Do these things preclude ADR surgery?

[ans]

1. 3mm of retrolthesis
2. mild lateral recess and foraminal stenosis
3. facet arthropathy
4. Mild neural foraminal stenosis related to intraforaminal endplate osteopyhyte formation.

I have too many levels of DDD for fusion I was told. This is from a six month old MRI; dont' ask why I just got this now.

Now I'm concerned that I'm too far gone.

Do MRI's showing facet arthropathy (two levels, L4-5; L5-S1) necessarily mean that they are shot or are they deceptive and only by a host of imaging can we get a rough handle on how facets are and how they'd respond to ADR?

I'm seeing another doctor in LA for an opinion this January. Thanks, Allan

PS I was seen by two docs, one of who checked this MRI out when I asked if my facets were ok; he might have conferred with another doc but told me that "You're looking fine". I've been a chump before but I'll see..

[Jim M2]

Allan,
Could you remind me again how long your lumbar has been problematic?

7mm disc height is roughly 50%. Maybe your facets are salvagable. I went from 50% disc height after diskectomy in 1981 to 15% disc height just prior ADR. I'm better off than pre-ADR but at 28 months post-ADR I still deal with chronic pain that can be quite debilitating.

How are you with walking, can you maintain a normal gait? I ask because I had trouble walking pre-ADR, and I suspect it was an indicator of bad facets.

Jim

[Mariaa]

My OSS said he wanted to get a CT scan to see the state of the facets, and do a 3rd discogram.

[ans]

I have have been been a moron; MRI's for the last 3 yrs. indicate facet degeneration but my OSS told me that they're fine.

I've had trouble since I was 21 but an MRI was performed due to foot drop about 3 years ago. I have "marked to moderate" disc loss at L4-L5; L5-S1 "marked loss of disc height".

Walking doesn't make me worse.

Thanks for your advice too Mariaa. I did not note that the facets were realized in the discogram but I assume (correctly?) that a discogram is related? Or just to make sure how things are re: pain indicators.

I suspect it's time to see Roy Simon for facet injections which fortunately did nothing. That was 2.5 years ago so perhaps a good sign as the MRI's then did mention facet degeneration.

Now I feel like a real patient on this forum.

And since my neck hurts, why not a cervical MRI. Gee, aging is charismatic.

W/appreciation, Allan

PS Anyone know what this means: " Mild neural foraminal stenosis related to intraforaminal endplate osteopyhyte formation." *Does this preclude* surgery. Are osteophythes "shaved"?

[sahuaro]

Alan:
You are hardly a moron--and while your anxiety is soaring and you are kicking yourself, you haven't gotten a definitive answer as yet about your options. And--it isn't clear whether this was the initial state of your facets (and you weren't told)or whether there has been a deterioration.

Maria: Is a CAT-scan a better option for visualizing facets than MRI's? I'm asking for clarification not only for Alan but for myself as I approach the time to re-evaluate my status.

[ans]

Yeah, I got worked up. My previous MRI's from 2003 show "moderate" facet degernation at least one level (I can't find the other one). I hope that MRI's aren't too clinically significant re: one's facet(s) condition. Thanks.

[annapurna]

One caveat: this post if from Annapurna's husband and I'm not as informed as she is.

Facet arthropathy is almost impossible to diagnose at mild levels from imaging or clinical presentation. If you do show it on MRI or CT, either works, you're probably in trouble, but get at least two people who know what they're talking about to read the films. Laura's had multiple people read her films and the answers have ranged from her facets are within normal variation of being perfect to she should seriously consider getting everying below the affected level amputated now and save time.

Assuming you do have facet arthritis that has advanced enough to be visible on film, there are several facet replacements either through trial or in trial now. Laura has all the details; please email us if you need the information and she'll send all the current stuff.

In answer to your PS, assuming I translate doctor correctly your veterbrae are growing spurs from the endplates that are beginning to pinch off the holes where the nerves exit at that level. The more important answer here is that the degree to which it is happening affects your chances for sucessful surgery, but it did say mild so you it's worth pursuing with somebody who knows what they're talking about/

[ans]

That's interesting b/c I had my MRI reviewed by a Maven who said they're fine - and this is the same one as from the report. And earlier on, there were two MRI reports of facet degeneration in 2003. I've also been told three years ago that I had arthritis - but in no particular location.

Hmm, maybe spring (and this'll hurt) for two opinions.

Thanks, Allan

[Mariaa]

Allan,
I didn't mean that the discogram was going to be done to determine the status of the facets, sorry, just meant he wanted to do a 3rd one which I really didn't need to state at all w/regard to facets. Sorry for confusion. Just the CT scan is what the doc wanted to order in terms of determining facet status..
I've never shown any problem on MRI with facets...and hopefully won't still be showing any by the time I actually get around to doing something with this spine in way of ADR.
My first step before any other testing is a BMD again tho~ might decide my fate rather rapidly..
And Allan, please, you a moron? Then I must be nearly be a neurosurgical genius.. (duh)...

Allan, In May, my doc had another MRI done (9 month after my 1 level fusion) because I was complaining of increaed pain. It showed one facet mild arthritic change but he ordered a CT. This showed 3 levels .bilaterally arthritic cysts...He felt at that time this was where my pain was coming from. However in July when I could finally get in for the injections to see if that was the case. I had no relief..That's when I went in for another discogram which showed pain generators at 4-5 , 5-S1. I read his report and he said "since the findings are rather surprising", he sent me directly to CT scan from the discogram. It showed annular tears at both levels. Obviously most if not all of my pain is from the discs but still the fact that the facets showed on films to be breaking down I am assuming in short order I will be having pain from these as well. ( this is why as you know I had to change tactics as far as ADR)
I hope this all didn't confuse you more!
Leslie