Facets and ADR indications

[Hooch]

Gday,

I'm trying to find some more info on facets and ADR.

From my research so far it seems to be that gross facet degeneration is contraindicated for disc replacement. What I'm wondering is if anyone has any insight at to what level of degenration is considered acceptable in clinical practice. I appreciate this will vary from surgeon to surgeon.

In my case I have facet hypertropy and some foraminal stenosis (asymptomatic), but very little inflammation in the facet joint itself according to a bone scan. Facet blocks in a couple of weeks.

Has anyone had experience of this through their own scans and surgery, or through research or stories they've heard? In terms of facet degeneration due to an artificial disc, is it commonly found to produce hypertrophy?

Thanks,
Chris.

[ajj1001]

hi. not sure of all the medical terms but my facets were A ok when I had my 2 level ADR. the facets started to show degeneration at l5/s1 4 years later. these caused alot of problems and led to me having plif last year.

[trkdoc714]

Mild facet issues were one of the deciding factors for me to go the direction I went. One opinion I received labelled them arthritic at 3 levels. His recommendation was a 4 level fusion/ laminectomy.

The ADR (Medtronic Maverick) I went for has a posterior center of rotation which, if properly placed, can prevent facet issues in the future. So far, so good as I've been pain free since I recovered from surgery.

It's a complex puzzle we have to put together to find the course of action that "fixes" our spines.

Good luck Chris,

Bob

[Metalneck07]

This a very good question one that I myself would like to know the answer.I have at L4-5 Dorsal Facet hypertrophy which is the level my doctor is proposing ADR.There is facet Hypertrophy at L3-4,L4-5 and L5-S1.I was told I'm good candidate??I had a dexa scan but no Bone scan . Did your doctor request the Bone Scan to determine if your a good candidate for ADR ?? I will be interested in any information you find on this subject. Good Luck hope you find the answers you need.
Caitlin aka Metalneck07

[Cindylou]

Caitlin, a dexa scan is a bone scan. They are one and the same. A good surgeon will require a dexa scane before any spine surgery, especially TDR (Total Disc Replacement). In my case, my facets were either mild or perfectly fine before my 3 level lumbar surgery. 3 1/2 years after this surgery my facets are all moderately arthritic, with my L5-S1 being severely arthritic.

[Metalneck07]

Thanks Cindylou for clarifing that for me.I had my Dexa scan it came back good.If you don't mind me asking what is your feeling that has caused this to happen at all three levels ? Do you feel the ADRs have played some role in this ? Do you think this has been a natural with age progression of your facets ?But I read your thread right I think 3 1/2 YRS. since your ADR Surgery ??? I just don't know what to think.
Caitlin aka metalneck07

[runagain]

Hooch,

As far as I understand it, an ADR can cause facet degeneration but they have not figured out why some people degenerate and others don't. ProDisc because the way it is made is said to in some cases, cause increased facet degeneration. Two years after op and my facets are still the same and they do not cause pain.
In a posterior fusion, at least, they take out the facets and therefore they are fused. They cannot degenerate anymore.
Bob is right, Maverick discs are thought to cause less of the facet degeneration problems.
However, before fusion or ADR, as the disc collapses, this can cause accelerated facet degeneration.
There is a lot they do not know about the spine.
New information, however, comes out fairly frequently.
One way to test the facets is to have them injected with a long-acting corticosteroid and an anesthetic. This can be both for diagnostic and treatment purposes. If the medicine does not help your pain, it can be thought that your pain generator is not your facets. If your facets are causing pain they can be treated with injections.
Some surgeons have done facet replacements, but this type of surgery is in early days.
Also, a Dexa scan is to check for osteoporosis or osteopenia. Osteoporosis is contraindicated in artificial disc replacement because it increases the risk of the disc subsiding (i.e. sinking) into the vertebral bone.


R

[Hooch]

Thanks Runagain.

If you dont mind me asking, you've had a hybrid procedure, but it hasn't turned out well? Did another level go?

I didn't realise in PLIF they remove the facets. I presume they grind them up and use them as filler. Is it standard in plif to remove both facets?

I don't know much about arthritis but I assume the hypertrophy and joint inflammation are part of the same process? So end stage facet arthrosis has plenty of bone growth and therefore possible nerve impingement and painful facet joints?

