ADR facet issues/failure? Need help!
 

I am thankful for this site and hope to find advice and support from the members as I struggle with what to do. Maybe there is someone here in the same or similar situation as I am. I am 9 years out from a l5-s1 prodisc. I was part of the US clinical trials. I had a prior posterior decompression at that level,(what I thought was a foraminotomy, but was perhaps more) which I now know is a contraindication in todays criteria. At the time, the surgeon was aware of it and didnt feel it was a issue as I was stable at that level.

Anyways, I had many good years, with a few bad flare ups when I did too much, that I managed to get over, although they took a LONG time to settle back down.

I have been in another bad flare up for the last 5 months. Perhaps it will settle down too over the next year, but it is the worse one yet. I am being treating conservatively by a physiatrist, who suspects it is my facets at that level. At first we were doing s1 nerve root injection, because I had a lot of leg pain along with the back pain, but we were getting minimal results. Last injection he did both the facet and the nerve, and the results were better, so he thinks it might be the facets. We are thinking of more steroids in the facet to calm it down or a RF lesioning.

I am depressed, anxious and scared. My life is ruined again and I cant do anything for myself and my family. I fear a revision is in my future at some point and I don't seen any successful revision patients posting, so I don't think the results would be very promising. Maybe I just have to learn to live with this and go on pain management.

So, I guess I am looking for help and advice from anyone who has facet issues post ADR. How have you managed? Did steroid or RF lesion get you over the hump? Anyone had a revison? Any new facet technologies worth waiting for ?

Sorry so long and rambling . . .

Thanks
Laurel

1999 Idet
2001 bilateral l5-1 foraminotomy
2003 l5-s1 prodisc
2012 Big flare/big problem

Hi Laurel. Welcome, sorry you are here. Unfortunately, people in this community have had revision surgeries: just search using the that key word -- use a simple or advanced search function above. You'll find many topics across a mix of different situations...

Can you tell us more about your comment below? Do you have a copy of your surgical reports? If not, it may be wise to get them. It's your legal right.

" ... I had a prior posterior decompression at that level,(what I thought was a foraminotomy, but was perhaps more..."

Also, I see you had hip surgery too. How might this be related to your lumbar disc diseases?

There is ALWAYS hope for any patient. So many of us have had unusual challenges before and after surgery, many do in fact recover without pain. We are here for you!

Hi and thanks for your quick and hopeful reply

The decompression was always described to me as a foraminotomy where "just a little bone" would be taken out. That is the way I presented it to my ADR surgeon, although he had scans and x-rays so I certainly think he could have seen and assessed the amount of decompression that was done. I did get the surgeons report, I don't recall when, I think it was AFTER adr, and was surprised to see the words"hemilaminectomy" and "faceteomy" (not sure if I spelled that right" in the report. Scared me, but it was too late. I think I gave the report to my current treating physician in 2008, but my memory might be incorrect. I looked through all my files and I can no longer find it. It has been a very long time, but I am sure I could get it again from the original surgeon's office.

As far as the hip surgery, in retrospect, not sure if the hip pain that I presented to the hip doc was coming from my back or my hip. All I know is that my back was supposedly fixed, and I had hip pain so I thought I would get my hip checked out. Hip doc convinced me it was my hip so I went through with arthroscopic surgery with him. The hip was tractioned during the surgery, and I think that pulled on the lumbar nerves, and increased my old friend the nerve pain in the leg. Eventually after that recovery and everything settled down, the hip did seem better and I was able push off on that leg in a way I couldnt before.

Thanks for the words of hope and encouragement. Right now I am feeling scared and also angry that I should have been advised to have a fusion. It is a terrible feeling to know that the device installed in your body is mistake and the "fix" (if there is one) is iffy at best.

I have tried searching "revision" but not really finding concrete success stories. . . .

Hopefully this facet stuff can be managed, and if things settle down I am promising myself to be more careful with my activities. Summer of 2011 was my best year yet and the actvities that I engaged in included: roller coasters, horsebackriding, shoveling horse stalls, carrying big bags of feed, chopping wood, all kinds of ranch work. I told myself I can just get back to baseline and can "only ride" I will be more than happy to pass off the manual labor to others

I understand -- almost too many challenges. When you can, pls do obtain your surgery reports. Any new(er) MRIs/XRays will hopefully corroborate those reports.

