Please clarify technical term?

[fortitudine]

I notice on this and other spine forums that there is a grey area in the use of 'anterior/posterior' , 'front/back' of cervical vertebrae.

As I understand it there are at least three place where osteophytes can form on the vertebral body: the front of the vertebra, and the front and back of the spinal canal. Spurs on the very front (anterior?) - the throat area, don't seem to be an issue. It's the ones that protrude into the spinal canal. Often a patient/MRI will say there are anterior or posterior bone spurs at cX/Y.
I have always assumed they meant around the spinal canal, but from further reading it is sometimes hard to tell whether 'posterior' is referring to the back of the vertebral body, which is also anterior to the spinal canal, or whether by 'posterior' they are referring to spurs growing forwards from the lamina/spinous process into the canal.

If posterior and anterior refer to the canal, then what do you call the very front (throat) part of a vertebra?

[mmglobal]

I'm not an authority on these terms and may be using them incorrectly myself, but I think of an anterior osteophyte as on on the front of the vertebral body. Poserior osteophytes would be on the back of the vertebral body. In other cases when I see these anterior / posterior, I see them qualified with more description about what anterior/posterior is relative to.

I will not be surprised if people dig up all kinds of examples of conflicting use these and other terms. The same terms mean different things to different doctors. (protrusion, bulge, extrusion, herniation?)

Mark

PS... anterior osteophytes are not always symptomatic. If they are too large or if you have unique anatomy surrounding the osteophytes, you may have substantial symptoms as the osteophytes interfere with your throat. Ask KL Aguilar over on Braintalk about this.

[necknose]

Hi Other Spiney Persons:

As I understand it, another significant problem with anterior "bridging" osteophytes, the ones that protrude "beak-like" from the front of the C-spine vertebra, is that such vertebra are prime candidates for auto-fusion, which intuitively implies that they must be removed, bringing us back to the topic of "Bone wax", or some other method for supressing the regrowth of removed bone.

A level fused around an ADR is still just a mighty fancy fusion. Ditto in terms of lack of mobiity at the operated level, as to ROM the result is the same as if that level had been fused instead of implanted w/ADR.

Or so it looks to me. Is "bone wax" the way to avoid this outcome?

Enquiring minds want to know! ASAP!!! Like yesturday!

Happy overeating day.

Good luck.

[KL Aguilar]

Mark is right. In early August, I developed an ear infection that did not respond to the antibiotic prescribed. I went back and was prescribed Keflex, which cured my ear infection, but led to hives from head to toe and thrush in my mouth and throat. A day or two later, I reinjured myself at work, apparently at C3-4 (I had injured C4-7 in 1995 and had CED surgery in 2000). OK, so I am going to doctors what seemed like every few days, due to the cervical problem (and resulting horrible pain) and the ear infection, hives, and thrush. Two weeks after starting the anti-thrush medication, I mention to my primary physician that I still have a strange feeling in my throat, as if something is stuck. She looks and tells me I have one patch of thrush remaining, sort of where the adam's apple is. She remarks that it is strange that it is only in that one spot. So I start a second round of anti-thrush meds. Two weeks later I go back and tell her it STILL feels like something stuck in my throat. She looks and says no thrush. She then takes two swabs (one at a time) and sticks them down my throat and orders blood tests. I get a call a few days later--nothing wrong with my throat.

I go back to the WC doctor who looks at my MRI and asks me if I have a sensation of something pushing my esophagus. He shows me on the films where a bone spur is pushing forward. Bingo.

At times, it feels like something stuck in my throat. Occasionally, food gets stuck going down and I cough and choke. Sometimes it wakes me up. It is very very annoying.

[mmglobal]

Auto-fusion in a virgin spine or in a post-ADR spine seems to be considered a good result. Stable and immobile is often the goal that represents a successful surgery.

These beak-like, bridging or 'claw' osteophytes do represent auto-fusion... the body is trying to immobilize the segment. They indicate how far down the degenerative process these segements are. When too far advanced, it may be best to let it go... not try to reverse... or remobilize.

Relative to ADR, as the osteophytes grow larger and larger, there are serious bone quality issues. The vertebral bodies are hard around the outside, where there is hard, cortical bone. They are soft in the middle, where there is soft cancellous bone.

As the osteophytes brow larger, the soft cancellous bone in the center of the vertebral body moves outward as the margins of the vertebral body moves outward with the osteophyte... either anterior as in nn's case, or posterior as in my case. If you lop off the osteophyte, if you are removing the bulk of the cortical bone that should have been supporting the prosthesis, leaving the softer bone that has moved outward, following the osteophyte; the risk of subsidence is substantially increased.

Because I'm concerned about this for my case, I've been discussing it extensively with the docs for years. Bertagnoli has been successful in pushing the limits as he understands more and more about what can and cannot be done. What may have been considered a contra-indication years ago, may not be a more ordinary case (for someone with experience with these further advanced cases.)

IMHO, bone wax is taking on too much importance in this discussion. There are structural issues... there is the issue of remobilizing an already immobilized segment... there is the issue of appropriateness of ADR with such advanced degeneration and modic changes... bone wax is just a tool that reduces the risk of undesired bone growth. I've seen some of the studies that discuss the risks associated with bone wax. It does not surprise me to hear that horror stories abound as technologies are misused or abused. I'm sure that the risks are very real and I'm also sure that some doctors will know what they are doing to appropriately manage the risks and proper application of a technology.

I'm about to spend some weeks in Germany and will spend time with both Zeegers and Bertagnoli... I'll post what I learn.

Mark