Cervical ADR Contra-indication/Indication with facet degenerative changes

[Chris G]

I am looking into a potential multi-level ADR procedure with Dr B in Germany and have shared my films and have a preliminary recommendation for a 2 level C5/6, and C4/5 procedure. I am 54 and am in great shape other then my cervical problem.

I wanted a second opinion and visited a leading ADR surgeon at Yale this week and he looked at my films and pain charts and he said that my facets may have degenerated too much to allow for success with ADR. He recommended have facet injections in 2 rounds Round 1 C3-4, C4-5, C5-6 and then round 2 C7-T1.

If I do not see any pain temporary relief from the facet injections then he said to have discograms at both C5-6 and C4-5 to see where the pain generator(s) are.

I have a 9 yr old fusion at C6-7 and have been pain free for 8 yrs up until early Dec 2009.

I have talked to several "reference ADR patients" who had 2-4 level ADR procedure with some facet degeneration and are pain free at 1-2 yrs out.

I have been told by one person that degenerative facet joints are not as important in the cervical area as the lumbar area due to size and loading differences. Is this true?

Will the extra height provided by the ADR ensure that most of the time the facets will not be touching?

Plus the surgeon will re-model the facets to remove the spurring/osteophytes (then coat with bone wax) and improve their morphology (too bad they cannot add a film of PTEX or teflon where the cartiledge has worn away)

Another question is how long are most patients pain free after a 2-3 level cervical ADR?

I got 8.5 yrs out of my C6-C7 fusion...

Thanks for any input from people with 1st hand experience with cervical ADRs and some facet degeneration prior to the surgery


Chris

[mmglobal]

Plus the surgeon will re-model the facets to remove the spurring/osteophytes (then coat with bone wax) and improve their morphology

Huh? Is another surgeon talking about another surgery? This is not part of the ADR surgery.

The problem with spine is that there are no certain answers to most of the question. For some with degenerated facets, ADR will improve the kinematics and spinal balance and allow the facets to heal. For others, the facets will remain painful... only getting marginally better or possibly getting worse.

Understanding how much of your pain syndrome is facets would be important, but false positives are not rare. When I was discussing my own facet injections with a client of mine who's a pain management needle jockey and 2-level Activ-L patient, he said, "I can make your back pain better with a steriod injection into your hip!" If that injection was into a facet instead, it would generate a false positive result.

I believe if you are considering 3 level surgery, a substantial pain reduction would be great. Pain-free may not be a reasonable expectation... it would be gravy. Remember that people in thier 50's with NO SPINE PROBLEMS will still have plenty of aches and pains.

I think your history demonstrates the uncertainty of spine. Were you better after your discectomy? Better after your fusion? What would have happend if you did the foraminotomy first? If your surgeries were successful in knocking down the pain generators in order, that is very fortunate!

[cherylstewart67]

it may not help the facet joint pain totally but at least would it help take pressure off the nerve root and limit any further degeneration of that nerve. it's not all about the pain; it's also about trying to heal the nerves and improve your hand and arms symptoms. if I am having trouble control my fingers and muscle twitching; that is NOT just facets!