If the reason for not getting ADR is the vascular situation, I'm not sure I understand this plan.
>>> did they do a CT Angiogram to determine vascular configuration?
It sounds like the plan is for something like a PLIF or TLIF at L4-5, followed by an anterior surgery for ProDisc at L5-S1.
The vascular situation is not known for sure. Unless you've already had an anterior spine surgery, it would take a very unusual vascular situation to preclude ADR. If my undertanding is correct and if this were me... I would proceed as follows:
> do anterior surgery for planned ProDisc at L5-S1.
> while he's there, he may discover that the vascular situation does not preclude ADR at L4-5. This all depends on how easy it is to mobilize the vessels. I've probably observed over 200 lumbar ADR imlantations and have NEVER seen a situation where the vessels presented any issue in a virgin approach. (And rarely in a revision.) So, it may be easy to do the ADR at L4-5.
> if it's not easy to do the ADR, they could still do an anterior fusion with something like a STALIF cage. This does not require as much room for insertion as ADR does. If the final configuration with STALIF or other anterior device looks good, they may not need posterior surgery.
> if there was no ADR at L4-5 or if the fusion config does not seem to be sufficient, they could flip you over and do whatever posterior surgery you needed in the same OR session. (If this occurs, the doctors and hospital will all still get paid for 2 surgeries.)
Telling you that you are not a candidate for 2 level ADR completely disarms any discussion about off-label use and the related insurance or risk management issues that sometimes steer the ship instead of medical issues.
I would rather recover from one surgery instead of 2. I would rather stay away from violating the great muscles of the back if I was already having an anterior surgery... why not do it all from the front?
Please note that I'm not a doctor... just a layperson. Don't believe anything you read on the internet!
Good luck... please keep us posted.
Mark
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