Shoreline

"Marked stenosis and facetal hypertrophy were causing pressure on the nerve roots at level L4-5, L5-S1 as well as L3-4. The facet joint was relieved at L3-4, L4-5, L5-S1 bilaterally and all ligumentum removed from the canal."....The bleeding-Blah, Blah, Blah..."The disc spaces were evaluated at L4-5, L5-S1 levels bilaterally and noted to be firm and hard."

Hey Bard, .Facet hypertrophy just means the joints are abnormally small, possibly worn down or you were born with one of several abnormalities, like Pars defect. Did they do test injections to see if the pain was coming from the facets or not, Many people can have facet changes or are born with abnormal facets like "Pars defect" and don't have any symnptoms, and some people have worn down or were born with facets that allow hyper mobility which can cause spuring, psuedo arthritis and stretching of nerves or hyper mobility.

It basically means they facets, 2 of the 3 joints that hold each vertabrea in place on the side, have worn down and deteriorated for some reason and likely no longer function as an actual joint. Because you only get 2 degrees of motion from each level, having facet hypertrophy doesn't necessarily cause pain without a nerve component like an impingement occuring. So removing a portion of the facets doesn''t always result in instability but is a possibility

The stenosis, is easy to detect with normal diagnostics and that alone, would require something surgical to correct to allow more room for nerves to pass through the facets and the forimam "outlets for nerves" A Foraminotomy could have been performed where the foramin (the area where the nerve roots exit the spinal canal) is removed to increase space over a nerve canal. This surgery can be done alone or along with a laminotomy.

His description of what exactly he did to relieve the impingements are pretty vague, he doesn't decribe how much of the facet was removed, What other bone structure was removed or touched, they could have removed the abnormal facets completely.They also may have done a Laminotomy - when only a small portion of the lamina is removed to relieve pressure on the nerve roots or a Laminectomy where the entire lamina is removed

The joints were not working corectly anyway and were impinging nerves so removing them was part of relieving the impingement. The procedure is called a Medial Facetectomy - when part of the facet (a bony structure in the spinal canal) is removed to increase the space.

Each joint only allows 2 degrees of movement, so removing the interlocking portions of the joint shouldn't cause that much instability in theory. But it can certainly lead to slippage in some cases. The doc tested both sides at each level for loss of disc space and stability without the facets holding things in place. At the time your spine appeared stable without the facts interlocking. However you could develop slipage of the vertabrea clled spondylolisthis, This usually ocurs as L5 shifts over S1 or L4 shifts over Lg when you flex or extend. This type of instabilty is treatd with fusions. I was wondering why he would remove the stabalizing pieces of your spine, but he felt things were still solid. But he can only move and put so much pressure on your spine when your laying on an OR table. Flexion and extension Xrays would be the first place to start to look for slipage. If that doesn't show, Flexion and extension can be observed under flouroscop or with a myelogram. But Many docs would rather be dismissive than look for ways their surgry destabalized your spine.

Nobody would conclude my fusions failed untill hardware actually snapped and allowed the vertabrea to slip again. There isn't a test to detrmine if a fusion is alive and thriving or the donar bone is dead and sand jus hasn't been absorbed yet.. So Untill I had concrete proof "broken screws" no surgeon would consider the fusion failed because the hardware was still holdng things in place. In your case, you have no hardware, so DX this type of problem should be easier and faster if your doc is wlling to consider you still have a problem other than the need for pain meds, It's too easy to explain away someones need for meds as addiction rather than accept their surgery did releve some of the problems but created others. I was wondering why they ddidn't use hardware to maintain alignment although you didn't appear to need a fusion at the time, without the facets, you may need one now..

I guess hardware placed at that time without a fusion would have made nserting donar bone more comfortable, so he kleft the option of a fusion open should your spine become unstable, and vertabrea start shifting when you flex, bend, twist or walk. There are definitely things tey could be looking for that may explain everything.

The spondy just seems like a good posiblity given the number of levels that he removed the facets on and the mechancical structure and workings of the spine.

What type of symptoms are you having other than pain?

Sorry this took so long to get too, but I really don't mind when i'm up to it. and I'm feelng up to it so fire away if you have a question or didn't understand something I wrote. Finding a good picture of a vertabrea with the different parts labeled will make it easier to understand what they did and how the facets inner connect and should work. His report really isn't very clear, another surgeon would definitely need some diagnostics to understand what exactly he did. Not testing you sounds more like refusal to accept his surgery didn't work or not wanting to know his surgery may have cured one problem and created another. But he did give himnself rom for another surgry. I guess the idea is that fusions are final, all you can do is attempt to refuse and extend a failed fusion, but he did leave room for more work should you need it. Ideally that surgery solved the problem but he left the option to fuse at a later date if you should develop other problems.

Strengthening the core muscles may help you with instability too if that is what the problem is. BY core I mean your abs and back. Many back surgery patients loose a lot of core strength. If your standing up right with your arms straight out in front of you, does this cause pain and can someone easily push your hands down with minimal pressure. Sort of the way when you hold a box close to your chest it dosn't load your spine the way holding something out at arms length definitely loads the spine and multiplies the amount of strength needed to keep your arms out and up.

I use light weights, 1# and 2#lbs and lots of reps to strengthen those muscles and stabalize my back where conventional stretching and strengthening may cause more damage and instability to my unstable spine. I can explain the excercsises in more detail if holding your arms out in front of you causes pain or your extremely weak, it definitely indicates you need to strengthen those core muscles that allow you to stand comfortably and can maintain alignment when you lacking some of the boney structure that naturally maintains alignment.
Take care, Dave