Go Back   ISPINE.ORG Forum > Main forums > iSpine
Register FAQ Members List Calendar Search Today's Posts Mark Forums Read

iSpine Discuss QUESTION:L5/S1 ADR or FUSION? in the Main forums forums; Hi Guys, I would like to know your opinion on whether or not L5/S1 is worth putting an ADR ...

Reply
 
LinkBack Thread Tools Display Modes
  #1 (permalink)  
Old 05-22-2009, 06:53 AM
Member
 
Join Date: Apr 2009
Posts: 69
Question QUESTION:L5/S1 ADR or FUSION?

Hi Guys,
I would like to know your opinion on whether or not L5/S1 is worth putting an ADR or better off fusing? Generally speaking and in my case.

I am considering further surgery at this level after microdiscectomy and now severe DDD with back pain.With only 4.5 mm disc height in the middle and possibly nearly bone on bone at the front and back of the vertebra. I have mild facet hypertrophy on one of my three radiologist reports,but the others didnt mention it. I feel I may have some facet pain though. Not yet tested. Discs above look really healthy and plump. I have no nerve pain.
So I am trying to decide : Is ADR too risky because of limited disc height and possible facet problems? Will the extra movement cause more pain? And fusion better for me as discs above look healthy enough for now. And also L5/S1 is said to have limited motion anyway.
I would greatly appreciate your thoughts.
Michelle.
Reply With Quote
  #2 (permalink)  
Old 05-22-2009, 07:58 AM
Senior Member
 
Join Date: Jan 2009
Posts: 327
Default

MM,

You need to check that your facets are not a pain generator before surgery.
IMHO, ADR better than fusion at L5/S1, but I am sure there are people on here that may disagree.
If you have facet pain, fusion is better.
It all comes down to the fact that it is your choice and what your surgeon recommends and why.
Reply With Quote
  #3 (permalink)  
Old 05-22-2009, 02:47 PM
cls cls is offline
Junior Member
 
Join Date: Jan 2009
Location: Colorado
Posts: 16
Default

Michelle,

I considered ADR and consulted an Ortho who is very much in favor of ADR and does not like to fuse but I was precluded due to low disc height. I was on the fence with ADR anyway but this sealed the deal. After reading countless threads on those who had ADR at L5/S1 the trends did not seem positive. Overall I did not get the sense that manufacturers have come up with a device that is a long term homerun and I did not like reading the numerous accounts of facet joint problems from those who had radiographically "perfect" facet joints prior to ADR but then developed problems down the road. It is a very tough thing to decide what kind of treatment to undergo but after researching and consulting highly skilled Orthos or NSs you will land on a solution that will feel right for you. The only piece of advice that I can offer is to find a top notch surgeon who is highly skilled in whatever procedure you go with. Surgeons will perfect the procedures that they are best performing. Good luck

One size does not fit all when deciding ADR vs Fusion there are just too many factors weighing these or any other major procedure. Here are some things to consider while researching your options and talking to your doctor:
Your age and general health - Is bone density an issue? Do you have any other health issues? Arthritis?
Your surgeon - what does he/she specialize in, are they known for being a top doc in this specialty? Do you know someone who has had the procedure from this doc that can give a good reference or at least share their experience?
How active are you? - What are your expectations for recovery?
Risk tolerance - Know the risks for any procedure and determine what you can live with.
Hardware/Procedure - With ADR there are more and more devices coming out. Learn what you can about them and understand the pros and cons of each. Which one will you have and why does your surgeon choose the device? With fusion, there are different methods and hardware devices as well. If you went this route would your surgeon perform an ALIF, TLIF, PLIF or XLIF? Would you use donor bone or BMP or your own?

