email from surgeon

[Shay]

Hello all,
I have received an email from a surgeon with diagnosis and recommendation for Shay and there are a few things that seems "off" for me but I'd like an objective opinion. I won't say who the surgeon is so don't ask.


"You do have moderate facet involvmenet – once the disc height is lost, the pressure is transferred to a larger-than-normal part by the facets. But facet pain is no contraindication to intervertebral ADR. Actually disc degenration and loss of disc height has transferred load and weight to the dorsal joints. Restoring disc height and -function biomechanically will unload the facets. "

"...would use a Pro Disc L type in your case. Because it`s tooling is optimized, because of it`s long experience. And ... does not favor unconstrained disc replacements, esp not for multilevel: Having a “free core” means no guidance of movement by the ADR, which is intended. And which is close to a physiological discs, which does not have a fixed centre of rotation either. But: degenerated discs are not virgin discs. They as a rule lack the necessary external guiding structures. A natural disc IS guided in it`s movement by ligaments, annulus and facets. It`s not “wobbling freely”. Exactly those structures are involved in the degeneration process, and either are slack, or calcified and tense. In ADR implantation with a good mobilization and regain of disc height e.g. the dorsal and lateral annulus has frequently to be resected. One should not compromise on nerve liberation to keep them unresected. And hence the additional guidance of a semiconstrained disc (like Pro Disc L or Acitve L etc.), are highly appreciated. These factors are the more relevant in multi-level, where positioning can positively influence spinal alignement in semi-constrained ADRs."

From everything I have read, facet pain or damage means no ADR.
Pro Disc is not advised for this very reason. Too much movement causing facet damage.
What am I missing? Perhaps I am not reading this correctly?
Thanks for your help.
Yona

[Harrison]

Yona, your logic and intuition make sense to me. One crucial question remains: what is the degree of facet arthrosis (arthritis)? This is critical to know.

Sadly, you may get different answers from different surgeons on this question; it may help to consult directly with a radiologist if possible.

[annapurna]

I'll take it a step further than Rich: in the early days there were patients that got ADRs with facet pain only to have the facet pain resolve as part of or after the surgery. You really need to know the degree of facet problems and get at least one more opinion, if not more, before you should make a decision. It sounds like something's wrong here but it might not be as bad as you think.

[Shay]

Shay plans on getting a few more opinions, I just wanted to make sure I was understanding the issue in relation to the email. Thank you.
Feels like I'm taking a course in spinal surgery, just without the test at the end of the class.
Wouldn't that be a cool idea? A course in all this, like a webcast.
Different topics could be taught/discussed. I'd pay $20 to attend one.
I'm such a nerd. I immediately think tech solution.
Yona

[annapurna]

Don't worry. We've been looking for the courses in stem cell biological repairs, diet, knee surgery and recovery, spine surgery recovery, and a host of other things. Where are the really useful college classes when you need them?