Intro from USA - Cervical Facet Syndrome and ADR

[VinceMH]

Greetings!!

In 2010, I had severe impingement with pain/numbness to my right arm that lead to ACDF C6/7, which was completely successful and a very easy recovery.

In 2020 I started to have pain in my neck, but no symptoms elsewhere. MRI showed moderate disc degeneration between C5/6 and mild degeneration of C3/4 and 4/5. The doc I saw in 2010 was retired, so I saw a different doc who recommended fusion of C3-7, which I was wary of doing. I got additional opinions from Mayo, another local doc, and Dr Ritter-Lang in Germany. The two USA docs said the pain was cervical facet syndrome and that fusion was not recommended and even if done, would likely not resolve the facet pain. All three docs recommended PT and possibly RFA.

In 2021, I had bilateral RFA to C3-5, which wound up being a horrible experience. The pain was gone, but also was my ability to hold my head up. My head felt like a bowling ball balancing on a golf tee. I had to "balance" my head to keep it upright. If I leaned forward, I literally had to use my hand to push my head back up to a "balancing point". After a few months, this situation got better.

The pain returned in 2023, but much worse than in 2020. I also have significant reduction in range of motion. I still do not have pain/numbness in my extremities. Knowing that disc degeneration will continue and eventually lead to some type of corrective surgery, I started looking for alternatives to fusion, which led me to this site.

Since I'm in the USA, the ADR solution is not approved if there is previous fusion and even if there was no previous fusion, ADR is only allowed for two levels. I am now considering multi-level ADR in Europe. I again consulted with Dr Karsten Ritter-Lang who recommended ADR C3-6. However, I have seen some critisicms of Kitter-Lane, so I am looking at other doctors in Europe. I plan to consult with Clavel, Desai, and Bertagnoli.

I am looking for feedback from anyone who had cervical facet syndrome and ADR. Did ADR resolve the facet pain? Logically, it seems that restoring the space between the vertebrae would also restore the space between the facets and resolve the facet pain. Thanks for listening. 2023 MRI attached

Cheers!

[annapurna]

The main argument about ADR resolving or not resolving facet pain was lumbar but the results and logic there should apply to cervical. Basically, the improvement in disk motion going from a degenerated natural disk to a correct height ADR would improve the motion of the facets and decrease pain. That's balanced by the tendency for all ADRs to allow for some degree of non-physiologically correct motion which overloads the facets. Experience with lumbar seemed to say that mildly damaged facets benefitted from the improved discal motion and decreased pain and severely degenerated facets held constant or got worse. Moderately degenerated facets were a crap-shoot to see if they'd improve or not.

Cervical forces should be lower than lumbar but all of the structures are also smaller so the stresses might be similar between the two areas. Cervical motion, from what I remember, is a lot higher than lumbar so you have that working against the logic of improving facet pain by using an ADR.

As one data point - Laura did end up with a pair of cervical ADRs and has mild ongoing facet pain from the hypermobile segments. Her pain is better than it was pre-ADRs and has resolved to the point where prolotherapy to limit hypermobility, exercise & stretching, and turmeric is enough to keep her functional - no drugs needed - but the pain isn't fully gone.

[VinceMH]

Thank you very much for the reply. Your explanation makes much more sense than any explanation I have gotten from a doctor!!

I saw another doc today who said "no way" to ADR with existing fusion. He also said that facet pain would likely increase with ADR since the ADR would allow movement in the facet joints. Basically the same that you stated in the case of severely degenerated facets.

Again, I appreciate the helpful response.

Cheers!

[Harrison]

Hi Vince.

Many years ago, I posted about the staging of facet arthritis. I barely recall the name of it; but it's important to understand how ADR surgeons can stage/classify the degree of arthrosis, which is typically an aging disease of some sort. I'll take a look using the advanced search function.

[Harrison]

Not the post I was looking for, but may be helpful:

https://www.adrsupport.org/forums/showthread.php?t=7036

[VinceMH]

Thanks Harrison!

[VinceMH]

I saw another surgeon yesterday who had an entirely different, and totally logical, view on the neck pain that I have. He is Dr Brett Reichwage at Baptist Hospital in Pensacola. I assumed that he saw my MRI and was going to recommend fusion, as my other two doctors did. He walked in and I started explaining that I wanted to know more about facet degeneration and it’s effect on ADR or fusion. He stopped me and asked what was my complaint. I told him axial neck pain and limited range of motion. He said he saw my MRI and there was no way I needed a fusion. He explained that the fusion procedure was created many years ago to correct structural defects that resulted in pinched nerves and loss of function or trauma that created an instability. In my case, there was no pinched nerve or instability, just neck pain. Fusion or ADR would not correct this, so why do it? It totally made sense. Every doctor said that fusion would not relieve the pain, so why was I even considering a surgical procedure that would not correct my complaint? He said that many surgeons see compressed or dehydrated discs, without associated loss of bodily function, and recommend fusion because that’s what they do, they are surgeons. He said, telling me I don’t need surgery will not make a payment on his Ferrari, but it was the truth. There is nothing wrong with my neck that fusion or ADR will correct! I should continue with conservative therapy in whatever form that helps, be it steroid injections, PT, muscle relaxers, NSAIDs, or anything that eases the pain and makes range of motion better, but fusion or ADR was not the answer. I felt a huge weight lifted from me with his words. PT is already helping with both range of motion and pain. I am having steroid injections next week that I expect will be even more helpful. I am no longer considering either ADR or fusion. I may get there one day, but it’s not today.

This forum is awesome for all the personal stories that are shared. It was a big catalyst for prompting me to research my issue to the “Nth degree”. I hope my story helps someone else one day.

Cheers!!

[Harrison]

That's great news Vince, thanks for the update.