Need Input
 

Hi Everyone,
I have updated my signature with the new diagnosis of my ongoing back problems. I have investigated the possibility of having two more ADR's (mavericks) at L3/4 and L4/5 but my surgeon does not want to do it. His concern is that the facet joint degeneration is of such a nature that only a fusion at L4/5 is advisable. I realise that with the ADR I will have continued facet joint pain, but I feel that I will at least be able to avoid further muscle and nerve damage and will be able to avoid future surgery that is often a given with a fusion at that level.
I would appreciate any advise or input.

A friend is comtemplating having an "O-Mav" disc replacement. I don't know anything about this and would appreciate input.

Kind Regards

Sandra D

With severe facet joint arthritis, you're risking continued growth of the facets and spurring if you use and ADR at L4-5. You could reach the point where the facets themselves begin to damage the nerve roots exiting at that level and need surgical correction. If you have at least two competent (in your opinion) surgeon who are refusing ADR at L4-5, you're probably too bad to risk it. I understand that you're concerned about fusion driving future surgeries but the spurring could driving them as well and, if the surgeons are right, is a lot more likely as you're already on the edge with your facets.

If you haven't got at least two opinions, though, definitely get a second or even a third. One surgeon's severe facet degeneration is another's mild to medium so you've got some wiggle room in interpretation. Another thing you could do is roll the dice on facet joint replacements and hope that they're fully developed in time if you end up needing them. They are out there and have been in use for a few years but the number of surgeons willing to attempt that in the world is still very low.

Sandra,
As I’m sure you know with further surgery there is possibility of damage to nerves from the surgery it’s self. Putting another ADR may not be the answer and I would get as many opinions from as many doctors as possible. I know I jumped in too quick. If I had researched more before my second operation and read the problems that others have had, I would not have gone on just one opinion and one option. Be careful you only have one body and I wouldn’t want you to end up in the same place as me.

Hi Annapurna, Thank you so much for replying to me. Just to clarify, I am afraid that I am not sure what "spurring"is and does is always happen with ADR? I have been checked for arthritis and I have been told that there is no signs of any. The facet seems to have been a problem from the time of my injury, but it had not been picked up or even mentioned until now so I am not sure what is causing it to degenerate. I have so many unanswered questions about my back but unfortunately, I am not getting the information I need from the doctors. I will be asking a lot of questions here so please bear with me.
Kind regards

Sandra D

Hi Rob, I know what you mean about jumping in too quickly. I did the same thing when I had my first surgery. I didn't even know what kind of ADR operation I was undergoing, I just wanted somebody to help end the hellish pain I was going through. I cannot describe the disappointment when my pain levels started increasing again just a few months after surgery and I am back on the same merry-go-round again. I have so many complications and I am trying everything to improve my situation but to no avail.
I am sorry to hear that your second surgery has not worked out for you. I am so afraid to have another and to end up in the same or worse place again. I honestly don't know what to do.
Thanks for replying to me and hang in there. Speak to you again.

Kind Regards

Sandra D

Sandra,

Spurs are osteophytes that form on bones, sometimes for compensation of stress. Other times it could be a result of the degeneration process, due pathogens, inflammation, etc.

Please this old FAQ:

http://www.adrsupport.org/forums/f49...spurs-ho-7317/

Looking through the FAQ, there is one point to emphasis: spurring or osteophyte formation can impinge upon the nerves exiting from the spinal cord at the level where the spurring occurs. Growth or enlargement of the facets have the same effect.

Some of your problem may be a misunderstanding of what facet joint disease and facet arthritis actually is. More knowledgeable minds may correct me but a simplistic explanation is that the facets are bony protrusions that have hyaline cartilage (real slick surfaces) on the mating surfaces. The hyaline drops the coefficient of friction to incredibly low levels (does the same thing in all of your moving joints) and permits free movement. Arthritis as a general term refers to damage to the hyaline cartilage, possibly minor and reversible, possibly serious and irreversible, possibly total loss and bony reactions under the missing areas. Facet joint disease includes arthritis but includes enlargement of the facets and inflammation of the capsule that the facets ride in. Diagnosing arthritis is really difficult because most people aren't going to the effort of checking for hyaline cartilage thickness. Diagnosing facet disease is easy because the capsular inflammation is easier to spot, even if the bone hasn't started enlarging. For you to have severe facet disease and have been experiencing problems for a while, I can't see how you wouldn't also have facet arthritis. You might not have facet enlargement, which is a cheap way to look for end-stage facet arthritis, but I can't believe that your cartilage is untouched.