Percutaneous radiofrequency neurotomy of the lumbar spine

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Home from my second radiofrequency nerve ablation of my lumbar spine.  Or percutaneuos something neurotomy. I forget what the proper term is.  Im on the couch and I can’t reach my paperwork. And Im not moving. Maybe I’ll edit this later.  But I think you know what I mean – where they burn the nerves that feed your facet joints in an attempt to stop you from feeling pain.

I had one on SI/L1 six months ago and it was very successful.  So I have been looking forward to this procedure, even though I hate being anesthetised, and have been suffering from procedure/surgery fatigue.  As in,  I don’t want to be poked or prodded or injected, or incised again for a very long time if I can help it.

I thought I was going to have L2-L5 on both sides done today. When I got into the operating theatre, and they asked me what procedure I was having today (routine), Dr Pain-management informed me he was only doing the right side, L2.  I said, no, please, I need both sides done, and all of the damaged facet joints.  As per MRIs.  He started to argue, saying he hadn’t done diagnostic injections on all of those joints.

I told him I’ve had multiple cortisone shots into all of those joints, and having them all done is the best chance I have of feeling good.  I stated emphatically that I didn’t want to have to return in two months for another procedure, so please, please (yes I begged) could he just do all of the joints.

I was getting ‘very emotional’ as pointed out by the anesthetist, who grabbed my arm and told me he was going to start injecting the sedation drugs.

I asked him to stop, I wanted to finish discussing what exactly was being done first, with my doctor.

The impatience and annoyance in the OR was palpable.  Dr Pain-management doesn’t have a good bedside manner, but he is a good doctor.  I focussed on him.  He told the anesthetist to wait.

The nurses were lovely, but they were standing clear.  Patients do not argue in the O.R.

Argue is really too strong a word. I was disagreeing with what was written on the sheet.  I was asking for the treatment I believed I needed.  I stated that I would rather have more done than less, this is my second ablation and while the first one was successful, I felt that I needed more joints done, higher in my spine.  The MRI shows severe facet joint arthritis up to L5. So I wanted them all done.  I’ve had so many procedures, and cortisone shots previously I’m quite sure they are all contributing to my back pain.  I’m just as sure that if I only get some of them injected, that I will still have a fair whack of residual pain.  I know pain free is a pipe dream.  But I want to get as close to that as is realisitic.  And why shouldn’t I aim high?

Then I said the magic words.  I told Dr Pain-management that I had discussed all of this with is nurse…we’ll call her Liz.  And that Liz had assured me she had discussed it all with Dr Pain-management.

He paused. He then agreed.

The anesthetist took charge.  We were running late now.  He said he was going to start injecting the sedation drugs, and it ‘might hurt a bit’.

It hurt like hell! I have never had I.V. sedation cause pain.  I actually had to tell him ‘It’s really hurting’.  And you know I didn’t want to admit that.

He said ‘oh, sorry, I’ll include a little local in there as well then.’  I remember thinking ‘he did that on purpose’ before my paranoid brain went sleepy bo-bos.

I wanted to remind those people in the OR that I was paying for this procedure. That while they were the experts in the procedure, it’s my body. That I may be just the patient, but I am an informed patient. And it’s far preferable to me to burn off a few nerves that didn’t need burning, than to have to go through all of this yet again.  The time, expense, fasting, organising someone to drive me there and back…all of this stuff AGAIN.  Hospital is not fun. Even just a simple day procedure is not fun.

But my brain went black. Probably a good thing really.

Last time I was awake through the entire procedure.  I was chatty and happy and could tell them when they were in the right place.  This time the guy just knocked me right out.  Unconscious patients don’t argue. Whatever.

I woke up a while later (no idea how long) in recovery overwhelmed with emotion.  I think it’s because that’s what I was feeling when I was knocked out.  The nurse was lovely and told me not to worry, lots of people wake up and have a good cry.  It’s just a side effect of the medication.  That works too.

The first thing I was aware of was severe pain in my back. Wait, wasn’t that supposed to be gone???

Horrible, sinking feeling in my stomach.  It didn’t work!  I know, I’ll cry. Oh yes, that’s better.

Five minutes later I was OK.  Logic returned.  The pain in my back is normal.  On reflection, the sharp lower down pains aren’t there, this is other pain.  It’s a strong ache and the post procedure instruction sheet says ‘You may feel like you’ve taken a very hard hit in the back’.  Sounds about right.  Add to that my arthritic hips, and this is all normal.  I remember my back was very sore for a few days after my last ablation.  Just momentary panic and confusion coming out of the sedation.

The rest of the sedation wore off quickly.  I wanted out of there as soon as possible.  I told the nurses I was feeling great, so they got me coffee (ahhh coffee!  Even bad coffee is sensational post fasting) and those little sandwiches.  I LOVE those little sandwiches!

I cut the blubbering and put on a big smile.  I was polite and grateful and asked if they could please call for my ride home.  They were short staffed because two nurses had called in sick and they were waiting for replacements.  So it took another hour.

But I’m home now. On my couch.  Not capable of much, the back pain is still bad.  But I do expect over the coming days that it will improve.  I am hopeful.

With the combination of methotrexate injections having more or less halved my arthritis pain and now this ablation on my spine, there is a real possibility that I’ll be up and walking around a lot more often than being couch bound.

I have been aggressively pursueing pain relief for months, and I am at the end of my to-do list.  Now we wait and see how good ‘good’ gets.

Dr Pain-management saw me post procedure and confirmed that he had done both sides, L2-L5.  I thanked him profusely.  He said my spine is weird. He was convinced that where I was pointing was higher, but it corresponded to L2-3, so he decided to do the rest, because it made sense.

He also talked briefly about a spinal cord stimulator implant for pain control.  He said to make an appointment with him in four weeks and we’ll discuss that.  And that we could do a cervical ablation as well, as the facet joints in my neck are pretty bad as well (he DID read the MRI) and he could help relieve that pain also.

We’ll see.

I’m very grateful that he decided to do what I asked for.  I wish I didn’t need to argue the point in the OR.  Not your strongest position, half naked on an operating table, trying to be polite and overcome pre-op nerves and still make a strong, reasonable case.  Shouldn’t have been necessary.  I will not trust ‘Liz’ the nurse again.

But it’s all over and done now.  I think good for me for being far more assertive than I used to be.  Also good for my doc for listening to his patient.  I’m sure the back pain will be much improved, possibly as soon as tomorrow.  I tend to bounce fast.  I have to.  Single mother and all that.

It would be nice if there was someone here to fetch me Tim Tams and cups of tea, but there isn’t. (Clearly my own fault. Yes, I’m still upset about that.)  I can get them myself, anyway.  The tea at least.  It appears the kids scoffed all the Tim Tams!  I really have to find better hiding places…

And now it’s time for a nap.  And I’ll report back in a week and let you all know how successful my percutaneous radiofrequency neurotomy has been.  (Knew I’d remember eventually.)  Nighty night.

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