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Arthroplasty Central Discuss Facet Joint Arthritis -- Multiple Levels in the General Discussion forums; Facet joint arthritis When I was searching for better descriptions of facet joints earlier today, I came across this image ...

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  #1  
Old 01-24-2009, 07:28 PM
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Question Facet Joint Arthritis -- Multiple Levels

Facet joint arthritis

When I was searching for better descriptions of facet joints earlier today, I came across this image of an arthritic spine, and it made me wonder: has anyone in this community ever been diagnosed with multi-level facet facet joint arthritis? It’s one thing to hear about it at one level, perhaps it is another matter to see it so graphically as the image on this web site.
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Old 02-07-2011, 01:06 PM
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Sorry to say, yes, I have mulitlevel facet arthrosis, and this is a timely topic as I'm narrowing down my surgical options. I'm very concerned about the Charite (my US doctor's recommendation) and the future of my facets. I have mild-moderate facet arthrosis at L5-S1 (but that level will be fused no matter where I decide to go) and mild facet arthrosis at the L4-5 level. Dr Boeree (UK) states the M6 will be fine with the mild diagnosis, and will create space again. The graded resistance will prevent over-extension. I'm concerned about the Charite's non-constrained design.
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Joey Sue - 46 years old
9/28/2011: Hybrid STALIF TT interbody fusion at L5-S1 and M6-L ADR L4-5 with Nick Boeree, UK - forever grateful to you Nick!
Prior to the fix: Severe DDD L4-5 and L5-S1 with moderate facet degen at L5-S1, but only mild facet degeneration at L4-5.
Still lurking: L3-4 Small annular tear and mild DDD, L2-3 mild DDD. Cervical discs a bit of a mess too, but no symptoms in any of these areas.
http://healthyback2011.blogspot.com/
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Old 02-07-2011, 09:53 PM
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Joey Sue,

Given what you stated (and only that), I would be concerned about any ADR at your L4-5. Staging the degree of arthosis on facets seems to be subjective, as are the nebulous agreements of constrained-semiconstrained disc designs on diseased facets.

There are several different grading systems for radiologists, but I don't know if there's a lingua franca for all clinicians yet. Can you do 50 hours of research, write a paper for the community and get back to us?! We'll love you for that. And then some.

We should expect more from the spine societies by now. ADR has been practiced in the US since 2000, and in Europe since the 1980s. This confusion on facet problems (disease and arthritis) is long-lasting. Case in point -- you responded to "timely" post from two years ago!

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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
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Old 02-07-2011, 11:59 PM
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The reliability of computed tomography and magneti... [Spine (Phila Pa 1976). 2009] - PubMed result

Quote:
The reliability of computed tomography and magnetic resonance imaging grading of lumbar facet arthropathy in total disc replacement patients.

Stieber J, Quirno M, Cunningham M, Errico TJ, Bendo JA.
St Luke-Roosevelt Hospital Center, New York, NY, USA.
Abstract

