For me, the decision to have ADR at T1-T2 had nothing to do with the theory of motion preservation versus fusion. I would not object to fusion at this level because it is largely immobile anyway. I had to have surgery at this level because of the substantial disc herniation there, substantial spinal cord compression and the resulting symptoms. For me, the ADR at T1-2 is simply an inexpensive interbody device. Why use this instead of a less expensive fusion cage???? BECAUSE IT DOESN'T HAVE TO FUSE!!!
There is a failure mode of fusion that I don't have to worry about because I am not needing to fusion to occur. Yes, there are potential issues with the ADR, but I am less worried about those than I am about the potential for the problems associated with fusion.
Based on the rationale presented for the hybrid, it would seem that if the same case were presented with a healthy L4-5, then fusion at L5-S1 would be indicated. I would venture a guess that the selection would really be ADR at L5-S1 because of the positive trade-off of risks/benefits for adr vs. fusion in good candidates. IMHO, you either embrace these theories or you don't.
If reimbursement issues are paramount, that should be a substantial part of the discussion. These issues may be a driving force and more or less important based patients (financial realities), insurance companies, different surgeons, different hospitals, etc...
I have a tough time considering 360 fusion when the anterior surgery must be done for the ADR. I suppose that anterior plates, STALIF, or similar anterior only fusion techniques may not be quite as solid as a 360 fusion, but how solid is solid enough? What are the issues that would make STALIF OK in some patients, not in others? The posterior surgery and posterior instrumentation are no small deal.
Gotta run... wish I could write more now...
Mark
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