When you can, pls see this outcome topic:

http://www.adrsupport.org/forums/f47...geneseo-11129/

You and "Ruby" have a lot in common: love of horses, mucking out stalls, hip surgery, figuring tough problems out.

thanks

I got a new MRI last week and go in to see the doc on Tues to discuss the MRI and get a new EMG. No plans for an x-ray as yet. I have the MRI disc, but would be clueless how to upload it or read it. As I understand, the implant obscures the level anyways, so don't know how useful it will be in evaluating the l5-s1 level. It will just be able to tell if there is anything new going on at other levels.

thanks for the link to Ruby. I read thru some of that thread. She is amazing lady!

Laurel

First, push for the x-ray. It's simple and easy and answers questions about subsidence and mispositioning. The MRI can be used but you'll probably need a CT, possibly with contrast, if you can't find the paperwork about your original surgery. The CT will permit imaging of the ADR level, if the imaging center is careful, but it takes time and effort to get them to do so and the contrast, which might be needed, is a significant risk itself. Really push the original surgeon to cough up all of the information available about that surgery. Also, see if you can get the pre-surgery evaluation information used to admit you prior to the ADR. They should have had an MRI for something to show that you were an acceptable ADR candidate.

The EMG seems like a pretty advanced diagnostic step when you haven't got an x-ray or the results from the MRI. It isn't a bad step, just something that tends to work better when the person doing the test knows what to look for.

thank you Annapurna

Today I asked for the orginal decompression surgery report. It should come in 2 weeks, if they even still have it because it is so old and they destroy records after 10 years. Tomorrow I go in for the results of the MRI I had last week and also to get the EMG.

I have a difficult time pushing for tests because the doctor wants to do things his way. The current doctor I am seeing is very good and nationally known, but he is a physiatrist and a pain management doctor, not a surgeon and not my ADR surgeon, so I am not sure if he would be looking at this situation the same way an ADR surgeon would.

I see from your signature line you also have facet issues, how are you managing them?
I would really like to be able to manage this situation conservatively and not surgically.

Laurel

Laura's successfully used rhizotomies, trigger point injections, TENS, and heat to deal with the pain early after her ADR. After we nailed down what was happening more, we sought imaging and confirmed the facet arthritis wasn't getting worse. Once we knew that, she added prolotherapy and didn't go back again for a rhizo or trigger point work. A lot will depend on what shape the rest of your spine is in. Conservative non-surgical approaches work for a lot but they do have limits.

hi
 

how effective is this prolotherapy? can it be used successfully for a DDD and after laminectomy?

well, Got results of my MRI today, no changes since 2008. Facets only show the same "mild changes" that were there in 2008. Of course, the level of the Prodisc is obscured, but they must have been able to see the facets, because they commented that the degeneration was "mild", same as 2008

Also got an EMG which was basically normal. In one of the last tests where he sticks a needle in your calf and asks you to push against his hand, he did say he notes some mild nerve irriation, would not really call it "abnormal". He said he could not tell if it was new or old or if it was coming from L5 or S1. He said it was a little on the right and a little more pronounced on the left. My pain is 95% right sided. So this is odd and perhaps not relevant. Ido know from a previous (and perhaps more thorough) EMG that I have evidence of "old" radiculapathy of L5. Wish I could remember if it was on right or left side. Oh well

So he said all in all it was pretty good news. I am feeling better, which I told him, so he ordered me a PT precription and I am supposed to go back in a month. All in all I felt pretty brushed off. Last week he was talking about doing a Rhizo procedure. Now he says lets do nothing. I know the facets would be better visualized on CT and we should get flex/ext x-rays. It is hard to ask the doctor for imaging studies when he has his own ideas and thinks just a month of PT will do the trick. He is hoping I will just get better and go away. Pehaps, because these facet issues started with a precipitating event of "overdoing it", he is right, they just need to calm down and everything will be ok. it is different than some post patients with post ADR facet issues in which the facet issues came on gradually or for no apparent reason. Augh! What to do, what to do? i guess I will go with his plan, do PT for a month and if things are still not good, be more aggressive and ask for CT and x-rays. I will post as things progress.