Facets again

ans · #1 (**permalink**) 07-22-2008, 02:36 AM

I think I might have asked this before. I think I've read that ProDisc isn't so hot is one's facets are questionable. I do wonder if there would be any difference b/w an unconstrained vs. constrained ADR (e.g. Active-L)? Speaking of which, anyone know when this disc w/be accepted by the FDA.

Also, how risky is it for a guy in his 50s whose MRIs show "moderate facet damage" yet who feels zero relief from facet injections. Yes, an impossible question.

Thanks for your time. - Allan

mmglobal · #2 (**permalink**) 07-22-2008, 06:41 AM

Activ-L is still years away from approval.

Answers about discs will not be known in a timeframe that is relevant to your decision. It will all depend on who's research you'll believe as we've already seen competing studies... prodisc is better... charite is better...

In reality, I believe that some people will do better with mobile core devices, while others will do better with stationary core devices... and I don't think there is a good way to tell who is who. It's a plus for the mobile core devices that they may 'auto adjust' a configuration and allow the center of rotation of the joint to move to where it needs to be and may even provide more normal kinematics. It is a minus for the mobile core devices that forces of the configuration may consipire to push the core in one direction and have it stay there... yielding a stationary core device with the core in the wrong place. The movement of the Active-L is VERY small compared to the movement of the Charite' so issues on the downside are much smaller.... and the issue of lateral movement of the core are elimiated as it does not move in that direction at all.

Some of us will have facets go bad with ADR regardless of pre-op condition. Some people will have facets get better after ADR even though they have moderate degeneration pre-op. I've seen films presented with grade 3 facets recovering after ADR.

You'll now know the answers to your question... you'll get conflicting opinions to the "are my facets too far gone for ADR" question depending on who you ask. It's encouraging that they are negative w/diagnostic injections. If disc height still OK, other options may be available... DSS?

Gotta go...

Mark

ans · #3 (**permalink**) 07-22-2008, 09:13 AM

Great answer Mark. Makes sense.

My disc heights are quite narrow/stenosis, lotsa DDD.

Thanks for your time. - Allan

annapurna · #4 (**permalink**) 08-08-2008, 02:06 PM

Thought I'd chime in here ANS. If you're feeling discouraged, surf over to facet solutions website. They've got a news article out about total segmental replacement (disc and facets). A combo disc-facet replacement is very serious surgery, but, if you're struggling with bony stenosis AND a painful, degenerated disc, then it's worth researching. Your condition is beginning to sound like what those devices were intended for.

ans · #5 (**permalink**) 08-08-2008, 05:36 PM

Thank you Annapurna. Appreciate your time. For anyone interested:

Facet Solutions, Inc.

Be well. - ans

dshobbies · #6 (**permalink**) 08-08-2008, 05:46 PM

Very interesting. How long has this been around? I'm wondering what the German doctors think of this. Do they use it or have they dismissed it? Are they taking a wait and see attitude? Mark, you're still over there. What's their take on this?