Jarrod, I wouldn't presume to recommend any surgery. In my opinion, all things being equal, I will choose motion preservation over fusion if I have the choice in treating a mobile segment. Not all our decisions are black and white. In some cases, you are highly motivated to use motion preservation devices because you fear adjacent segment disease more than you fear the risk of ADR. If you were talking about fusing 2 segments in the middle of your neck, you would be highly motivated to use ADR instead of fusion.
Because of all the structure around the thoracic discs, they move much less than the highly mobile cervical discs. Think of your c-spine as a highly mobile system on top of an (almost) immobile t-spine. The highest risk of adjacent segment disease will occur at the mobile segments adjacent to a fusion. The longer the fusion the more the risk. When you are talking about a 3-level construct from C5 to T1, the segment that you will be most concerned about will be C4-5. T1-2 is already in the mostly immobile system and a single level fusion above it would not put it at risk.
When I'm talking about the options at C7-T1 I'm thinking about C4-5. Will there be a significant difference in the potential excess load placed on C4-5 if you have 2 ADR's and a fusion below, compared to 3 ADR's below? I think not. The 2 mobile segments at C5-6 and C6-7 will insulate C4-5 from whatever additional load is generated because of a fusion at C7-T1. I would never say that I recommend a fusion there. I'm just pointing out that there is less motivation to maintain (preserve, restore) motion at C7-T1 because of the 2 ADR's above. All things being equal... I'll choose motion preservation, but if there is some motivation to fuse (possibly because of some borderline contraindication, or the difficulty of ADR at that level), that motivation will trump the desire to preserve motion. That desire is reduced by the 2 ADR's above.
It sounds like I'm talking in circles... I hope I'm clear.
Remember... I'm not a doctor and these are just my impressions based on my experience. Take it for what it's worth... the ramblings of a computer nerd.
Good luck!
Mark
PS... say "Hi" to Messi for me! Make sure you take in a game.
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