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  #1  
Old 01-17-2018, 06:41 PM
Paul C Paul C is offline
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Default Doc says ADR will not relieve pain due to facet arthritis.

Friends,

I had my first visit to an orthopedic spine surgeon today. Going in, it was my expectation that he would offer a fusion (which he did) but I was also curious if he'd recommend a minimally invasive surgery to get me through at least the next couple years. My L5-S1 is in really bad shape, and the L4-5 is not far behind it. I am not ready for a fusion just yet, and he tells me that the lesser surgeries (microdiscectomy, foraminotamy) will provide no relief because they would only address leg pain, which is not my prevailing symptom.

I suspected he would be against ADR. He told me that ADR would not improve my situation because of facet arthritis. My MRI report says nothing about facet arthritis, and does not mention the facets at all. He went on to discuss the nuances of insurance companies and FDA approval as evidence that ADR is inferior to fusion. He recommended that when I am no longer able to tolerate the back pain I come back for an ALIF. He estimates 60% of patients experience relief with this procedure. I have read that US surgeons commonly take this line.

I am resisting becoming discouraged, but I suppose it is possible that I could be doing irreversible damage to my facets that will still cause me trouble even after ADR, if I am eventually able to get it. I also wonder if the source of my back pain is the facets themselves, and if I might be wasting my time on anything but a fusion.

Has anyone had experience with this situation? Any advice or personal experience appreciated.
Cheers,
Paul
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37 y/o with 17 years of lower back pain. DDD L5-S1 and L4-L5
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  #2  
Old 01-17-2018, 10:24 PM
pittpete pittpete is offline
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Only one way to find out honestly...Go get facet block and if successful then a rhizotomy.
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Born 1970/1995-Hurt at work/1996-Right disc fragment L4-L5 discectomy-On/off back pain,no serious leg pain until/2007-Right herniation L5-S1,recurrent small herniation at L4-L5 with unbearable leg pain/6/08 discectomy L5-S1/leg pain relieved/occaisional mechanical pain/2012-Cymblata 60 mg,occasional aleve/2014-LB pain not debilitating but chronic,Rhizotomy relieves facet pain on right side/2015-L4-S1 collapsed,facets shot/4/15 PLIF L4-S1 with facectomy
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  #3  
Old 01-18-2018, 03:27 AM
Runner16 Runner16 is offline
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Quote:
Originally Posted by Paul C View Post
Friends,

I had my first visit to an orthopedic spine surgeon today.

Has anyone had experience with this situation?
Hi Paul,

I think the key here is you said FIRST visit. I was cervical but what blew my mind when I started all of this was the raging inconsistencies between surgeons.

I found each surgeon recommends their specialty with a very plausible argument. I speak from experience....I had 16 consults.

I also was given advice based on "statistics" vs my personal situation. I was told for example I had no motion in my neck but this doc never evaluated my Xray. Several other docs noted and reviewed my Xrays with me...and pointed out I still had movement at the problem areas.

Another surgeon insisted on running a CT scan as my pile of recent Xrays/MRI's were not "sufficient". She wanted to do a fusion and prove to me I had posterior osteophytes thus I was absolutely not a candidate for ADR.

CT came back clean. Their response...."we didn't expect that" and please pay another $450. After promoting ADR they eventually admitted they don't do many any more....for the last 8 YEARS. Bah, I had initially refused and I should have stuck to my guns. They had a new machine and needed to get it paid for....?

In my opinion, it is critical to get several opinions preferably from different perspectives. Frankly, I found some good docs and I ran into some I felt were misleading to put it politely and some use scare tactics. I feel some use ADR advertisements to get you in the door then default to less expensive fusion.

I say all of this with the belief fusion is a good idea in some cases, no doubt about it but you should find the best fit for YOU.

Hold your ground, get some good Xrays/MRI's and start pounding the pavement until you find a doc you feel good about.

It will happen.

Its a journey, but you'll get there.

Good Luck!!

Runner
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2015 - Left arm pain and numbness appeared out of nowhere during a short run. Assumed it was my new sports bra.

2016 - C5/6, C6/7; Disc extrusions, osteophytes, radiculopathy. Left side only.

Clinging to the fantasy this will resolve spontaneously on its own.

