Katie, Take a deep breath and try to relax (I know, easier said than done). You are in great hands, Dr. Bitan is extremely competent and highly 'decorated', so to speak. The man is a friggin genius from everything I have read and heard. I have absolutely never heard a bad thing about him (which is rare, as even the best dr's have unhappy patients- you can't please everyone.) I, personally, have already decided if I were to need something done with my L5/S1 (which has 1mm herniation, as of 6 months ago), I would have it fused. My L4/L5 has the Active L disc. I also have a small herniation in L3/L4, which if it ever comes to it, I would have another Active L implanted. From everything I have read and heard,
in my opinion, people who have the L5/S1, L5/L4 and L4/L3 all with ADR's have problems with too much movement. That's why I would have the bottom one fused, as it sounds like the movement in it is not important (I'm sure that's an understatement).
In the ADR world, all you hear is fusion is awful and evil. It must be remembered that not everyone is a good ADR canidate. Some people have excellent results with fusion and long lasting pain relief, with no continued problems. We do know the good, bad and ugly of fusion, it's been around for a long time. With ADR, we really don't know. Why do some people have ADR, get relief and are back to square one in 5 years? We don't know the long, long term results... it's a gamble. I think with a hybrid, you are getting the best of both worlds. You get the movement, the known pain relief and longevity of fusion, and MOST important, what you and your surgeon think is BEST for YOUR BODY.
I'm sure it is very scary, facing the fusion, the very thing you had dig up all the hideous, awful research on. Now, you are trying to get one. The thing is, you aren't just getting a fusion. You are getting both, 'meeting in the middle' so to speak. A hybrid makes perfect sense to me, in theory at least and it does to seem to have extremely promising results.
Another thing, Dr. Bitan may want to do two fusions and one ADR based on something he sees in your MRI? Maybe something about your anatomy that leads him to believe this would benefit you the most? One thing that I also firmly believe and have heard repeatedly is that, the single most important factor of succesful ADR surgery is you surgeon and their skill (other than you being a good canidate, which a good surgeon is going to screen out the clinically 'bad' canidates). The device implanted is not as important as the surgeon; that's why I felt safe going into a clinical trial. I trusted my surgeons skill and knew that I was in awesome hands. I wasn't crazy about getting the Charite, as all the bad press out there; but it's also been around the longest- so there is more information on it. These new discs, we don't know, the information is not there.
I got the Active L, which is the only disc ( from what my surgeon said) that the surgeon can not only choose the implant size based on anatomy; but can also choose if it will have the smaller keels or the large center keel. It is also kinda a hybrid in it's own right, in that it is kinda both restrained and unrestrained. Meaning, the top piece is only connected to bone, the bottom piece has the plastic (whatever you call it) core connected to it and is connected to bone on the other side. So, there is no fear of the plastic coming loose; but also no fear of it being too rigid by being a one piece unitl. Is that clear as mud? Anyhow, my surgeon felt the smaller keels were best for my anatomy and I trust his decision. He also made it clear that even though the control in the trial was the Charite or ProDisc, that if he got in there and didn't feel I was suited for ADR, he would do a fusion. I liked this because he wasn't going to just do ADR, regardless, that he would do what he felt was best for me.
You could have the most amazing device implanted; but if it is not done by a skilled and experienced surgeon, it's not gonna make a difference.
Sorry so long; but I am passionate about spines
Keep us updated and know that you are in good hands! Have you watched the video on the Charite site of Dr. Bitan doing ADR surgery? At first, I didn't think I could stomach watching it, knowing it was going to happen to me. But, I also wanted to know exactly what was going to happen to me. It was very informative and extremely interesting. I would suggest anyone thinking about ADR to watch it.
Here is the link:
Beth Israel Medical Center
You are in my prayers,
Kathy