Facet Joint Replacemet?

[mtoto]

Hi everyone

I am Mtoto, a 39 year old female from Germany. (Please excuse me if I write a little "strange" sometimes, especially my medical English is not too famous..)

Here´s a brief summary of my story:

I´ve been suffering from increasing back pain for around 9 years now, been on heavy drugs for 6 years and -as probably most of you- I am sick and tired of it all...
I guess my main diagnosis is severe inflammatory degeneration of the facet joints as the pain can be diminished, pretty reliably but only temporarily by injection of steroids/lidocaine. In addition, MRI shows a severe prolaps, some disc protrusions and stenosis of the spinal chord but fortunately I dont´t have the typical pain symtoms that can come along with all of that.
Over the years of facet degeneration a sliding vertebra developed but so far I could "catch" that one with consequent build-up of the spine supporting muscles.

But since last year the inflammation episodes came in much shorter intervals and much more powerful and I am seriously struggeling to handle it these days. I am having allergic reactions to NSARs so I refuse to take them and steroid injections all the time imho cannot be the ultimate solution either. Plus, the stronger the inflammation is the more tissue is likely to be destroyed, and the degeneration progresses even quicker. In addition, with the inflammtion, that tends to spread even to the vertebrae, I cannot do my workout routine, so the muscles degenerate and the sliding vertebra can follow gravity very happily, causing further pain. Kind of a vicious circle...

So I was thinking maybe replacement of the facet joints could stop the whole process as even if an instabilty remains, grinding on non-body tissue should cause no irritation, no inflammation or further degeneration. Does that idea make sense?

Unfortunately my current docs have never heard about facet prostheses so I have to do some research and ask around a bit. Maybe someone here can help me:

- has anyone here any experience with facet joint replacement?

- could anyone recommend an experienced doctor who does it? (I already contacted Dr. B. in Bogen/Munich, haven´t received a reply yet)

- some doctor I contacted for facet replacement wants to replace 3 of my disks first (he wants to use Freedom Lumbar Disc). Isn´t ADR totally contraindicated with severe facet degeneration??? *confused*

Any reply or comment would be greatly appreciated!

Kind regards

mtoto

[mmglobal]

mtoto, welcome to the forum!

Yes, severe facet degeneration is a contraindication for the current crop of anterior column only ADRs.

There are many alternative systems. Total Spinal Motion Segment System (TSMS, see here) includes an anterior ADR and a total facet replacement, BOTH IMPLANTED VIA A POSTERIOR PROCEDURE. I've seen a few of these surgeries and they were quite impressive.

There are other systems, including minimally invasive 'facet resurfacing'.

For most of these new technologies, I don't think there is anyone with more experience that Dr. Bertagnoli.

Good luck! Please keep us posted as you make progress. All the best,

Mark

[mtoto]

Thanks for your quick answer, Mark.

Even me I came across the facet resurfacing (FENIX and Zyre), and I especially like the fact that it is minimal invasive. TSMS I have never heard of (thanks for the link), I only saw "Inlign TMS" of the same manufacturer but, to be honest, all these complex solutions are kind of scaring me off.

Plus, my main concern is that all of those procedures are pretty new, no reliable data or studies and the doctors can basically tell or promise me anything just to get a new "guinea pig" with me, I have no idea how to valitate what they promise me...
Like this other doc I mentioned: I asked for facet replacement and he tried to "sell" me an ADR. Scary. There the facts were pretty easy to put together, as even you confirmed: ADR and severe facet degeneration is a no go.
But as soon as it gets to all the further biomechanical stuff that has to be considered I see no way how to make an informed decision without any valid data of surgery outcomes available.

Anyway, I´ll keep you updated what happens.

Kind regards
mtoto

[mmglobal]

I agree with your assessment of the difficulties in validating the info you are getting, but disagree about the ultimate data that will be produced. I've been living spine 24/7 for more than 10 years. For last 8 years, I've been attending the surgeons conferences and spending a lot of time with many of the greatest surgeons in the world. I see something of a disconnect between the data that is presented and the real-world experience. Most data is generated based on an agenda and is often 'spun' in a way that presents their agenda. Note that many of the negative studies also are also based on an agenda and many of them are not to be believed.

You are doing the right thing by getting as much info as possible about all your options. Sadly, your options will be somewhat limited by your situation. Hang in there... you'll know when it's time to decide.

All the best,

Mark