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Wouldn't you know, I had to google to find your thoughtful posts, a few months ago, on the subject I'm pondering now.
For what it's worth, here are my thoughts about one of your options, fusion at 5/1 and ADR at 4/5.
I've found no specifics yet in my google searches, to confirm that fusion increases the risk of adjacent segment degeneration, even in the case of fusion at 5/1. But I would argue we have one very significant statistic already: Is it not true that 5/1 is the level that most frequently fails? And what is 5/1, but the disc that has solid bone, not another shock-absorbing disc, beneath it. So, isn't 5/1 analogous to the level adjacent a fusion: any level that does not have a shock-absorbing disc adjacent (especially below) is going to get more stress and be vulnerable.
However, let's think about fusion at 5/1 with ADR at 4/5. The vulnerable level is 4/5; that's the level that meets solid bone. But your 4/5 will be plastic and metal, able to stand up to the abuse (and no innervated annulus to complain). So, that would be an ideal situation in which to have 5/1 fused, if fusion appears the best option at that level.
That's my first thought. My second has to do with your statement that you have a lot of DDD. Do you have vulnerable levels in addition to 5/1 and 4/5? It is my current hope that borderline discs can be saved with one of the biological therapies just now coming available. Especially combined with ADR, we might be the first generation of back sufferers to need major back surgery only once in our lives.
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