Degree of Facet disease before turned down for TDR

[Jack]

Originally Posted by Abbe

This is an excellent discussion and on I have been very concerned about. I am hoping Dr. Fribourgh will make the right choice once he gets in there and sees what is going on at my L4-5 level. It might be too far gone to do an ADR and I think I am prepared mentally for that. From what I have been told L3-4 is a prime candidate. I am going to go back and look at the last MRI report and see what it says specifically.

Abbe,

When you go back, ask them to give you a copy of the MRI on a CD. It should work with Mac or Windows. It has an autoloader too. You can copy individual films and post the significant ones with your name. I would love to see some for comparison purposes.

[2cool4U]

They should be compatible w/Macs, but not all of them are. To make matters worse, some will not run in Windows Vista, either. Mine will only load on XP or older versions of the OS. And the images are from my own freakin' hospital!

So much for portable medical records and information sharing. Two steps forward...

-tc-

[ans]

I have ~ 3-4 mm of retro-something (= spondy). I wonder how much of an issue this could be for an ADR.

[Jack]

Originally Posted by ans

I have ~ 3-4 mm of retro-something (= spondy). I wonder how much of an issue this could be for an ADR.

This is a question I have as well. There was an earlier post by tc that described how spondy is graded (it is a % of total disc space distance). I have read several sources that said Grade I is the upper limit of what is acceptable for disc replacement. There is information on this site as well that discusses relative contra-indications for ADR.

From what I have read, the majority of spondylolisthesis is caused by fractures in the spinal isthmus at some point in the past. This is the thin area of bone on either side of the spinal canal between the vertebra and the bones of the facet joints. Some say it can be as far back as childhood. The structure of the ligaments around the spine as well as the integrity of the discs help to prevent undue strain on the facet joints. As we age an the disc starts to dry out or at such time as the disc starts to fail, slippage occurs. My questions revolve around how much is too much loss of disc height disc, and how much is too much damage to the facet joints. L5-S1 seems to be the place where this is most important. Just by looking at the orientation of our spines it is pretty easy to see the loads are not just up and down at this joint. Sheer forces probably are highest here.

[Jack]

Originally Posted by tconner94

They should be compatible w/Macs, but not all of them are. To make matters worse, some will not run in Windows Vista, either. Mine will only load on XP or older versions of the OS. And the images are from my own freakin' hospital!

So much for portable medical records and information sharing. Two steps forward...

-tc-

tc,

As truckers would say "I heard that". Reminds me of a previous discussion we had about furnishing Radiologist more information than just a statement like "low back pain" in order to help them read a radiological study. My films from '05 & '06 were not on CD but were of the old fashion plastic variety. I had each study in a separate envelope, labeled when and the type (CT, MRI, flexion plain films, etc) I put a brief 4 line description of chief complaint, history, and a request to evaluate the facet joints clipped to the front of a big envelope containing all the studies.

I couldn't get them past the RT. She said "Oh, all we need is the printed report" after she said "we can pull them up on-line". I told her I doubted it. After a brief struggle on my part, she reluctantly took them to what I hope was the Radiologist. My note was gone so I hope so. I think, not being an expert on reading MRIs, I ended up with a conservative read. I noticed it was signed by a resident and "checked" by an attending. This may or may not have been reflected in the degree of conservatism. If I didn't have a copy of my current MRI, I would request a second opinion. This is a good indication to me of our litigious society and the push to cut costs by pushing things along in an assembly line fashion. I have a friend who is a plastic surgeon at this same hospital. When I'm around and he is in clinic, I'll stop by for a brief chat. He gets all kinds of grief, and I do too, if the BS session takes more than two minutes. The Radiology tech, I'm sure was just trying to push things along not what anything to upset their SOP. There was a sign in the waiting room that said if you have to wait over 15 minutes to tell them at the desk.

[2cool4U]

for all of my appointments! I must be doing something wrong.

We do grade spondylolisthesis as I've previously mentioned. However, we also measure it, which apparently for ADR is the most appropriate indicator. Now, please do your own searches into this and don't take this post as the final word, but there are several articles quoting 2mm as the greatest degree acceptable. I don't know if this an absolute contraindication or a relative contraindication. I also don't know if it varies by device type.

Obviously, if it's only a relative contraindication, then your surgeon will assess your complete situation (there is a list of complete criteria on here somewhere, I think). It has been a while since I looked at basic research (lab investigation, not clinical in other words) into the mechanisms and pathophysiology that cause spondylolisthesis, but theories were only speculation then. Some said congenital (birth) and others said microfractures or repeat stress. We do know that people are born w/defects in the pars articularis and never change alignment. Others show up with unexplained spondylolisthesis, sometimes with disc disease and sometimes without. It has been a long time since I read an update, and I didn't go looking last year when I was researching for my own surgery since it didn't apply.

The radiology comments are interesting, especially for a teaching hospital. We are not a teaching practice, and yet our techs are trained to bring us jackets or digitize the films from other places. I can't promise you that they do it all the time, but I know I get things this way on a regular basis. I would've guessed that a residency program would place greater emphasis on that since they usually have the luxury of more time than we private practice guys.

Hope this helps.

-tc-

[Jack]

It seems I spend to much time in every day Googling back pain and the like. I did find one site with good pictures and text to explain and show spondylolisthesis.

It helped me a lot. Hope it helps others too.

http://www.back.com/causes-mechanica...listhesis.html

Just for grins, there is a Scotty Dog image in the lateral view of the spine and no tconner94 can't play. Where is it?

[ans]

I had ~ 3-4 mm of retrost (allright, backwards spondy) and w/get an MRI in a few days.

I must check how much can be tolerated for each disc e.g. Charite (assuming my facets aren't shot). I read that for intense cases, special fusions are required. Of course, I know nothing about this.