[annapurna]

Jim,

About what happens to degenerated facets behind an ADR, I don't think that anyone really knows. I asked Dr. Fenk-Mayer this a couple years ago and she said that the fate of arthritic facet behind and ADR is one of the great mysteries of spinal medicine.

If you think about it, though, you could really only get two outcomes: better or worse. In the first case, the normalized loading and motion permits some sort of joint healing the pain eventually subsides. This is known to occurr in patellofemoral joints in the knee following patella alignment surgery. In the other case, the arthritis progresses as you described and you get spurring that leads to stenosis. At that point, pain from the facet joints would probably take backseat to the nerves being pinched by the bone spurs.

At that point, you could choose a wide decompressive laminectomty with fusion or with a motion preserving device such as TFAS, AFRS, TOPS, or one of the many follow-on devices that will no doubt be in use by the time we have to worry about stenosis.

Best of luck to you and Blair and all of us facet-spineys. May the new year bring hope for better spine health to us all.

Laura