Facet Joint Degeneration and ADR

[WPKat]

Hi Kathleen,

I find your thread interesting as I have developed facet joint degeneration after my lumbar surgery.

I have facet arthrosis at the level of my two lumbar ProDiscs unfortunately. It seems the theory that disc replacement prevents further degeneration is not so in my case. My Lumbar surgery was six years ago and was a great short-term success. On my two-year x-rays there was evidence of the further degeneration but at that time I was asymptomatic, however, as time has passed, there has been progression of my degeneration to the point that it is now throughout my lumbar spine up to the thoraco-lumbar junction. The ProDiscs themselves are working fine but I have facet arthrosis at those levels and the adjacent segment degeneration (the four levels above the prostheses are involved - too much for any further surgical intervention I'm told). I believe this is a natural progression of the disease although I have no way of knowing if it is an acceleration of the degeneration; I have no regrets about undergoing the surgery, I am still currently better than I was prior to the surgery most of the time. Only time will tell whether I continue to worsen or not.

I have been offered radiofrequency ablation (which I've declined for now) and am due repeat facet blocks in a couple of weeks time. I believe devices which address both the disc and the facets will be helpful in situations such as mine but there seem to be few surgeons undertaking such procedures at this current time. The evolving facet replacement surgeries, which are in their infancy, look very interesting. I am not unique but am in the minority as the abstracts Justin posted mention. That said, I still feel I am fortunate to have had the oppourtunity to have both my lumbar and cervical disc replacement surgeries and have no regrets at all.

I wish you all the best in your quest for pain relief, don't stress about the discogram, yes it hurts but it's over very quickly, see it as a means to an end. Many of us have been through them and survived, if you're not sedated just take a deep breath and try to relax as its easier to get the needles in if relaxed. Do let us know how things progress.

Kind regards

Lynda

Hi Lynda,

I appreciate your sharing your story with me.

One would think that after all I have already gone through, I wouldn't think twice about having a discogram done, but so not true. It was scheduled quickly and well before I had a chance to talk with my pain specialist about her approach. I have to admit that after reading one-to-many Forum posts (on different sites) reporting their bad experience with it, I decided to postpone. I want, and need, to talk to my pain specialist first to make sure I will be adequately sedated during the test as well as ask what can be done to calm my back down afterwards.

The result of living with daily back pain has made me extraordinarily cautious about doing anything I know will piss off my back. Interestingly enough, I have no problem with the needles going in my spine, it's how long it takes for my back to calm down afterwards that gives me great pause when considering any procedure.

Your facet degeneration occurring after ADR is certainly noteworthy and cause for reflection. As I read through my 5 MRI reports (all done within months of each other), facet arthropathy is mentioned on all of them, but the severity is not noted until the fourth one. As a result, I have no idea if it was that bad prior to my back surgery or if it became worse as a result of having it done. I'm sure a radiologist or surgeon could compare the MRIs before and after surgery, but of course, I cannot figure that out on my own.

I have sent my stuff to 5 surgeons with only one response so far. I believe that one in particular, Texas Back Institute, performs facet joint replacements. It will be very interesting to hear what they come back with in terms of a recommendation.

Thanks again for sharing!

K

[Justin]

Hi Kathleen,

I was not sedated for my discogram in 2003. It was painful, but the pain was very short-lived. You will need to bump up your meds for a day or two afterward, as your nerves will be upset.

I'm very glad that I had my discogram performed.

Good luck!

[runagain]

Kathleen,

I had two discograms (Yeah, lucky me).
The first one was without sedation and I definitely felt it (ouch).f The doctor put Lidocaine in the discs and calmed them down, however, I was sore for a while and had the increase in pain a lot of people talk about.
Second, with sedation, very different. My response was not screaming in pain, even though I had pain. The disc that was OK had no pain. Afterwards, at night, I think I remember, I had a huge increase in pain that eventually went away. However, like people told me, if the discogram is positive, be prepared to have surgery.
Like a recent study showed, the discogram stirs up the discs and can lead to increased degeneratiion.
I wasn't sure on the sedated discogram exactly what they did but I got the report and found out. With this one they also injected the painful disc with lidocaine (an anesthetic) and they did tell me I was given pain medication through the IV (toradol) and I had antibiotics in IV prior to discogram, which is important to prevent an infection. When I had the increase in leg pain, I was put on oral antibiotics in case I had an infection.
With the extreme pain after the disco, I increased my pain medication.
I would say with the sedated disco, the pain you feel is blunted and not as bad. However, your response may be not as great and therefore the doctor might not say it is a positive test.
To be sure, i think the unsedated discogram is more definitive. Of course you may have no pain and therefore you are OK.
I had a lot of pain with the sedated discogram but it was for a short time and it wasn't the pain I would have felt if I was not sedated. But, I have read that any disc that produces pain in a discogram is not normal.
Everyone is different. I was told by some people that it was the worse pain imaginable and others it was no big deal. Both discos fell somewhere in the middle. I think it depends on the guy who is doing the injections. Also how degenerated the disc is. I would not hesitate to have another discogram if it was needed.

[WPKat]

Two discograms ... ... holy cow, I applaud you!

I see my pain specialist on Monday. She is a extraordinarily nice doctor and I would really be surprised if she does the discogram without conscious sedation. I also want to see what can be done to calm my back down afterwards (like Toradol perhaps). I feel that I am already a "veteran of pain" and you know what - enough ... is enough. Having had conscious sedation three separate times already, I know I will be able to feel the pain just fine and really don't think I need to feel the full force of it for the test results to be conclusive. I am willing to bite the the bullet on the increased pain afterwards, but ...
sorry folks, I am just not prepared to go through with it without the conscious sedation

As a side note, the pain and weakness in my left leg is definitely returning. Once again, I often feel as though something is wrapped tight around my left calf and the side of my left thigh hurts as well. In between my left big toe and the one next to it is numb when I stand. Otherwise, the rest of the numbness I had in my left leg hasn't yet returned.

