back pain

[skj]

Hello, I'm a physio student and a family member asked me about
having back surgery to denervate the lower lumbar region in hopes
that his back pain would diminish. I was wondering if anyone out there
had some advice for me to give him or if they know anything of that
surgery and if it is successful. Thanks!

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[billyboy]

Hi mate,
I don't know an awful lot about this technique. I think it might be termed neurablation.It sounds pretty drastic to me, & it really depends on how much your rellie is suffering & what he's had tired before. I don't imagine the success rate is that wonderful or we all would have been reading plenty about it. Perhaps if all else has failed & the only other option is a fusion, then it might be worth a shot.
I wonder if they might do better on a pain management programme? Perhaps your rellie is looking for a cure where one might not be available ? If I find out anything more I'll be back in touch.
Has he tried a Tens ?

Take care,....Billyboy

[pablowieckowski]

Provided that a diagnostic zygoapophyseal joint block is successful in diminishing the pain, denervating the joint can lead to a reduction in pain. However, as there are lots of different structures in the lumbar spine capable of nociception, it is very difficult to be certain that the joint is the only source of pain. Add to this central sensitization at the spinal cord level, and you can have pain without any real nociception. In that case the procedure may noy work at all.
Even if it were to work well, it may not abolish 100% of the pain (as there may be more than one level causing pain). And peripheral nerves do regenerate, which in most cases leads to a return of symptoms a few months later.
One concern I have with such procedures is that they also denervate the motor supply to the Multifidus muscle, with theoretically disastrous consequences in the long term.
If all the possible benefits are weighed up against all the possible risks of the procedure, it then comes down to personal choice, I guess.

[perfphysio]

Have a look at the work of Bogduk, & Twomey or Twomey and Taylor et al. They have done a lot of work on rhizotomy (I think that's what you call it), mainly in the cervical region. Their works may give some reference to longterm outcomes and pitfalls of various sensory denervation techniques.