2 1/2 years post op - Charite ADR L5/S1

[Michelle]

So sorry to hear you're still having problems! It's frustrating, huh? I hope they're able to calm your facets down. I'm dealing with mine right now too, though mine were arthritic before my ADR. Can they do both sides at the same time? Mine did. Anyway, I hope it gets better soon for you! Hang in there!

[Blairsara]

Laura and Michelle - thanks for your kind words I really appreciate it! Being in constant pain is a daily battle and I look at it as though I will not give up and be defeated.
Like I said I went to the back doctor on Friday and found out the results of my CT scan. But I asked for a copy of the cd with the results for my own records. I just looked at it now and my doctor failed to mention that I have a bulging disc at the L4/5 level and it said that it was 1.5mm. I havent done any research about bulging discs but it said on the results that 1.5 is minimal. If it's at 1.5 now will it continue to grow?
I am a little confused on some of the terms so I was wondering if someone could help me out. This is what it said:
L5/S1: bilateral facet arthropathy; bilateral anterior projecting osteophytes from facetes which are mild sclerotic, left greater than right. What is sclerotic?? than it says that my central canal and nerual foramina are widely patent. What does that mean?
Hope everyone had a good weekend!

[Poncho]

Hi Blair,

Bulging discs - it may be a benign problem at this point. Many people live with bulging discs every day and have absolutely no idea they have them because they present with no symptoms. Then, there are other people out there that have a slight bulge of the disc and are in horrible pain. This is one of the reasons that it is soooo hard to diagnose spine problem(s). AND this is why finding what the cause of your pain is.....

This bulging disc at L4-5 could be nothing.... and I hope that it is nothing....

What dermatome path is the pain following? It sounds like the PM doc has things narrowed down to the facets - considering that you received some relief with the left sided rhizo.... This also makes sense because it corresponds to the arthropathy or enlargement of the facet joints.

Mild sclerotic in this case appears to mean a mild narrowing. Think of the heart when they talk about arteriosclerosis which is a "hardening of the arteries" - basically this type of sclerosis is caused by a plaque narrowing a heart artery - Same concept applies to the spinal canal they are saying that there is some mild narrowing there.... Keep in mind that narrowing and inpingement are two different things.

Now - they are saying that the spinal canal is widely "patent" meaning that there is nothing obstructing the spinal canal - my impression is that they are saying that even though the spine has some areas of "narrowing" there is no obstruction or impingement of the neural structures.

Hope this helps..

Poncho

[Blairsara]

Poncho
Thank you so much for responding, I appreciate it. I'm guessing the reason why my doctor didnt mention that I had a bulging disc was b/c that it's not related to my symptoms, and he believes that my pain is directly related to my facet joints. This makes sense to me because all of my symptoms point to my facet joints and the rhizo significantly helped the pain on my left side, since I don't feel it anymore. I'm guessing that when a bulging disc is a problem is when its hitting the sciatic nerve and then causes pain. My mom suffered from a bulging disc, but didnt have surgery and now she's fine.
I think youre right that the bulging disc is nothing at this point considering my symptoms, but I wonder if it's directly related to the Charite because I didnt have a bulging disc before my ADR.
Again thanks for the info on those terms I tried googling it but was having problems. Hope you're doing well.
I'm going in for a facet block next week so hopefully that will help with the pain.
Thanks.

Blair

[mmglobal]

With more advanced DDD, the doctors describe 'modic' changes to the vertebral bodies. These refer to changes in the bone and are representative of how far you are down the degenerative cascase. After we've had DDD for a while, the endplates start to look like they were dusted with powdered sugar. As you progress down the degerative cascade, these changes become more pronounced. These are sclerotic endplates:



I'm not used to seeing facets described as sclerotic... but Blair's description was talking about osteophytes... are they from the facets or from the vertebral body?

Mark

[annapurna]

Blair,

Thanks for posting your test results so that we can all learn. From what I've understood, the descriptor "sclerotic" when applied to a joint surface refers to densification or hardening of the subchonral bone. This hardening typically occurs in response to a mechanical overload such as would occur in the case of articular cartilage loss (arthritis), or a change in joint biomechanics. Since you've said that your Charite permitted excessive extension to the point of permitting subluxation of the facets, this could be the source of the overload.

The presence of osteophytes on the facet joints would go hand-in-hand with the sclerotic bone as another response to overstress. Osteophytes are typically a joint's crazy way of trying to stabilize itself or increase it's contact surface area in order to reduce stress (load per unit area).

The term "patent" applied to nerve openings typically means "wide open".

If I were drawing conclusions from this description, I'd say that your facets are taking a beating as shown by the sclerotic bone and osteophyte growth. On the other hand, the osteophytes have not yet gotten large enough to even start to close down the foraminal or central canal nerve openings. I'd be interested in seeing the thickness of your remaining articular cartilage on the facet surfaces and whether or not there way any sign of effusion or synovitis in the facet capsules. If you've still got articular cartilage left, then it's likely that the facets would calm down once you corrected the improper loading coming from your ADR. If you have little or no articular cartilage left, you might want to think about doing something else down the road.

Forgive me if I yack too much, but, your CT report reads almost like my MRI reports. I feel like I've found someone else in the same situation as me.

Best,
Laura

[mmglobal]

From http://www.asnr.org/spine_nomenclature/glossary.shtml

discogenic vertebral sclerosis: Increased bone density and calcification adjacent to the end-plates of the vertebrae...

[Maria]

Hey Blair,
I wanted to say how much I enjoyed meeting both you and your mom that day at Dr.Regan's office. Both Dr. Regan and Dr. Apostle were so kind and gracious that day to take the amount of time they did in seeing me, I was truly impressed. I think you have a wonderful team there taking care of you.

