has anyone had radiofrequency ablation or rhizotomy?

[LisaW-B]

Has anyone here been “nerved,” and then able to successfully ride after?

I’m a candidate, and want to ask as many people who ride who’ve done it as I can, and gather more information before I make a decision.

A year and a half ago, I had a series of two epidural injections on S1 and S2 that lasted almost a year and allowed me to ride first level dressage and trail ride without pain. Really, I should have gone back after six months, but I didn’t want to.

This past January (2013), I had another series of two. My mid-April, my symptoms had returned and I ended up unable to ride for a few weeks at all, scratched a horse show, etc.

Went back to my pain specialist, and we discussed the arthritis on my facet joints, especially on my right side. And so a week ago, they did a bilateral lumbar medial branch block – which is still working a week later, and which immediately allowed me to be active, stand up bearing weight on both feet, and RIDE.

The next step, according to them, is ablation. I have had back pain ranging from moderate to severe for about 12 years now… It took me 10 years to go get the epidural I probably should have had in the first place. I’ve been in and out of physical therapy for a decade, yadda yadda. I had a discussion with myself recently and told myself I’m going to stop attempting to ride dressage tests anymore (or for the foreseeable “anymore,” at least). Small figures and turns hurt me the most, and I think schooling tests for the past month trying to get ready for the show I ended up scratching did me in more than anything.

My facet joints are my biggest problem. They’re arthritic and angry. The discs are slightly bulging but not bad. The epidurals have taken care of most of the sciatic type of pain but not the facet joint pain/stiffness.

My husband works at a hospital and knows really good specialists who could perform the RA, and those who specialize in rhizotomy (although that’s not covered by insurance).

If you’re an active rider, or active person in general, have you had this done? And what was the outcome? Was it worth it? What kind of recovery period was there? How long did it last for you?

Thank you for any insight.

Spines and all their associated parts are overrated.

[AlfalfaGirl]

I have no experience with that but I wish you well! Hope they can get you out of pain and back in the saddle. I am off for months because of thoracic back surgery. Ugh. So ready to get out to the barn and see my horses. my feet are still super numb but my balance is better thank God!

[Candle]

Yes, it gave me my life back as I knew it before. I do regenerate nerves and so have had it done a couple of times now. Worth it each time. I could never have taken care of horses without it, much less ridden. PM me if you want more details. Oh, and I was fully recovered within 48 hours, and that was only because my body doesn’t process conscious sedation well.

[Laurierace]

I had one and it did not do anything. There really was no recovery period though. My test nerve block lasted six days, they said anything over six hours is considered a positive response so we were all surprised when it had no effect at all. They said they could have gotten it not in the exact right spot and were thinking of repeating it but opted for the epidural instead. That lasted six glorious weeks but the follow up epidural didn’t help at all. I guess the next step is a spinal stimulator implant which I am hesitant to do. I am far from an expert but it seems to me that your good responses to the block is a good sign. Best of luck.

[SaddleFitterVA]

Yes, for my left SI joint. Had it done in 2011 and I think it is still holding. The nerves are probably regenerating as I sometimes get a twinge, but my most recent treatment was a pair of epidural injections for my discs.

if my pain mgmt specialist recommends it again, I would follow her recommendation. She is fabulous and has kept my back sound for riding since 2008.

[Dr_Doolittle]

Have had it on my S/I (a year ago, and just got one side done again, will have the other side done next week), and have had it done twice on my lumbar facets. I have lumbar DJD, and a bulging disk (and DJD) at L5/S1.

It did help, but the “law of diminishing returns” came into play; even though my S/I was NUMB–along with my buttocks–there was still some residual pain. The numbness was a small price to pay for any pain relief, however!

I have been through PT (which has helped!), and the bottom line is that my lumbar spine is jammed and immobile, while my S/I is unstable (and hyper-mobile), so the RX has been lumbar mobilizations and LOTS of deep core strengthening exercises, isolating the rectus abdominus. Apparently this is a common problem with riders I have been riding minimally, though teaching and handling horses as usual; there is always some pain, and I try to engage my core muscles when lifting–and avoid heavy lifting whenever possible!

