[annapurna]

Thanks Rich, but Jim wrote that detailed reply. I'll just add something to his replies.

I've noticed that the more experienced ADR surgeons like Dr. Bertagnoli tend to be less conservative about facet condition when considering ADR candidates. If you'd like a second opinion from a non-US surgeon you might want to ask Dr. Zeegers. He's one of the most experienced ADR surgeons in the world and did a fabulous job on my L5/S1 ADR.

I'll also give another opinion as to why the non-US surgeons tend to be less conservative about facet condition: they have more options in the event of post-ADR facet pain. There are several different devices ranging from posterior stabilization to true facet arthroplasty devices available in Europe that are only in clincal trials here. Although no surgeon wants to consider a re-intervention, it's easier to balance the possibility of retaining motion (ideal situation) with non-optimal outcome from facet pain when you have something other than revision to fusion to address that pain.

If you have questionable facets, you should ask yourself how you would deal with facet pain post-ADR. Although there are lots of devices and procedures available to deal with this problem, they're all new and many would require a trip overseas. At worst, you could face a tricky revision to fusion. If you don't feel that you could handle that possibility, then I'd think twice about ADR. If you're willing to live with the possibility of post-ADR facet pain, I'd ask Dr. Bertagnoli what he could do if you needed additional treatment for facet pain. Arm yourself with information.

I have post-ADR pain in both my lumbar and cervical spine. Could be facets, or muscles, or ligaments, or all three. Diagnostic injections haven't returned any consistent results even though I've gotten enough to feel like a human pincushion. If I could isolate my pain to the facets, I would personally have NO problems trying out any one of the many different facet replacement devices now available in Europe one the surgeons have a bit more practice. That's just me. I don't mind getting lots of surgeries as long as I have reason to believe they'll do me lots more good than harm.

If you're interested in facet arthroplasty, check out the news flashes on Facet Solutions and Archus Orthopedics websites. Both have facet replacement devices that have been used successfully with ADR's. Big step for spine patients and all that. Wouldn't go out and get them tomorrow, but an example of how many new facet options are arriving.

Hope this helps. Feel free to PM if you want to chat facets or anything else.

Best wishes,
Laura