ADR Risk - "facet" issues?

[Harrison]

Clarissa, I can only answer that by sharing what I learned from personal experiences, speaking with a few patients and having chats with a few chiros. The easy answer is that it depends on the injury!

If it's not too bad, rest and NSAIDs may help. A friend of mine just came back from Asia, and though her lower back was pain-free, got an adjustment in her upper and lower back. Her cervical area and shoulders are better, but she's had lumbar pain ever since. And that was 9 weeks ago. Was is a facet injury? Dunno, maybe...but it still bothers her.

That's where your doctor(s) can help. If things are still painful after a few months, it's time to talk to a good spine doc.

[Clarissa]

Thanks for the info. I ask the question because my injuries are very small and I still have really bad muscle spasms everyday. I've been getting trigger point injections which do help. The muscle spasms still come back. My PM Dr. said something about a nerve possibly irritating a joint. No more than that. I am going to ask him about the facet joints since I read they can irritate muscles. I'll see what he tells me.

Thanks again for answering my questions.
Clarissa

[JJames]

Hello Kimmers,
Thank you so much for your replies. I apologize for my delay in responding. I've been having a tough time "coping" with increasing back-related health issues and several side effects (medication, medications to offset the side effects of those meds, work, family, etc). Although the money/medical insurance/FDA are preventing me from having the bi--level ADR anyway, I have an appointment with my surgeon to discuss some of this on 4/1. He has done many ADR surgeries, and I do have faith in his abilities.

If and when I am finally able to get this surgery scheduled, should I ask him if he's checked to see if I show that I may have post-op facet issues? Should I assume he's already checked the films? Also, I plan to at least inquire about the possibility of the Hybrid surgery (L5/S1 fusion & L4/L5 ProDisc ADR) and get his opinion. I would suppose the same facet-related concerns/questions should apply, right? It likely will not matter, as I have little confidence that my medical insurance will pay for that procedure either!

Thanks again - Jeff

[kimmers]

Jeff,

No apologies needed.
You never know about the insurance. They could pay on an appeal or not.
What I found out was there are agencies that help people who have no insurance or are underinsured. Though it was costly to have BC deny my surgery, it was worth it I believe. They have paid for all the post-op visits and meds and so forth but they have a high co-pay thing. They never threatened me with not paying for my care if I went through the surgery. I really believe that is outside their bounds of term of policy.

I blame them for the problems I have now because if I had had surgery earlier when my disc was in better shape, I might not be having a problem with L5/S1 now. Who knows? I might have been thinking clearer too before surgery if I hadn't been so wrapped up with fighting them. I would have asked for another discogram to confirm that no other discs were pain generators.

I would ask for a facet block to rule out those as pain generators. It is both a diagnostic and therapeutic treatment. I had one before surgery and I had one at end of January. If you don't get relief, you can pretty much tell that the facets are not a pain generator. They did more than one level on me. Also, the MRI report will tell the degree of hypertrophy in the facets, related by the radiologist. But my doc read all the films himself and didn't always agree with the radiologist.

Good luck with your surgical appt. Make sure to bring a list of questions and do not rely on your memory.

Kimmers

[Harrison]

Jeff, you may have seen this short post -- it's a short & visual: Facet Joint Arthritis -- Multiple Levels Also, carefully review this topic -- reading about the different artificial disc designs and facet considerations: Different Artificial Disc Kinematics - Spine Biomechanics: ClinBiomech 2009 Jan3 Epub

It looks like you are on the right track to ask your doc about the facets!? Any news?

[Sandy123]

Hi, I was here about 5 years ago investigating ADRs. And now I'm back because my back is giving me more pain and sciatica. So about 5 years ago I did send my xrays to Germany and Malte got back to me saying they approved me for 2 artificial discs even though the report here said bad facet joints. Since it was about $40,000.00 and I wasn't in that much pain I decided to forget it for awhile. Maybe that was a bad choice as I bet my facets are worse now. I also have scoliosis and have 13 discs fused T3 to L4. My bottom 2 discs L4/L5 and L5/S1 are bad. I wonder what is causing the sciatica, my facets or my bad discs. I'm just dreading going in again and hate getting my only 2 discs fused. I wish I would have went to Germany 4 or 5 years ago now.

Oh one more thing. When having the sciatica spasms and I'm stuck there and can't move, I yelled for my husband to bring me some marijuana - 3 puffs & 3 minutes I could relax my muscles and be able to walk again. It works like a miracle and here in Colorado it's legal, thank God. I was fused 18 years ago when I was 37 years old and went from 91 & 78 degrees to 65 & 45 degrees. It was a horrible operation since I was so old and so severly curved. And I know thats why my bottom 2 discs are bad but I was surprised to get the ok from Germany, really. I was hoping the the U.S. would have come further in givng ADR's but it looks like they are dragging their feet still.

[Hooch]

Consult with scoliosis specialists regarding the treatment of your lower discs. With a long fusion and a scoliosis curve above those discs there is a massive lever force which artificial discs are not built to withstand.

Liz had to have her adr's removed and fused (with disastrous results) because she was simply not indicated for disc replacement, despite her original op being performed by one of the top adr surgeons in the US.

http://www.adrsupport.org/forums/f47...if-plif-10353/

Just be aware that are surgeons ability and willingness to perform disc replacement does not equate to his/her ability to select the best operation for you..

It's a complex situation you're in.. Stenum are no good to you in deciding the best course of action. Consult widely, talk to the scoliosis specialists, they are the ones who will be most familiar with your condition.

[Sandy123]

Hooch, wow thanks for giving me Liz post! I really got a lot out of it and to be scared for sure. I was surprised to see that she was approved by 4 other surgeons for the ADR so it might be a possibility for me but I'm pretty sure it won't. Well I do have some research to do but need to do something soon. I see you had surgery not too long ago and hope you are doing well. I think you had the ALIF which I just read is minimially invasive which hopefully if I can't have ADR I wish for minimally invasive which there still aren't that many surgeons who do that. When I saw the orthepedist about 2 years ago he wants to fuse and said 4 1/2 hour operation. So this time I want to go to a different surgeon. Thanks to all who went before us!