Jim, there was some discussion about using interspineous spacers (specifically coflex) to open facets. There is also some consideration for Dynesys to open posterior elements and restrict motion. These configurations have been done in a handful of cases. The good thing about the posterior systems is that the collateral damage is small and revising to fusion is simple. However, there is discussion about fusing failed ADR, getting good fusion and still not getting relief. This would tend to indicate that the problem has always been inability to diagnose the pain generator. The speculation is that even with successful fusion as the first surgery, the patient would not have gotten better. When asked about this situation at the complications poster session yesterday afternoon, Dr. Bertagnoli indicated that if there are not clear indications for fusion, he would still consider fusing the failed ADR patient as a last-ditch effort, but only after casting the patient, INCLUDING ONE leg. This immobilizes the lumbar spine. If this substantially reduces the pain, that gives more confidence that the fusion will help.
I'd be surprised if the facets will fuse spontaneously on their own in the presence of a highly mobile segment. I'll ask.
Mark
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