As mentioned, I agree that you are an inspiration to us all and I was so impressed to learn that you are in law school and dealing with this spinal "stuff"~ you go girl

No matter who tells us (the patient) what about pain, how long we will have it, how to control it and so forth, ultimately we have to deal with it. No one can most definately tell us that our pain will be infinite or not~ so this is something that we ourselves must move forward with, deal with and hopefully one day overcome or learn to live well with it.

You are young and have the world at your feet~ that is something no one can take away from you. My sincere best wishes for the outcome of whatever you will endeavor to overcome pain and get your spine in order.

take good care and look forward to seeing you again in the future when I may retain you as my attorney???!!!! (before that hopefully)!!!!

[Blairsara]

Hey guys,
first sorry for being mia, I've been really busy since school started and dealing with my back. So I'm here to give a new update. As I said before I had the CT scan and shared the results. I went in for another facet block but this time on my right side and it didnt help at all. Dr. Regan didnt want to see me until 3 months after the facet block. But I cant go through this semester like I did last semester so I want to get a rhizotomy on the right side, which Dr. Fuller thinks is a good idea.
I was a little frustrated that Dr. Regan didnt mention that I had bone spurs, didnt mention that I had a bulging disc, and a few other things. His intern was the one who came in and told me what was going on, and then Dr. Regan came in and said it was my facet joints and wanted to go the same route that we did with my left side. It wasnt until I looked at the CT scan myself and the results and then got answers from you guys plus doing research online that I understood what was going on.
Right now I'm grappling with what to do next, in terms of fixing this problem. The only thing that can fix it right now is a fusion, or I wait a few yrs for the new procedure. But I dont know if I should do the new procedure after the problems that I've had from the disc replacement. I dont want to end up being a guinea pig for and keep going in for these new procedures. What happens if I get the new one and then the same thing happens.. then what I keep waiting and then doing more new procedures?
At least now I finally figured out my daily pain cycle and can take my meds accordingly. Dr. Fuller put me on lyrica because of the burning, radiating, pulsating, aching etc... and it has helped a bit.

Maria - It was such a pleasure meeting you as well! I'm glad to hear that your meeting went well. Dr. Apostle is great, kind of cute too huh?! I think youre right about having them as a great team, but I am going to go to different doctors, a few neurosurgeons and some other ones to show my CT scan results and to see what they think I should do for my next course of action - fusion vs. new procedure.

Thank you so much for calling me an inspiration. The one thing that I've learned from this whole experience is that I can help other people who are going through constant pain and are having a difficult time staying positive and not letting it defeat them. I look at it as though my back will not control my entire life and my dreams, but rather I deal with it face on and will get through anything.

When are you going through with your surgery? I hope that everything goes well and my thoughts are with you!!! Take care and good luck!



Laura -
Thank you so much for all of that information.. you rock and I totally appreciate it. So thanks!! It really helped me get an understanding of what's going on since I didnt get a straight answer from Dr. Regan's intern and Dr. Regan just said, "its your facet joints and lets take the same course of action that we did with your left side."
I'm curious to know what your MRI results said. For me, it's good to knwo that there are people out there that are dealing with the same kind of problem as me. It's hard considering I'm in that 5% group. You had ADR right? Are you thinking of waiting for the new procedure or doing a fusion?
I hope youre doing well, and again sorry for taking so long to respond.

Thanks again you guys for your kind words, I really appreciate it and it really does mean something to me. Thanks.

Blair

[Blairsara]

Mark
It was from my facet joints. The results are all dealing with my facet joints minus the bulging disc.

[Maria]

Re scheduling surgery~ I've been given a brief reprieve from pain and am enjoying it immensely~ I wonder how long it can last? I'd like to schedule surgery for when it's over!!!!!

However, WC being what it is, I'm going to have to name a date and change it if necessary. Before I do the spine surgery I will be doing a bunion surgery~

Last time I did this on the left foot.. since my gait was off for nearly a month (gimping) my back went out for 8 weeks.. and WC wouldn't authorize an ESI so I had to just live with the pain and get over it. Took too long!!!

Hopefully I won't have such a lengthy recovery with this bunionectomy tho I do want to get it over before I would have spine surgery so I wouldn't tork my gait afterwards intentionally.

I hope you will soon get some relief from whichever treatment you undergo! Take good care and hope you are doing OK! Maria

[Blairsara]

Maria,
I am so glad to hear that you're doing really well! congrats! I'm sure youre catching up on things that you were unable to do while you were in such excruitiating pain. I hope it lasts a long time!
Good luck with the bunion surgery. Is it painful? I hope not, and I hope it doesnt affect your back like it did the last time. what's an ESI? I hope you have a fast recovery, and that it doesnt take away from you living without back pain at the moment. When are you going in for that surgery?
No new updates for me.. basically the same thing. I need to contact Dr. Regan's office to find out when I can do the rhizotomy. My PT gave me a name of a great accupuncturist so I'm goign to start doing that. Figure I'd go to him the days that I'm not going to PT. Right now I'm just trying to focus on managing my pain so I can get through another semester. I just hope that I dont have to go through my entire law school education like this.. I know I can do it, but I really dont want to. But we dont always get what we want.

I'm looking into going to other doctors, neurosurgeons and other spine specialists, any recommendations? Considering that I'm going to have to have another major surgery in the near future, I would like to get second and third opinions on what I should do - fusion vs new procedure. Like I said in my last post I'm really afraid that if I do this new procedure I'll end up in the 5% bracket again, and I dont want to end up being a guinea pig. Do you know of anyone who had ADR and than ended up getting a fusion? Did they have problems with their surrounding discs?

Again, its great to hear that you're doing well! I hope it lasts for a while and make the best out of it! Take care. Hope you had a great superbowl weekend!