The “recovery” from the RFA (which is an uncomfortable procedure, but bearable) is a day or so; I sat on a soft ice pack and took some pain meds, but have gone to work within several hours of getting it done (though this didn’t involve riding or heavy lifting.

I think “YMMV”, and some people get great results, while others get “meh” results. My results were somewhat in the middle, though the second round of RF for my lumbar facets wasn’t as effective (WRT pain relief) as the first round.

It sounds like you are an ideal candidate for this, so if insurance covers it…?

I think all of us with chronic back pain are pretty much willing to sell our souls to the devil in exchange for ANY help with our pain–and any hope for improved function! (In my case, I was told that PRP would help me, but of course it’s not covered by insurance–and I don’t have the $3,300 for the 3 treatments–so off the table it goes. :-/)

[LisaW-B]

Thanks, you guys… this is all helpful information. I think I know this is the next logical step for me, but sometimes it’s hard to make yourself take the next step. OTOH, like Dr. Doolittle says, selling my soul doesn’t sound like such a bad trade some days!

My facet nerve block lasted just over a week and still hasn’t quite worn off, which is really good as far as the diagnostic goes. Last night was the first night I thought I might not be able to get any sleep from tingling nerve pain, but I did end up sleeping through – and without the aid of what I jokingly call my vitamin V (vicodin), also no need for Advil.

Seems odd to me that so many riders have fact joint issues, and I live in an area where so many doctors I’ve been to SEE so many of us riders, and yet it seems like the last thing they check for. For me, it was almost an afterthought: “Oh! Well, you DO have all this arthritis on your facet joints, especially on your right side…” My doctor had mentioned continued epidurals, too, but I don’t like the side effects of the steroids, mostly womanly in nature, for me.

If I get the RA done (and I probably will) I’ll be sure to report back after.

[Eclectic_Horseman]

Hi-
I just saw this, and wanted to chime in with some encouragement if you haven’t done it yet. I had Radio frequency ablation back in 2006 at L3/L4. I had radiculopathy (nerve pain) across my thigh and running down the front of my leg and across my toes. The procedure completely blocked my pain for 18 months, and I thought that it was well worth it. After 18 months, the nerve did grow back with a vengeance, but the disc that caused the pain had shrunk back so I was in less pain after it settled down. So I encourage you to do it since the procedure itself is not very painful and there is virtually no layup time.

I think that I can answer your question about why doctors check the spine last, even though spinal conditions are so common especially in riders. It’s because our backs are literally like train wrecks, so they are going to be able to diagnose something even though it is not really the cause of your pain. I went to a doctor who did the opposite–diagnosed the back pain first-- and therefore totally missed the fact that I had absolutely no cartilage left in my right hip. Oops. Boy, was she embarrassed! :lol:

[infiniti]

Hi there, I had an RFA done on my C-spine about 1.5 years ago. I have facet joint syndrome in my c and t-spine from a car accident. My story was similar to others that superficial blocks and cortisone showed temporary relief, so then we did an RFA type of procedure where the current pulsed and interrupted the nerve signal for about 30-60seconds. This was to avoid putting a heat lesion which is the complete RFA. Unfortunately it didn’t last long, so I had the RFA done. My symptoms started to appear again about a year after, but very slowly and very managable. I then had shoulder surgery on the same side which actually reduced some of the neck pain. So fortunately 1.5 years later I haven’t needed another RFA and probably will not for some time if ever. However I was told I can expect the effects to last 1-1.5 years, so feeling pretty good about my decision.

You should know though that a possible side effect is neuritis over the nerves that are burned, and I did have this happen. It was like numbness and then some tingling as the nerves rebuilt. It’s not permanent and definitely didn’t outweigh the benefits of the procedure.

I also wanted to add, that like others, often the second cortisone shot was a disaster - meaning it didn’t work well so the weight gain wasn’t worth it

The key to these kinds of procedures is managing your life to minimize stress and injury (ie. strengthen muscles) and take your meds. With all of this your procedure has the best chance of succeeding and lasting longer. Just my two cents and best of luck.