Why does fusion help facets and not ADR?

Maddie · #1 12-04-2008, 12:02 PM

There probably is a previous thread about this in the archives, but I can't handle sitting for long periods to search for it.

There is a new poster in one of the other sections who said she was having both adr and fusion over two levels in her cervical area because one of her facet joints was toast, and needed the fusion.

Why does a fusion help with the pain of the arthritic facet when adr doesn't? What do they do that makes a difference?

rhatzy · #2 12-04-2008, 04:26 PM

I believe it is because in fusion they actually remove the facets.

Mark

CharlesinCharge · #3 12-04-2008, 06:05 PM

In some fusions they remove the facets, but not all. I had an XLIF fusion, and they did not touch my facets. The main difference between ADR and fusion when it comes to facets is that ADR allows the facet joints to continue to be mobile, whereas in fusion they are locked in place (i.e. fused, as is the entire section of the vertebra). My surgeon told me that even if the facet joints are very arthritic, the pain comes from movement. If you lock them such that they cannot move, the pain stops. A good surgeon who sees that the facets are bad prior to doing a fusion will use screws to lock them down---this helps with the overall fusion and also keeps the facet joints from moving. No motion, no pain. Think about it, if you had a very arthritic knee but somehow you never moved it, you would not feel any pain.

Maddie · #4 12-05-2008, 12:26 AM

Thanks guys. Both replies makes sense. Just one more question though, Charles...wouldn't just the constant pressure on the facet cause pain, if it was inflamed....even if it wasn't rubbing?

Also, what is an XLIF fusion, and where did you have it? At Stenum also? And why a fusion instead of the ADR at your L3/4....because of inflamed facets? I need adr at the same levels you had, and they said my 3/4 also had a slight herniation, but not needing treatment. I am hoping that it doesn't get much worse in coming years.

CharlesinCharge · #5 12-05-2008, 11:23 AM

Maddie,

The facet joints are very small, with a small area of cartilege on them. They don't have the large surface area of a knee or shoulder, where inflamation could cause pain even without a lot of movement. I suppose if the facets were really inflammed you could get pain without movement, but my surgeon told me that the main pain generator was movement (bone rubbing against bone because the cartilege covering had worn away, which is the definition of arthritis) and fusion prevents that movement.

If you read my signature, you see that I had DDD at three levels but only two (L4-L5 & L5-S1) tested positive for concordant pain when I had my discogram. When I went to Stenum for my ADR surgery, I asked them to replace L3-L4 as well, because I felt it would continue to deteriorate and I did not want to come back in 2 years for another surgery. They declined, and so I only had the two levels done. I got a lot of pain relief, but was never 100%. About a year later I was involved in a traffic accident, and my back pain increased quite a bit. Eventually after several other treatments failed, we did a CT and MRI and the L3-L4 disc looked worse than it had 2 years earlier. They did another discogram on that disc, and this time it tested very positive for concordant pain.

Problem is, another ADR surgery is very difficult because of the scar tissue on the blood vessels on the spinal column (that are moved during surgery) from the anterior (frontal) approach. Dr. Zeegers in Germany was willing to put in a Active-L disc from a lateral (side) approach, but I had already spent $35,000 out of my own pocket to have my first ADR surgery and this was going to cost me another $40,000 out of pocket. I simply could not afford another huge financial hit, so I chose to have the XLIF fusion, which is currently the most advanced and minimally invasive fusion available. My facets were slightly degenerated at L3-L4 but could have handled an ADR surgery.

XLIF (Extreme Lateral Interbody Fusion) is done from a lateral (side) approach, through the psoas muscle. The incision is not very large and they use arthroscopic instrumentation. They put a special plastic spacer in the disc space, which is supposed to be easier on adjoining segments than the traditional steel cage. Hardware (rods, screws) are not usually needed. My surgery took place at 7:30 AM and I went home the same day. Most people I know that had fusion spent 2-4 days in the hospital. I had it done locally (I live in San Francisco) by a surgeon who had done more of them than anyone in the U.S., and my insurance (Blue Cross) paid for everything.