Oh yeah, and the sudden pain spikes coming out of nowhere are increasing too

I believe my spinal nerves are in the process of regenerating, which is to be expected since it's been around 7 months since they burned my nerves and I was told it would last 8 months (now ... if I was younger, it would have lasted longer ). But since that procedure did not reduce my overall back pain, I'm not inclined to do it again.

I can live with the left leg business and the pain spikes don't scare me anymore. For me, the radiating pain and intense aching that starts in my lower back and moves downward is a far bigger problem.

K

[Katie]

Kathleen, I really feel for you. In a way, your situation is much worse than mine. I have never had relief from any of my pain, except from the daily narcotics. To have it go away and then come back with a vengeance...to me that would be much worse. How discouraging.

In my case only, i would never have another discogram unless they could guarantee that the conscious sedation would work. I was one of the 'lucky' ones who did not react to the cocktail of narcotics and it was the worst thing I've ever had to bear, including 22 hrs of childbirth. There is no reason you should have to go through it without sedation.

[rhatzy]

I hear that they are now implanting artificial facets. I know there are already a couple of them out there. So, if mine start to go, then I guess I'll just get me a couple of those. I understand the procedure is a whole lot less invasive, Kind of like getting a discectomy.

Mark

[WPKat]

As I thought, my pain specialist will give me everything in her arsenal for pain management during the discogram. We discussed the reasons for having it done, the process and the type of medications that would be used. She will also be injecting a numbing agent into the discs afterwards and will give me Toradol to help calm my back down. The medical professionals that work with her are first rate, very personable and kind as well. Although I am not at all excited about having it done, I am confident that I will be in highly skilled, kind and caring hands.

The date for the discogram is set for April 8th (I would have scheduled it sooner, but she is going out of town).

She also said that if I do nothing at all that I will not get better and will end up with more damage to my spine over time. This is not a surprise as two other doctors have already said the same thing.

Despite my facet degeneration, ADR and Stenum Hospital are still my first choice. Stenum because of their reputation, experience and the countless former patient references I have received and read. ADR because of the inflexibility of a fusion. However, I feel it is only prudent to have the discogram done and review a few other surgical recommendations first. To that end, I have sent my medical information to six surgeons - 3 in the U.S. and 3 out of the country (including Stenum). When I sent them my information, I didn't mention any particular procedure because I want their unbiased opinion on what should be done.

Mark,

I have done some preliminary research into facet joint replacement and as far as I can tell it is still in the clinical trial phase here in the U.S. I doubt I would be considered a good candidate because of my other spinal problems. However, I should find out soon enough because one of the places I sent my medical information to does clinical trials for facet joint replacements. I know they do single level ADR, but do not know if they do "off label" multiple ADR. They also do several types of fusions. Obviously, I am very interested to hear what solution they recommend.

I would like to know if anyone on this Forum has had facet joint replacement. If so, then where? What was their experience - successful or not, recovery, etc.?

Thanks,

K

[Chris G]

Facet Degeneration and ADRs in the Cervical spine

Does anyone have any experience with the Pro Disc C being used with slight to moderate degenerate
facet joints. I have some facet degeneration C3-C7 and have been told by Dr B in Germany that
my facets are not that bad and i should have a successful outcome for a 2 or 3 level ADR above my C6-C7 fusion.

It would be great to hear from some success stories who are now pain free even though their facets were
grade 2/4 or 3/4 in the scale of 1-4 with 4 being the worst.


Chris

[WPKat]

Facet Degeneration and ADRs in the Cervical spine

Does anyone have any experience with the Pro Disc C being used with slight to moderate degenerate
facet joints. I have some facet degeneration C3-C7 and have been told by Dr B in Germany that
my facets are not that bad and i should have a successful outcome for a 2 or 3 level ADR above my C6-C7 fusion.

It would be great to hear from some success stories who are now pain free even though their facets were
grade 2/4 or 3/4 in the scale of 1-4 with 4 being the worst.

Chris

Chris,

If you read this entire thread, you will notice that there is ambiguity concerning the acceptable level of facet degeneration for ADR. It is of great interest to me, because among other things, I have "rather severe [bilateral] facet degeneration at L3/L4" and have been approved for a double ADR at Stenum Hospital in Germany. They are using the M6-C (cervical) and the M6-L (lumbar). I believe they have other ADR devices available, but don't quote me on it.

This weekend, I compared the design of the ProDisc, CHARITÉ® and M6-L.

Prodisc
Synthes ProDisc

CHARITÉ®
The World's First Artificial Disc

M6-L (also M6-C)
Spinal Kinetics

I am not an engineer (there are a few on the Forum that can chime in), but in visually comparing the designs, I personally like the M6. According to Stenum Hospital, the M6 will take the load off of my facets. It's been a while since they explained it to me, but my discs are like a flat tire resulting in a heavy load being put on my facets. Once the proper disc space is restored, my facets will not be under as much pressure.

Of course, no ADR device can reverse existing facet degeneration, but some can make it worse. Since you are considering the ProDisc, you should take a look at this study:

Synthes Prodisc: SAS 2007 Abstract 3 Prodisc-L

Took me long enough, but I found an abstract of a study done on the M6-C, unfortunately, there is no mention of facet degeneration beforehand (but none reported afterwards either):

Elsevier: Article Locator

I am in the process of obtaining additional surgical consults, especially since concern has been expressed about my facet degeneration and ADR.

K