2017 - Gave up on the dream. 2-level C5/6 & C6/7 Signus Rotaio ADR 15Nov17
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Old 01-18-2018, 08:39 AM
Paul C Paul C is offline
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Pete,
Really good point. I think my visit has me wondering where exactly my lower back pain is coming from. I had previously dismissed the notion of injections, mostly because I have what I perceive to be a clearly mechanical defect in my discs, and I saw injections as only being something that would assist me in continuing to ignore that problem. I think I now see value in facet injections as a diagnosis tool, and might look into giving it a try.
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  #5  
Old 01-18-2018, 08:46 AM
Paul C Paul C is offline
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Runner,
Indeed it was my fist visit, and I'm learning this process is far more complex that I expected. My current medical coverage does not support ADR, so I knew that this doctor would be recommending fusion. I anticipate transitioning into a different career in the next five years and will have more options to pursue ADR at that time. I was hopeful that a foraminotomy would make it easier to get to that point.

As I have considered the results of my visit, it occurred to me that the surgeon attests ADR is unsuccessful because it does not address the facets, and only a fusion can stop that pain. However, he said that in ALIF patients, only about 60% experience relief, with 20% staying the same, and 20% getting worse. It sure seems to me that ADR patients have a better success rate than this.
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  #6  
Old 01-18-2018, 06:52 PM
pittpete pittpete is offline
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Exactly Paul, not a fix but like you said a diagnostic.
Some times you need to be very proactive in diagnosing your own pain generators because everyone is different.
I was going down the ADR road and was fooling myself knowing how bad my arthritic facets were.
Fusion isnt the end of the world if its done for the right reason in my opinion
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Born 1970/1995-Hurt at work/1996-Right disc fragment L4-L5 discectomy-On/off back pain,no serious leg pain until/2007-Right herniation L5-S1,recurrent small herniation at L4-L5 with unbearable leg pain/6/08 discectomy L5-S1/leg pain relieved/occaisional mechanical pain/2012-Cymblata 60 mg,occasional aleve/2014-LB pain not debilitating but chronic,Rhizotomy relieves facet pain on right side/2015-L4-S1 collapsed,facets shot/4/15 PLIF L4-S1 with facectomy
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  #7  
Old 01-19-2018, 03:46 PM
Blizzaga Blizzaga is offline
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Getting the injections for the facets is a good idea. It is all about taking one step at a time and trying to get as much diagnostics of your body as possible. I got the facet injections and they had zero-effect on anything. It made me confident that facet pain was insignificant and that ADR would be the logical solution. Following a logical clear path is a good way to stay sane through the long path of pain.
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  #8  
Old 01-20-2018, 08:35 PM
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Harrison Harrison is offline
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Runner, that was a good, helpful post. Thanks for sharing....and WOW on the number of your consults! That's got to be one of the most I've seen on this site.

Paul, forgive me if this was already mentioned, you should get your MRI read by 1-3 other docs -- radiologists who preferably have spine experience.

If in fact you don't have facet arthrosis, you need to find another doctor!

That said, look up facet arthritis (arthrosis) staging. There are a few different systems for assessing the severity of facet arthritis. Next week, I can refer back to a book I have from the inventor of the artificial disc and update this topic on this. If you don't hear from me, and want this info, pls PM me.

See if this link works, a preview of her book. I was able to access it:

https://books.google.com/books?id=rm...20book&f=false

The book is called:

The artificial disc

Karin Büttner-Janz, Stephen H. Hochschuler, Paul C. McAfee (eds.).
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  #9  
Old 01-21-2018, 01:25 PM
Paul C Paul C is offline
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Thank you very much Harrison and Blizzaga. I am troubled that the ortho surgeon was so confident to declare that I have facet arthritis, though there was no mention of it on the report interpreted by the radiologist. Nonetheless, it was an educational experience that has given me more tools to inform the decision making process when the time for surgery comes.
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37 y/o with 17 years of lower back pain. DDD L5-S1 and L4-L5
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  #10  
Old 01-26-2018, 08:44 AM
Cheryl0331 Cheryl0331 is offline
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Default rhizotomy

I had the test facet blocks. They worked really great for me at first because they shoot you with so much numbing and steroids. Then the following month I had the rhizotomy and it only lasted a few months. The only thing that I can say is that the ADR kept the facets from getting worse. However, my facet issues were mild to moderate and that may make a big difference! Its good to get at least three opinions; sounds like you're on the right track.
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50 years of age/5ft.7in./137 lbs./non-smoker/conservative treatments failed/2007 fusion C4-6 w/peek implants plate & screws, failed due to long term use of cox-2 inhibitor/2008 revised w/donor bone replace plate & screws/2009 fusion w/Roi-C implant C3-4/2015 MRI & CT shows incomplete fusion, significant central canal narrows at C3-4, mild posterior spurs C4-6, major ddd at C6-7, segmental kyphosis at C7-T1/ May 4th 2015 2-level ADR with Dr. Clavel Barcelona Spain, Hospital Quiron.
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