STUDY DESIGN: Prospective inter-rater and intrarater reliability analysis.
OBJECTIVE: To compare the inter-rater and intrarater reliability of magnetic resonance imaging (MRI) and computed tomography (CT) for grading of facet arthropathy as well as determining whether there is a contraindication to total disc replacement (TDR).
SUMMARY OF BACKGROUND DATA: Several classifications attempted to evaluate lumbar facet joints and their degree of arthropathy. The Fujiwara-MRI and Pathrea-CT classifications remain the most commonly used.
METHODS: A total of 10 fellowship-trained orthopedic spine surgeons and 3 orthopedic spine fellows evaluated 50 levels from L3-L4 through L5-S1 on parallel axial MRI (T1 and T2) and CT images. The degree of osteoarthritis was graded on a 4-point scale (Fujiwara-MRI and Pathrea-CT). Surgeons evaluated whether the degree of facet disease represented a contraindication to TDR. Grading was performed during 2 sessions. Weighted kappa statistics were used to describe inter- and intraobserver agreement.
RESULTS: The inter-rater reliability for MRI was 0.21 and 0.07 (fair to slight) among attendings and fellows, respectively. inter-rater reliability for CT was 0.33 and 0.27 (fair), respectively. The mean intrarater reliability for MRI was fair, 0.36 (attendings) and 0.26 (fellows). The mean intrarater reliability for CT was moderate, 0.52 (attendings) and 0.51 (fellows). For possible TDR contraindication, the inter-rater reliability for MRI was 0.22 and 0.01 (fair to slight) among attendings and fellows, respectively. Inter-rater reliability for CT was 0.33 and 0.45 (fair), respectively. The mean intrarater reliability for MRI was fair, 0.36 (attendings) and 0.26 (fellows). The mean intrarater reliability for CT was moderate, 0.52 (attendings) and 0.51 (fellows).
CONCLUSION: The current grading system for facet arthropathy has only fair agreement. CT is slightly more reliable for grading. Intrarater reliability was only fair for MRI and moderate for CT. Only limited agreement existed between surgeons as to the extent of facet disease that would pose as a contraindication for TDR.
Just make sure there is a decent layer of cartliage. It will show up as a black sort of line on the mri, with a space in between the facets full of lubricating fluid. Compare the diff levels on the scan to get an idea.

I had one surgeon who wanted to wait until he opened me up, and if the facets did not distract smoothly, fuse it. It sounded like a reasonable idea to me, but he wanted to leave another level alone and wait for stem cell therapy.

If you google 'fujiwara facet' you can find a few low quality pics of the grading system.

Good luck.
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Old 02-08-2011, 08:47 AM
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Quote:
Originally Posted by Harrison View Post
Joey Sue,

This confusion on facet problems (disease and arthritis) is long-lasting. Case in point -- you responded to "timely" post from two years ago!


Ha! That I did! Guess that's just what I'm looking for right now, and the subject, not the date, jumped out at me. Glad someone responded after 2 years! I'll get working on that paper in my spare time.... so, you can expect to see it sometime... after retirement?

Thanks Chris for the information. I'll have to look at my MRI slices at work today and see if I can figure them out. Luckily, I work at a hospital and can probably rustle up someone who does understand them!

I don't think I can expect a consensus from a physician anytime soon on my mild contraindications and whether or not ADR is a good idea. I'm an occupational therapist, and when people come to me for therapy, I try therapy. When you go to a surgeon, you can generally expect to get surgery. Having done all of the conservative measures and the fact that I'm refusing a 2-3 level fusion, of course they are likely to recommend an ADR. So, it's back to the only slight reassurance I have that I'm a good candidate... my own research.

This is a crazy roller-coaster ride.
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Joey Sue - 46 years old
9/28/2011: Hybrid STALIF TT interbody fusion at L5-S1 and M6-L ADR L4-5 with Nick Boeree, UK - forever grateful to you Nick!
Prior to the fix: Severe DDD L4-5 and L5-S1 with moderate facet degen at L5-S1, but only mild facet degeneration at L4-5.
Still lurking: L3-4 Small annular tear and mild DDD, L2-3 mild DDD. Cervical discs a bit of a mess too, but no symptoms in any of these areas.
http://healthyback2011.blogspot.com/
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Old 02-08-2011, 10:26 AM
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Is Facet replacement an option in conjunction with ADR? I haven't done much research on this, but I have seen a few articles on trials, and Dr. Bertagnoli's website shows the Zyre Facet Implant System as an example...
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Old 02-08-2011, 07:38 PM
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Yes, facet replacement solutions have been developed to work with an ADR. They're still relatively new but have been in use for a few years now.

BTW, I know that many will protest that ADR is only a few years old but Europe's been playing with ADRs for something like 20 years. Facet replacements are still in their infancy in comparison and, like all new technology, may have a few bugs to work out. They're probably better than being crippled with pain but everyone needs to draw their own line about how bad they'd have to be to try a new device.
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