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14527604 tn?1435002851

Rapid Facet Degeneration & pain (I'm 24)

I have had several back MRIs and X-Rays. Over the past 6 months I have gone from Unilateral mild facet degeneration to bilateral facet degeneration, a perineural cyst, facet hypertrophy at one level and facet enlargement at another level. I also have scoliosis.

My latest MRI showed-
    L4-5:  There is mild facet joint hypertrophy without evidence of canal or foraminal narrowing.
    L5-S1:  There is minimal disk buldging. There is no significant protrusion. There is mild facet joint enlargement without apparent canal or foraminal narrowing.
    Prominent perineural cyst at T11-12 (my last mri in April measured it as 11x12mm and obstructing neural foramen.)

My last EMG showed an old rediculopathy resulting in permanent nerve damage. My doctor said that the old rediculopathy is the cause for my foot drop, numbness and weakness.

At this point in time I have been through a total of 4 rounds of injections since the end of July 2014. .I have had no releif with any of the injections and the arthritis is significantly worse since then. I have done several steroid packs to reduce inflammation and have spent months on Meloxocam. The pain management doctor wants to do another round of injections and for me to consider a nerve oblation. I don't see the point in frying the nerve if I get zero relief from the injections. If anything the injections make the pain worse. During my last round I never took to the numbing medication and fro the following week my pain was worse and I was unable to go to school or work.

I did follow-up with a neurosergeon for a second opinion since my other doc is for pain management. He reviewed all of my scans. He was the first doctor of 4 to mention one of my vertebrae shifting in my flexion/extension x-rays. All of the other doctors said my flexion/extension xrays were normal. His recommendation was to continue PT (which I have now been in for over a year) and repeat x-rays & MRI in 6 months to look for change in stability. He also recommended to continue seeing the pain management doctor.

I am only 24 and have osteoarthritis in multiple joints. I am not overweight. I actually recently finally gained weight. My BMI is (and has always been) at the low end of normal. I am getting really frustrating with the pain. I have gone from being very active to struggling to get inside from my car. I don't see the point in doing more injections since they are so painful and I get no relief.

Are there any suggestions? I'm to the point of just asking them to do a fusion. I'm also wondering if a fusion would prevent my curve from getting worse (over the past few years the curve has gone from barely noticeable in x-ray to being noticeable when the doc looks at me from behind when I stand). If my degeneration is progressing so quickly an I'm only 24 wont I end up needing the fusion at some point? Would it be best to do it now before it gets really bad and causes more permanent nerve damage? I am also tempted to ask them to put me back in an LSO or LSTO brace. I was in one 6 years ago when I first hurt my back. I'm wondering if the brace even just at night might make it more comfortable when I sleep. My spine is like jello and sleeping is very painful and requires a lot of pillows to position myself just right so I don't roll. It is also very common for me to need to sit on the floor hugging my knees, and roll back onto my tailbone so everything can shift/clunk back into place. It's the same clunking feeling as when my shoulders have to be relocated. When it happens I can feel my whole pelvis shift forward and rotate.

I am now wearing an AFO to correct my gate in hopes that reduces some pain, but it hasn't; although, walking without tripping & falling is really nice. Some random additional information:  I am waiting for genetic testing to come back to see if I have a hereditary connective tissue disease (the are thinking Ehlers-Danlos Syndrome or Stickler Syndrome), I dislocate multiple joints everyday, have had multiple joint surgeries, and I have severe progressed arthritis in other major joints as well.
1 Responses
7721494 tn?1431627964
OK, calm down. mild facet degeneration and mild facet hypertrophy are the same thing.

If you have a bad disc, you're probably going to see bilateral facet disease. Its the disc, along with the two facets that provide three point stability for that level of the spine. When one part is affected, the other two must compensate.

So this is all part of the same disease you saw 6 months ago.

What do you mean "old radiculopathy"? This implies that once you had it, and now its gone. Have you had back surgery? If not, how were the nerve roots treated to make a radiculopathy "old"?

Perhaps you mean a chronic radiculopathy? Where? Where's the stenosis that has done the nerve damage?

If the pain is coming from your facet joints, then medial branch neurotomy (done with RF ablation), will treat that pain.

However, your pain may not be originating in mild facet disease.

It sounds like your interventional doc is shot happy -- four rounds of injections and no relief. Why have any more?

I have some questions for you.

Where's your pain?

Did these symptoms and signs come on because of a traumatic injury, or is this degenerative disc disease?

Is your pain being medicated?

How bad is that scoliosis, and where is it?

Do you have any symptoms from the cyst? It is causing foraminal stenosis.

Finally, fusion should not be done to reduce pain -- in many, fusion exacerbates pain. Don't jump into surgery because you're desperate.

Aren't you receiving pain control medication? Why not?
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