Bone Spur/Osteophyte Removal: Cure Worse Than The Disease?

[biffnoble]

Hi ADR Candidates/Spineys:

One wonders whether or not the large bone spurs (bridging osteophytes)that commonly protrude from the front of cervical vertebra can be removed without provoking a cascade of: more bone growth, inflammation and ultimately degeneration of the treated levels which may lead/contribute to "auto-fusion". Apparently certain (out of USA) Dr.'s use "bone wax" to suppress bone re-growth where bone has been "ground off".

Does "bone wax" do the trick/is it effective? Does it last? Can it it be used in the vertebra canal as well as around the anterior (in this case an ADR procedure is mostly anterior) surface of the vertebral body?

The common "lore" in USA spine surgery particularly ADR surgery is to avoid removing bone in the areas discussed above for fear of causing a degenerative cascade resulting for example in auto-fusion at the treated levels.

Thoughts? Opinions?

Good luck.



BTW: With all due respect to the fantastic practitioners who implant the Prodisc-C what is the bone "reaction" to the keel notch cut into the vertebral body? If there is fear of a growth/inflamation cascade due to the removal of osteophytes on the exterior of the vertebra are the same consequences to be expected from bone remove from the outside of the vertebra?

[Harrison]

Biff,

Very insightful questions, as always. As you know, we touched on some related issues in the past, though your points are more specific. A few of my comments:

- Some patients have had heterotopic ossification (HO) after ADR. Tony comes to mind, with his lumbar ADR. Though it is not common, it happens. Therefore, it is a risk!
- Here’s a Wiki reference to bone wax: http://en.wikipedia.org/wiki/Bone_wax
- The keel cut in the bone has always me wonder about the bone’s “healing” response, but patients have done remarkably well with the ProDisc.
- Regarding spurs, they grow for a reason. I’ve read that it often to mechanically compensate for destabilized areas, but I think that’s just part of the story.

See this FAQ

http://adrsupport.org/eve/forums/a/t...1/m/6161000181

[annapurna]

One thing to remember is that auto-fusion only works in a joint that can grow increasingly immobile. With ADR at a given level, those osteophytes will not be sufficient to immobilize a level which could either lead to increasing osteophyte size or change in osteophyte shape as they fail to immobilize the joint.

[go*big*red]

Just food for thought here - I was told that bone spurs grow in the spine in my case, because my discs have been bulging since childhood most likely and the bone goes "oh my gosh, there's unprotected disc out there, I must protect it" and so it grows a spur to protect it. And, in looking at my mri's, sure enough, where there's a bulge, there's a spur. Some are quite large, others not so much. It looks like the size of the spur depends on the size of the bulge.

This ran true in my neck as well where the herniations were at 5/6 & 6/7 there were spurs also.

[annapurna]

That's still hard to say. Do you have bulges that have led to micro-instability that the spurs are growing to compensate for or is it a single level interaction: bulges lead to spurs?

[tmont]

Biff,

I'd make sure to ask a lot of questions about bone wax if it's to be used to prevent the regrowth of osteophytes. Apparently it can cause a lot of complications, namely infectious risks and CSF leaks (from the link in Rich's post):

"Bone wax increases infection rates and impairs the ability of bone to clear bacteria.[6] In the presence of bone wax, the number of bacteria needed to produce osteomyelitis is reduced by a factor of 10,007 In a recent study of infection rates following spinal surgery, surgical site infections occurred in 6 of 42 cases in which bone wax was used, and in only 1 of 72 cases in which it was not used.[7]

Bone wax remains as a foreign body for many years, and can cause a giant cell reaction and local inflammation.[10] In skull base surgery, bone wax has been reported to cause granuloma formation and CSF fluid leaks.[11][12]

The alternative to bone wax is called Ostene. It does not have any of the complications know to occur with the use of traditional bone wax."

But if you check out OSTENE, it boasts of NOT having the same complications (infectious risks AND the inhibition of bone growth) as bone wax:

http://www.ostene.com/BonewaxCompl.html

Ostene won't do you any good to that end. So...looks to me that if you want to use bonewax to 'prevent' bone regrowth (autofusion) after osteophyte removal, then you accept the infectious risks that go along with it. To me they're definitely non-negligeable, esp in the cervical spine.

I'd really drill (no pun intended) your docs on which product they'd use and why as this looks a 'gamble within a gamble' when you check out these sources alone.

Trace

[JKDE302]

Originally Posted by go*big*red

Just food for thought here - I was told that bone spurs grow in the spine in my case, because my discs have been bulging since childhood most likely and the bone goes "oh my gosh, there's unprotected disc out there, I must protect it" and so it grows a spur to protect it. And, in looking at my mri's, sure enough, where there's a bulge, there's a spur. Some are quite large, others not so much. It looks like the size of the spur depends on the size of the bulge.

This ran true in my neck as well where the herniations were at 5/6 & 6/7 there were spurs also.

Thats what I was told also. How did the 2 level fusion work for you?