[mmglobal]

How much distraction is too much? Please remember all the 'I'm not a doctor" qualifiers here... I'm just sharing my layperson's experience... I can be completely wrong.

I don't think they know during the surgery. They can't ainticipate how much damage is being caused in the posterior elements. When will they abort ADR and convert to fusion. There will be a different answer depending on the doc. I've seen completely collapsed disc spaces that most surgeons would say is too severely collapsed for ADR, still be completely mobile and have a VERY easy implantation. I've also seen much less severely collapsed segments that are VERY immobile and are VERY difficult to remobilize and might have had ADR procedure aborted by less experienced surgeons.

I think we might wish for more "OK this is too tough" kind of assessment. More accurately would be wishing for surgeons to know BEFORE scheduling the surgery when they would be getting in over their heads. Much of the trouble I see comes from surgeons without a great deal of experience getting involved in very difficult cases.

I already see facet replacements or other posterior stabilization technologies being applied behind ADR. It's still very new. Even when common place, each case will still be completely unique. IMHO, it will be many years before this can be done in the US because the new technologies will not be applied to these types of cases until long after approval.

Mark