Ablation questions

This question is actually for mom, who also has PsA. She’s had 4 back surgeries, lower back, with fusions. She has been in constant pain and the last 6-8 months have been horrendous. She’s actually been considering a revision type surgery, as there’s broken hardware that may be contributing. Hospital for Special Surgery in NYC wanted to a very dramatic revision surgery, going all the way up through her thoracic spine to open things up. (Spinal stenosis one her issues.) Surgeon number 2 at Univ of Rochester says no surgery. It could leave her in even worse shape. She has a third opinion in Boston next month.

Non surgical options that she’s pursuing are medical marijuana (already has a card), spinal cord stimulator and ablation. She was tested years ago see the stimulator would effective but at that point wasn’t.

So she’s got lots of questions about ablation. Both about procedure and the outcome. I’m seeing lots in search here about outcomes, but so much about the procedure. Is this an outpatient procedure? Doctor’s office or surgical center? How long does it take get relief? How often does it need to be repeated? So lots questions about the actual procedure and recovery. I’m sure we’ll have more questions after getting some responses.

RF ablation is an out patient procedure. I am not aware however that it is being done much anymore and many insurances no longer cover it. My personal opinion is that it is a very bad idea and I would NEVER consider it for myself (and I am a wee bit more experienced at the orthopedic stuff than most)

With RFA, when it was firts being done, you basically treat a patients’ pain once and they would get one to two years of relief. Of course the pain would always come back with a vengeance, and they would need another treatment, at the time, this was pretty revolutionary stuff and was widely done. Then the long term results started coming in. About the only folks doing it now are the “For Profit Spinal Pain Centers” (and thats being generous towards these quacks)

The downside of RFA is that they are destroying tissue. In the case of the spine, that tissue is the little nerve that takes pain signals from the joint. We know from other areas of medicine that when you take away a nerve supply to a joint, bad things happen. Eventually, since the patient can’t feel the area and continues to place forces on the damaged area, the pace of arthritis of that joint quickens. This is called a Charcot joint also known as Neuropathic arthropathy (or neuropathic osteoarthropathy) and refers to progressive degeneration of a weight bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity due to loss of sensation.

My sister despite my vehement objections had it done anyway. I can’t say as I blame her necessarily as she was in constant pain, dependent on a walker much of the time and had actually lost several inches of height. She left the hospital feeling pretty good Then the local wore off. She reach massive amounts of pain. the docs told her to wait it out as it was just some close by nervers and it would pass. It did in about 6 months and she she actually felt pretty good for the next 3. That was until driving home from her daughters house she developed severe pain and lost feeling in her left leg. She fortunatly was able to pull over in heavy traffic call 911 and ended up in emergency surgery having some major reconstruction and revision surgery (which was done abdominally) After a long and painful recovery she is back to where she was before the ablation except she still has drop foot. Even I didn’t have nerve enough to say I told you so. The lower back is less susceptible than the cervical area (my sisters was lumbar, her doc who did the RFA would never consider cervical FWIW (and as far as I’m concerned shouldn’t have done lumbar)

I don’t know enough about your Mom to offer an opinion. But do think a tie breaker opinion makes sense. It may well be if she could get a year or two of relief, it might be worth it depending on age and general health.

The other option is to hold on. There is a new procedure that just recieved FDA approval developed by Relievant Medsystems Inc., a California-based medical device company called Intracept® It is new enough that I wouldn’t be comfortable with it in most centers even if they are offering it (not yet anyway) Jeffrey Fischgrund, M.D., Beaumont Hospital, Royal Oak MI and principal investigator of the FDA-approved Relievant SMART trial however I would consider. (Thats a long way from you BUT they may be able to refer you in your area, you are surrounded by the best surgeons in the world)

They are now enrolling for the phase 2 trial. I’d contact http://www.relievant.com/2017/10/26/relievant-medsystems-announces-first-patient-enrollment-in-the-intracept-clinical-study/ and see whats up.

Big revision maybe, RF no way. But that’s just me and I don’t know your mom’s back. What I used to tell folks back in the day is that the BEST you can hope for from spinal surgery is to stabilize, occasionally you might get better but most improvement is temporary.