Nerve ablation 11/30/17

After my nerve ablation at the end of September we knew we were working with the right area. But since the pain had come back after 2 days we weren’t quite sure what the next steps would be. I decided that I wanted to start working with a new doctor. The one I had been working with was really helpful, but he didn’t preform medial branch blocks or ablations so he would have to send an order over to Utah Valley Hospital then whatever Interventional Radiologist was on call that day would preform the procedure. So I had a different doctor each time I went in, and didn’t have a chance to meet with or talk with them before the procedures. This created a lot of confusion and it seemed like we were always making last minute phone calls between my doctor and the radiolositst trying to clarify my unique situation.

It turns out that I never did have the nerves blocked or ablated (killed) on the vertebra that actually had the injury because of miscommunication. So I found Dr. Faber (thanks to a friend) at Spinal Interventions and had a really great consultation with him where we went over my imaging, speculated what had gone wrong with my ablation and made a plan.

He speculated that when I had my ablation done in September that the anesthetic they injected spread out and numbed the area that the pain is actually coming from. But that they didn’t kill the right nerves, if they killed any nerves at all. From the look of the ablation imaging he thought it was possible that they missed killing the nerves on L4 & L5 all together (because of the needle placement). We also found that they inserted so much anesthetic that it was almost impossible to know where the pain was coming from because it could have spread pretty far. He speculated that the source of the pain is likely around the vertebra that is broken (sounds obvious) and that the anesthetic spread down to that area. That would explain the 2 days of relief, followed by the return of my pain after the anesthetic wore off.

He also helped clarify what my spinal abnormalities are. I have what is called a transitional sacrum; where the top of my sacrum (S1) is only partially connected to my sacrum and looks/acts like a Lumbar vertebrae instead. So they call my S1 an L6 because it is more like a lumbar vertebrae than a sacral vertebrae. You can see in the first picture how my S1 or L6 is only connected to my sacrum on the right side of the picture (which is actually the left side – MRI flips the sides). My breaks, and my spina bifida occulta are both located at the L6. The doctor said I have an over arch in that section, that caused extra pressure & inevitably added to the cause of my injury.

Sacrum showing transitional S1/L6:

Side view showing over arch & lumbar-like S1 vertebrae:

Vertical view of S1/L6 showing breaks on both sides that I did not have previous to 2010 child birth:

So first we did a trial run with medial branch blocks. He blocked the nerves (with 1/4 the amount of anesthetic that Utah Valley used) at level S2, then L6/orS1. I could feel quite a bit a relief but we decided to also block the nerves at L5 and after we did, I had complete pain relief for about 2 hours before it slowly came back.

That is exactly what we were looking for. Dr Faber was very careful to pinpoint each nerve involved, block one at a time while communicating with me, and only use enough anesthetic to block that one section so we don’t end up with more confusion from the anesthetic spreading to other areas.

So today I had my first round of nerve ablations to kill the nerves we pin-pointed a couple weeks ago. They have to split it into 2 procedures because the doctor said it is too hard on your back to have that many ablations done in one day. So today I had the nerves ablated on the left side at L4/L5, L5/L6, & L6/S2. Everything went as planned but since they don’t inject very much anesthetic I am in a lot of pain following the procedure. We won’t know anything definitively until a few weeks after I have the right side done. The right side is scheduled for next Thursday.

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