This is just off the top of my head, I am sure there are many more factors to consider. I'm sure others will chime in.
__________________
L5/S1 Disc Ruptured - Completely Gone
2/19/09 MIS-TLIF

Last edited by cls; 05-22-2009 at 03:54 PM. Reason: Added an additional thought
Reply With Quote
  #4 (permalink)  
Old 05-22-2009, 05:13 PM
dshobbies's Avatar
Senior Member
 
Join Date: Oct 2006
Location: Los Angeles
Posts: 1,597
Default

MM,

I agree with Runner. Fusion puts a burden on adjacent segments which can lead to further deterioration resulting in more surgery down the line. This does not mean it will definitely happen in your case.

Your choice of surgeon before deciding which way to go is a primary concern. Choosing a doctor who performs both surgeries is more likely to recommend what is best for your circumstances as opposed to what he is more comfortable with himself.

Good luck to you, Dale
__________________
3 level Prodisc adr S1-L3, Oct 12, 2005
Dr. B in Bogen, Germany
Severe nerve damage in left leg, still working on it
Reply With Quote
  #5 (permalink)  
Old 05-23-2009, 12:42 AM
Kathy's Avatar
Senior Member
 
Join Date: Jan 2009
Location: Dallas, TX
Posts: 305
Default

I have an ADR at L4/5 and had a 1 mm herniation at L5/S1 and L3/4, prior to surgery with L4/5 have a grade 4 tear. If I had to have something done on L5/S1, personally, I would have a fusion. I agree with cls, I have heard too many stories of people having problems with too much movement, when they have the lowest level done. This is just my opinion, do your research and pick what is best for you.
__________________
34 years old-
1/06- In wreck with 18 wheeler
Numerous MRI's, PT, chiropractic, accupuncture, TENS therapy, massage therapy, facet injections, epidural injections, Nerve study, Discogram, confirms pain in L4/5, IDET, decompression, Bi-lateral neurotomy L3/4/5, denied by insurance twice, in Active L clinical trial, had surgery March 17, 2009 in Miami, FL- received Active L disc
Had Baby #3 after ADR!
Reply With Quote
  #6 (permalink)  
Old 05-23-2009, 01:35 AM
Member
 
Join Date: Apr 2009
Posts: 69
Default Love to hear from L5/S1 spineys!!!.

Thanks for your replies..... I am finding the decision very difficult to say the least.
Everyone seems to have a different opinion on this one. And of course it really does depend on the individual case.
I have seen 2 renowned surgeons in Melbourne that use the Charite and both of them said no and recommended a Tlif. I dont know how many they have performed but I dont think it would be many. Their reasons were because of previous surgery,scar tissue, disc height, possible facet issues. I think they like pristine conditions because they may lack the experience but at the same time they may be right in being conservative. These may well be sound contraidications. I will wait on my opinions from Germany and am expecting a completely different opinion. So who do I then trust?

I sometimes try each one on for size and imagine how it would feel in my back to have either of these procedures done. It makes me realise that I do have a certain amount of motion in that segment that I would lose with fusion. For example when you walk you seem to move quite a bit in that area from side to side albeit not as much as above.What I want to know then is Do you completely lose all movement there when you walk? And it then gets transferred above?
Then I imagine having ADR in there. I find it really hard to imagine what having the height back wold feel like and then that extra movement after so long.My back has flattened a bit over th 2 .5 years and I dont know if my facets would cope with the extra lordosis.
If it didnt cause pain then I would be right. If it did cause extra pain then I dont know how id cope.
So maybe thats my answer. I have become more and more intolerant of pain as time goes on. I am just sooo sick of it!!!!
I would dearly love to hear from anyone who has had either procedure at
L5/S1.
But welcome everyones opinion.
Michelle.
Reply With Quote
  #7 (permalink)  
Old 05-23-2009, 05:49 PM
dshobbies's Avatar
Senior Member
 
Join Date: Oct 2006
Location: Los Angeles
Posts: 1,597
Default

MM,

I know you're sick of the whole process.

Stop dwelling on this until you hear from Germany. If you get differing opinions, then you start up again but give yourself a break and don't deal with anything you don't have to.

Of course, please let us know what you hear from Germany and we'll all tell you again 'this is what I think'.

