Maria, this may be an interesting discussion. I've talked about this many times with many of the leading surgeons I deal with. Many of them say that the autofusion process is typically incomplete and that the patients experience continued movement and pain, even when the movement is very small.
I really question the view that they have. Nobody ever comes to them to say that autofusion is complete and their pain is gone. They only see patients that have failed.
There are specific cases of autofusion that I have seen that have had good outcomes in terms of reduced or eliminated pain at the level that has fused. The one discitis case I know autofused into a configuration that mostly resolved the LBP at that level. I'm told that after the debridement surgery, they always autofuse.
Several cases of subsidence I've seen have resulted in autofusion with good result. While the subsiding plate is still moving and changing, it's very painful. It also releases the osteoblasts, osteoclasts, etc... that promote autofusion. After it stabilizes, it's no longer painful and if the disc space isn't too severely collapsed and the configuration is somewhat sound, it autofuses with good result.
Neither of these types of cases have anything to do with autofusion without surgery. Your questions are interesting. I agree that if the autofusion process is so advanced that ADR or other arthroplasty solutions would not be considered at that level, what value would discography be? At the other levels, an '06 discogram result will be of little value in 2010, unless your situation is really the same (which is hard to imagine.)
Did you have the endoscopy yesterday or is it next week? Bummer about the GI issues... I hope you get that solved soon.
Call me when you have a chance... take care... all the best,
Mark
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