The Reliability of Computed Tomography and Magnetic Resonance Imaging Grading of Lumbar Facet Arthropathy in Total Disc Replacement Patients (2009)

Conclusion. The current grading system for facet arthropathy has only fair agreement. CT is slightly more reliable for grading. Intrarater reliability was only fair for MRI and moderate for CT. Only limited agreement existed between surgeons as to the extent of facet disease that would pose as a contraindication for TDR.
Conclusion. The current grading system for facet arthropathy has only fair agreement. CT is slightly more reliable for grading. Intrarater reliability was only fair for MRI and moderate for CT. Only limited agreement existed between surgeons as to the extent of facet disease that would pose as a contraindication for TDR.

Degenerative Changes of Discs and Facet Joints in Lumbar Total Disc Replacement Using ProDisc II: Minimum Two-Year Follow-up

Conclusion. After TDR using ProDisc II, the degenerative changes in the discs and facets at the adjacent segments appeared to be minimal. However, in 29.3% of the TDR segments, the facet joints presented PFA (progressive facet arthrosis), which was more common in female, malposition of prosthesis on frontal plane, and 2-level TDR in a minimum 2-year follow-up.

Sounds like they don't know jack.

[runagain]

Hello to you, Hooch, again..

Let me see. I was just checking some sites because some don't even tell you what happens to the facets in fusion.
Just checking PLIF (posterior lumbar interbody fusion).
But first, no, I have not had a hybrid. I had ProDisc-II at L4/5. Due to some doctor not getting paperwork to the surgeon, L5/S1 was overlooked as it was not showing symptoms or it didn't look like it. It is water (over) under the bridge. Went real bad less than six months after ADR.
That is it in a nutshell. Despite some unnamed people (not on this site or any site, I mean professionals, and I use the word loosely) saying I had a problem at l4/5, that was incorrect as latest tests show/confirm L5/S1 is the problem and has been for a while.

Onto you.
I read on one site that they grind down the facets, but I do know that the facets fuse or are supposed to.
One site that is fair is eorthopod.com | ...enabling communication.. But only from researching several sites, can you get some kind of exact picture of what happens during surgery and then each patient is different, has different indications, etc..
I believe they are going to grind down both facets, or otherwise, you might be lopsided. But the important caveat is that the facets are taken out of the equation. Or they are supposed to be.
Yes, spines can be confusing.
My understanding is that the facet hypertrophy is the arthritis. The facets enlarge, or in other words, hypertrophy.
I was just reading and I don't know why this did not sink in before, but from what I read, as the disc shrinks and the vertebral endplates get closer to each other, the nerves are compressed and the facets also deteriorate.
Maybe think of it as a tire that loses air. I have heard the analogy of a disc to a jelly donut.
I have read that even with good facets on MRI, they can be worse. A good doctor should look at your x-ray/test report and not just read the radiologist opinion.
Before my surgery, I had my facets checked with facet injections, although they read to be very (with the emphasis on very) minor deterioration/hypertrophy.
Before any surgery was mentioned for me for my latest problem, I had my facets ruled out twice with injections.
Must be mentioned that these facet injections were not a day in the park. They are expensive, with insurance, and they were done in a surgery center under anesthesia.
The doctors and the researchers know things, but they do not know everything.
The human body is not like the text books and things happen during surgery. Doctors are human after all, heh, Justin?
I advise people to take everything with a grain of salt, so to speak.
As I have said, and several people on here and doctors say, The most important thing is the skill of the surgeon doing your particular procedure.
But as I was reminded by someone last year, even the best doctors make mistakes.
And remember, any surgery is potentially dangerous.
I was told before my surgery (by a doc) that if the pain was interfering with my quality of life than it was up to me to have surgery but that was an indication.
I came to just about the same conclusion as you that they don't know everything (but more than jack) and that is why it is best for the patient to get multiple opinions and be their own best advocate.

R

[Hooch]

Yeah well perhaps I should replace the colloquial 'jack' with 'developing indications' (medical term for we dont know jack)!

I hope you get your problems sorted, sounds like a very trying process.

I'll keep poking around (but I'm pretty well at the point now where further research is starting to require a bit of medical knowledge, which I don't have) and will quiz the surgeons when at the next appointment, but if anyone has any prior knowledge of this stuff please do jump in.

I'll report back with anything I get told.