discuss results of ESI

Follow-up appointment with Dr. Dobecki to discuss the results of my recent second round of transforaminal epidural steroid injections (ESI) performed on March 19th at Mission Valley Heights Surgery Center. We will also discuss next steps (i.e.: where we go from here).

Dobecki is of the opinion that the ESIs are not working (should get 3-6 months of pain relief), although I said there could be extenuating circumstances which could perhaps account for my lack of substantial pain relief (e.g., I surfed after the first round, and then got knee surgery and have been walking awkwardly with a cane after the second round). He agreed and said perhaps we could try a third round of ESI.

However, before that, he would like to try a diagnostic facet injection to see if some of pain could be coming from the facet joints. Apparently the MRI does show that my facets are strained and swollen. So, with the diagnostic facet injection, he injects a medial branch nerve block which should give me something like 50-80% relief. If that works then we can do what he called radiofrequency oblation where you send an electricl signal to the nerve to rescramble the impulses. Apparently it is possible to get around six months pain relief with this method. The other possibility is to actually burn the nerve, although this is not a good idea for someone as young as myself because the nerves will attempt to grow back around the burned area and could lead to even greater pain.

If none of this stuff works, then he can always implant a spinal cord stimulator which is also not recommended for someone my age. Dobecki says the impant is more of a "salvage" operation or a "band-aid" which doesn't solve the underlying problem and is probably not a good option in general.

So, we are left with the elephant in the room -- disc replacement. Dobecki says the procedure is only 5-10 years old, so there are no long-term studies. He is not an expert on the procedure (not his specialty). He did assure me that all medical procedures are constantly being improved, so if we are able to buy some time, then that would be a good thing.

So, we are scheduling the facet injection to see if that will help....