Knock-on effect from collapsed disc

[Mark / Australia]

Hi all,

I've been trawling through many many posts here learning as much as I can, and I have a couple of quick queries I was hoping someone could comment on:

1. If a disc is too far collapsed, and the space between vertabrae is too small, is it correct to say that an ADR may not be viable and that a fusion is the only option?

2. With a degenerated disc which will most likely eventually need replacement or fusing (of the vertabrae), is it likely that facet joint damage will occur if this is left for too long? Or is it too simple to say that a degenerated disc will "always" cause facet joint (or other) damage?
In my partners case, it's been nearly five years of the L5/S1 disc being largely useless in doing it's proper job.

Input appreciated.
Cheers,
Mark

[annapurna]

The answer to both of these are tied together. A collapsed disc will alter the loading on the facets and lead to increased likelihood of damage to the facets. If you get to it quickly, there's little chance for damage to accumulate. If you take a while getting to it, the facets may start going and your chances of bein pain-free after ADR decrease. How long is arguably dependent on too many things ranging from how good your nutrition was when your facets were growing to the phase of the moon and the color of the socks you normally wear.

For that matter, Sir Alastair had some damage, can't remember how much, to his facets, got ADR, and his facets improved. Blair had perfect facets, got ADR, and basically lost her facets starting almost immediately after the surgery. In theory, a collapsed bone-on-bone disc could be replaced with ADR with the caveat that there'd be a lot of distraction pain. In practice, beats me.

You've mentioned that you have good imaging studies. If your surgeon spends the time to read them (no guarantee of that unless you ask him/her to) they should be able to tell if the facets are enlarged or showing signs of sclerosis, both of which indicate early facet damage. The problem from there is deciding how much facet damage is too much to pursue ADR rather than fusion. That I can't help with except to suggest getting several opinions.