and he orders a new MRI.

The new MRI shows facet arthropathy at the L3-L4 and L4-L5, which he believes is causing the pain and it may not have been the disc at all. So last week, when I go in to review the imaging, he tells me that i have the option to have a medial branch block done to determine if that is what is causing the pain, and eventually do an RFA. So i had the MBB done this week and it reduced my pain by about 80%, which is great, so i have a follow up to discuss next steps. In the meantime, the meds that i have been on have not been helping as much, so i also had a pain management appointment today. In discussing with him what my ortho doc's plans were, i asked him if there are other options out there in the case the RFA doesn't work. He brought up having an SCS implanted. In talking with him and his experiences with his patients, he noted that only about 50% experience pain relief and in those that do, the average pain relief is about 6-8 months.

So this is where i am. I am wondering if anyone with facet arthropathy has decided between getting an RFA done and having an SCS implanted. My major concerns is that the RFA is not permanent. Anyways, any thoughts on the subject would be appreciated. Thanks

Also, i know no one here can give medical advice. Just looking for other's experiences.

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1 Response


I had the Medial nerve blocks and they didn't help me si I'm getting the SCS Tuesday. Trial. My si joints are my problem now after 2 lumbar surgeries, the last with fusions L4-5-S1. After the MBB my left side si joints started really acting up. A RFA can last anywhere from 6 to 18 months because the nerves grow back. If you can handle possibly just a 50% relief in pain, I'd go for the SCS. Best wishes and come on Tuesday.