Interspinous devices - any experiences?

WyleECoyote

Hi,

I've just learned about the DIAM - flexible buffers that can be placed between the Interspinous process to relieve Kissing Spine. I've not been diagnosed with Kissing Spine but rather with facet joint degeneration. Unfortunately steroid injections only relieve the pain somewhat for about a fortnight, and RFI Ablation doesn't help much either.

Anyone had experience with these? They sound like they could be worthwhile investigating.

Many thanks,
WyleECoyote

stickywicket

I've never heard of this let alone had one but I googled it and the BMJ, in an article whose header my tablet refuses to copy and paste, says conventional surgery has a better, more lasting outcome.

And, yes, steroid jabs are short lasting and only mask what's going on.

WyleECoyote

stickywicket wrote:

I've never heard of this let alone had one but I googled it and the BMJ, in an article whose header my tablet refuses to copy and paste, says conventional surgery has a better, more lasting outcome.

And, yes, steroid jabs are short lasting and only mask what's going on.

The advantage is these are minor surgery and don't go near the spinal column so nerve damage is almost completely avoided. Plus 2 day recovery time. They significantly reduce the load on the facet joints as well. If it doesn't work or causes an problems you just whip it out. Pretty amazing huh?

Anyone interested can google 'Interspinous spacers' or 'DIAM spine'.

stickywicket

I tried again and found this.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4014612/

Conclusion

Although patients may obtain some benefits from interspinous spacers implanted through a minimally invasive technique, interspinous spacer use is associated with a higher incidence of reoperation and higher cost. The indications, risks, and benefits of using an interspinous process device should be carefully considered before surgery.

WyleECoyote

Thanks for the link. That was helpful for context as I see that study was assessing effectiveness in treating lumbar spinal stenosis. I don't have that. I have facet joint arthrosis which are not addressed by the go-to surgeries such as fusion etc.

I'd be very interested in hearing from anyone that has had the spacers inserted with good or bad results. It doesn't matter what condition they were inserted for - would still like to hear your experiences.

Thanks all. I'm having a hard time with the pain again. You know how we just cope but every now and then we go on a search thinking 'there must be something out there!' then we give up and keep on keeping on. I'll probably get over this phase. I've been 'getting over it' for 20 years.

frogmella

If you persist you can get fusion for facet joint arthritis. I had it and am totally cured. To be fair I do have private medical insurance but my surgeon had done it on the NHS too. Keep badgering away.

WyleECoyote

frogmella wrote:

If you persist you can get fusion for facet joint arthritis. I had it and am totally cured. To be fair I do have private medical insurance but my surgeon had done it on the NHS too. Keep badgering away.

I have private too but I honestly didn't know you could get fusion for facet joint degeneration. Can I ask you a few questions? (I got my refreshed referral back to the private spinal surgeon today so hopefully will see him soon.)

Which facet joints did you fuse, and did you have degeneration of the nearby (to the fusion) facet joints? How have your nearby facet joints coped with the extra load (I assume there is extra load)?
Do you have issues with sacro-iliac joint degeneration?
Had you tried other procedures prior to the fusion? (eg steroid injections, denervation)
What has the recovery and long-term impact been like for you?

Thank you so much for mentioning this. It gives me some hope that maybe... one day... something might get fixed.

barbara12

HelloWyleECoyote and welcome to the forum
I am down to have spinal decompression, or fusion if that doesn't work on 2 disc, am I right in thinking they do the Interspinous in America, I remember reading about it a while ago..just wish we could move on ... :roll:

frogmella

Hi, of course it os ok to ask questions! That is what we are here for! Although, now cured, I feel like an imposter!!