Take a break until you hear more. You deserve it!

Dale
__________________
3 level Prodisc adr S1-L3, Oct 12, 2005
Dr. B in Bogen, Germany
Severe nerve damage in left leg, still working on it
Reply With Quote
  #8 (permalink)  
Old 05-23-2009, 06:01 PM
Senior Member
 
Join Date: Sep 2006
Posts: 2,260
Default because of this reason I procrastinated..

This is one of the very reasons I couldn't bring myself to make a decision re surgery .. in '03 I was accepted for clinical trials to do ADR on L4 and L5S1 and then by '06 I have some moderate facet arthopathy at L5S1 and only a one level disc replacement is FDA approved so WC auth'd a disc replacement at L4 and fusion at L5S1.

I'm so freaked about fusion and the possibility of screws that I didn't have the surgery.

I have an elderly father that lives cross country that I need to be on call for and just felt that I couldn't be sure of the recovery w/fusion at any level.

Ok so I procrastinated until now and as I'm aging things aren't getting any better back there/in there!

It's a tough decision to make and I surely understand altho I do hope you won't procrastinate as long as me and can move forward with your life with a sound surgical decision. Good luck from one that understands that rather circular way of thinking..
Reply With Quote
  #9 (permalink)  
Old 05-24-2009, 01:28 AM
Member
 
Join Date: Apr 2009
Posts: 69
Default

Yeah, thanks. I am sorry..... I guess my anxiety is showing.
I am a Gemini and the twins are constantly fighting with opposite opinions neither one gaining the upper hand. I will try and relax untill all the data is available.
It has been an extremely stressful time for me. My partner of 18 years left me late last year. I had to sell our house which I just moved out from and now im at my parents place with my 17 year old. I have other health issues also ....so the list goes.
I am sick of the pain and want to be able to move on with my life but as we all know this surgery thing is no sure garantee of that. I think if I was older than 34 and had lived a bit more I would find it easier and not resent having to take it so slow as much. I will just have to be patient and positive a little while longer.

Thanks for your support,
Runner,cls,Dale,Kathy and Maria.
Reply With Quote
  #10 (permalink)  
Old 05-25-2009, 06:45 AM
Junior Member
 
Join Date: Nov 2008
Posts: 21
Default

I can't really say what would be best for you MM, but since I have a dodgy L5/S1 and if I had a choice of Fusion or ADR. I'd go fusion. I am way too scared of an improper placement or device failure or facet stress. Just reading about Phylly and Mark from Perth and quite a few others, I realise its complicated to get the ADR out.

I've also spoken to a few people who have had fusion at l5/s1 and they have not had much movement limitations. I emailed one lady who works on her farm all day, lifting bales of hay etc, horseriding and she's feeling great. I think the kicker is that any fusion these days must consist or removing the entire disc inserting a interbody and then using bone, preferably donor. Not excising the disc and just fusing with rods and screws will lead to a lot more pain as they disc is still leaking chemical irritant. see MartyUSA blog

http://www.ispine.org/forum/surgical...gery-over.html

I'm also now a little wary of BMP from what Mark Mintzer wrote http://www.ispine.org/forum/ispine/1...-data-too.html I honestly don't know if BMP is the problem or not. But I'd prefer if my doc didn't use it.

I'm not too concerned of adjacent disc degeneration. I wouldn't be planning to do any heavly lifting, I just want to be pain free. So if L4/L5 did degenerate, I'll deall with it then. Perhaps after another 10 years they would have improved on the ADR and you would then assess the options.

probably the hardest part of fusion is to constantly remind yourself that you are still fusing and musn't stuff up that fusion process. Its easy to forget if you are 4 months in and semi fusing and you start bending.

But as you rightly said. There is definitely no guarantees and sometimes just dumb luck can play a part.

hope you can navigate to a pain free existence Michelle.
Reply With Quote
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are On



All times are GMT. The time now is 05:45 AM.


Powered by vBulletin® Version 3.7.2
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.