Facet Query Again?????

[joel]

Hi joel here,

I was wondering if anyone could tell me how to definitively rule out facet degeneration before ADR.
I have had 2 lots of facet injections that relieved some pain but my MRI scans say they are within normal limits.

Are there better tests/scans to show facet degeneration?
And would anyone have ADR knowing that they had previous facet pain or is that asking for trouble?
What kind of classifications are there for facet damage and how are they relevant to ADR (Justin)?
Thanks again,
joel

[KBear]

I was told that since I had received facet injections and gotten no relief, that this was a good indicator that my facets were not my pain source. My mri said that I had moderate arthritis, but all 3 surgeons agreed that I still fit the criteria for ADR. I also had 2 discograms (2 years apart) that both duplicated my pain 10/10 at L4/5.

To some degree, we all have facet arthritis and many have had ADR successfully with it. However, I would be weary of having it, if I had gotten relief from facet injections. Have you had a discogram yet?

[rhatzy]

The only definitive tests so far is a facet block where they inject numbing medicine into your facets. If it relieves your pain then you have facet problems. An MRI is also helpful however, everyone over the age of fifty has some wear on their facet joints but no symptoms.

Mark

[cavalier]

Joel - just a quuik note to back up K Bear i did the same before my ADR as my Facet findings were the same as hers - they were not a pain generator for me either so knowing that i felt good to move forward had they been I would have stopped from doing ADR. & also yes to Mark's input above as well.
Problem I am told as i wanted to do the same with my Cervical now is that it is too close to the brain stem & not as controlled & more risky -no one here in Memphis wants to do it - anyone ever have Facets done for the Cervical ? I sure would love to know if I can do it safely that is. I asked Dr. Fenk-Mayer about doing this ahead of time here & she said go for it as i have of course the same findings of Arthritis in my neck.
Jill

[Justin]

Hi joel here,

I was wondering if anyone could tell me how to definitively rule out facet degeneration before ADR.
I have had 2 lots of facet injections that relieved some pain but my MRI scans say they are within normal limits.

Are there better tests/scans to show facet degeneration?
And would anyone have ADR knowing that they had previous facet pain or is that asking for trouble?
What kind of classifications are there for facet damage and how are they relevant to ADR (Justin)?
Thanks again,
joel

Hey Joel,

Sorry this is so late--I'm just now seeing this post. One way to rule out facet degeneration is by imaging studies (magnetic resonance imaging [MRI] and computed tomography [CT] images). CT is considered superior to MRI; however, patients are exposed to radiation from the CT scan.

Here's a great thread about CT Guided Facet Joint Injections. Facet injections don't "show" degeneration per se, but they are used to help determine if one's facets are implicated in pain generation.

And would anyone have ADR knowing that they had previous facet pain or is that asking for trouble?

Facet degeneration is a contraindication to artificial disc replacement. Many of the current artificial discs on the market "load," or place extra forces, on the facet joints. This can ultimately lead to accelerated / increased degeneration of the facets. However, in many cases this is thought to be minimal and depends on variables such as malposition of a device.

What kind of classifications are there for facet damage and how are they relevant to ADR (Justin)?

Joel, radiographic grading of facet degeneration is usually used. A surgeon can make a recommendation about artificial disc replacement based upon your films. Patients with moderate to severe degeneration of the facet joints are usually instructed to investigate other forms of intervention.

I hope this helps.

[Cindylou]

I'm just now seeing this posting too. I guess the million dollar question then, is, if you've already had lumbar adr's and THEN your facet joints are positively identified as pain generators, what is the next step for relief? My big fear...is there anything????

[Justin]

I'm just now seeing this posting too. I guess the million dollar question then, is, if you've already had lumbar adr's and THEN your facet joints are positively identified as pain generators, what is the next step for relief? My big fear...is there anything????

Hey CL,

In that case, I would say facet injections possibly followed by ablation if the injections worked well.