This is the Cliffe Notes of my story!
I originally had a prolapsed disc and DDD at L5S1 and was fused for that. It got infected and after many battles with my then surgeon and repeated flare ups of pain/swelling/illness he finally removed the infected hardware after 20 months.
Then the pain didn't get better and he couldn't explain it - despite mentioning the facet joint problem at L4L5 and poking me in the back at that level to confirm that was the issue. I think he thought it couldn't be that causing so much foot/leg/back pain.
Anyway, after persisting for about 6 more months I went to see my new surgeon (lovely man, happy to share details by PM) who worked out that the facet joint arthritis at L4L5 was the issue for me. He confirmed it with injections (done under general as he is an absolute perfectionist and that way he is certain they go in the correct area). They worked for about 3-6 months. Then he offered me fusion at L4L5. Best thing I ever did. Apart form some back ache if I stand still for too long or sit on bad chairs for too long I never have an issue.
As this was my second fusion I now know how my recovery should have been first time! First time was awful due to the infection. Second time was great. Obviously the immediate aftermath was a bit grim but I was done on the Tuesday and out of bed walking unaided by Friday. Came home the following Monday and was fine. Was banned from housework for a year (shame!) and took all his advice re exercise etc. Built back up slowly. I am now three years out and back to fell walking and I swim miles!
My advice is to keep on at your surgeon. If that one isn't helping much then try another one. They all have different ideas and different methods. There is hope out there. I think that many surgeons just don't understand how bad facet joint pain is and the impact it can have. I was lucky and found a good guy who saw my problem and could/would fix it!
Happy to answer any more questions. I spent many pain filled years researching spinal issues - might as well pass on what I learnt!!

WyleECoyote

Hi Frogmella,

Thank you so very much for sharing this. I finally saw m spinal surgeon today and I asked him about facet joint fusion. I also told him I was no longer a candidate for RFI Ablation/Denervation because BUPA UK won't allow it to be performed more than once (absurd considering all nerves grow back - I know).

He took another look at my MRI and Standing X-Ray and we went over my history again (steroid injections helped but only for two weeks). He reiterated that my L5-S1 facet joints are florid-looking on the scan and he feels confident that previous improvement with steroid injections indicate we have been focussing on the right joints. He has ordered another set of lumbar MRIs and standing x-Ray's so he can compare them to the ones we ran two years ago as a precursor to recommending a facet joint fusion.

I was so much happier when I left because by the time I see a doctor I'm so sleep deprived and in pain that I'm emotionally depleted about the whole thing. But then when I got home I got a very sceptical reaction from my husband who has obviously seen me try many treatments without success, and who is spooked by spinal surgery because his father was paraplegic (after a gliding accident). So now I'm not so enthusiastic. But I just don't want give up if there is any chance I could have a better quality of life with less pain. So, I really appreciate your description of your procedures. It gave me something to focus on after this discouragement. :cheers:

frogmella wrote:

Hi, of course it os ok to ask questions! That is what we are here for! Although, now cured, I feel like an imposter!!

This is the Cliffe Notes of my story!
I originally had a prolapsed disc and DDD at L5S1 and was fused for that. It got infected and after many battles with my then surgeon and repeated flare ups of pain/swelling/illness he finally removed the infected hardware after 20 months.
Then the pain didn't get better and he couldn't explain it - despite mentioning the facet joint problem at L4L5 and poking me in the back at that level to confirm that was the issue. I think he thought it couldn't be that causing so much foot/leg/back pain.
Anyway, after persisting for about 6 more months I went to see my new surgeon (lovely man, happy to share details by PM) who worked out that the facet joint arthritis at L4L5 was the issue for me. He confirmed it with injections (done under general as he is an absolute perfectionist and that way he is certain they go in the correct area). They worked for about 3-6 months. Then he offered me fusion at L4L5. Best thing I ever did. Apart form some back ache if I stand still for too long or sit on bad chairs for too long I never have an issue.
As this was my second fusion I now know how my recovery should have been first time! First time was awful due to the infection. Second time was great. Obviously the immediate aftermath was a bit grim but I was done on the Tuesday and out of bed walking unaided by Friday. Came home the following Monday and was fine. Was banned from housework for a year (shame!) and took all his advice re exercise etc. Built back up slowly. I am now three years out and back to fell walking and I swim miles!
My advice is to keep on at your surgeon. If that one isn't helping much then try another one. They all have different ideas and different methods. There is hope out there. I think that many surgeons just don't understand how bad facet joint pain is and the impact it can have. I was lucky and found a good guy who saw my problem and could/would fix it!
Happy to answer any more questions. I spent many pain filled years researching spinal issues - might as well pass on what I learnt!!