[johnb]

I'm not using the same surgeon anymore. I don't think an ADR would be appropriate at a level where facets have fused. I've read other comments about facets being improved by ADR but there is no clinical evidence to support that. Maybe if the facets are at early stages of degeneration but my surgeon said that he is seeing facet problems in many of his ADR patients and it is inconclusive whether they had some problems before or the disc caused them according to him. He also said that he has seen some problems with ADR's that don't match the disc height. One of my friend's brother has a charite done 3 years ago with him and is doing very well. It's all about indications and matching patients with appropriate treatments.

I'm not going to speculate on what treatment is going to be done in the future. My nerve pain needs to be found and addressed in the least riskiest way possible with consideration for future spinal problems too. Determining the state of my spine by a competent and HONEST physician(s) is the main goal. I have 2 degenerated discs that are no longer painful. However, stenosis is a factor now that they have lost height. Do you remove a disc that isn't painful or should you decompress around it? I don't have to worry about instability at levels where facets have fused. It's basically a posterior fusion with less grafting. I'm certainly not going to have a multilevel ADR. Too risky for ME. Others may have more tolerance for that kind of risk. Then again, I don't want a stif spine at my age and accelerate the disease process. The good thing is, I've done atleast a 1000 hours of my own research while I was laid up after my surgical failure and I'm informed now.

I've had disc disease for over 15 years now and I don't have ANY of the same back pain I had when the only thing that was wrong with my spine was annular tears and some initial drying/desication. The pain I had then was completely different then what I have now which is 95% nerve pain. No facet pain and no discogenic pain. In light of this, I wondering if radical long segmental fusion or ADR is appropriate? In hindsight, I know the difference in sensations. THe IDET I had years ago solved the old type of back pain but I ended up with a new one which was facet pain after my L5/S1 collapsed which accelated my facet pain. Facet pain was much more painful than discogenic pain, especially in the latter years. Something else noteworthy, I noticed a heating sensation in my back on the sides where the facets are shortly after they dynesys implantation. That was my facet joints fusion when the bone and bone quit moving against each other. The areas where bone is fusing (being created) is hotter than normal bone for biochemical reasons that are beyond the scope of this discussion. It is amazing what you can learn when you are laid up with a laptop in bed for days on end. discogram was not concordant for pain at L5/S1 after it collapsed in height.

John