fusion/spine questions

[yvette]

Well I have been told due to my vertebrae's movement I am not a candidate for the adr. - So now faced with the option of fusion or living like this.

My diagnosis, severe DDD of L5-S1 with ofcourse spondyothesis. The thing is he said that the vertebrae is not activley moving anymore when seeing flexion/extension xrays and no nerves are impinged. He said that the pains in my legs and feet are from nerve irritation from the disc and vertebrae.

So would this be considered instability? Because I have read if instability is causing the problems then fusion would probably help. The doctor seemed to think fusion would help with all the pain in legs and feet since nerves are not impinged....although I don't understand that whole thng with constant feet and leg pain.

I am assuming the last two surgeons who told me I need adr and wait for the fda, would now recommend fusion since I can't get adr.

Surgeon said, that he believes I am one of the best candidates although that does not gaurantee sucess. He said my films are all cut/dry with this being the only problem area. My age 36, no other health problems and my weight.

I asked him if I were his wife, what would he suggest, he told me if it were the same exact scenario he would tell her to do it.

He did explain I could live the rest of my life like this on pain meds, which over time would not work as well, but could be changed. Or try surgery, which may get me back to work with a wonderful recovery, or may still need pain meds.

Although I have great support from husband, he has never experienced back pain and its such a huge decision, I am trying to clearly find my best chances in making this decision. Obviuosly this isn't going away as I've tried that. Shots, therapy nothing has helped. Been off work for almost a year.

Any insights, would be greatly appreciated.

[mmglobal]

Yvette,

I would still recommend being evaluated by a surgeon who has a great deal of experience with ADR, and has experience with ADR in more difficult cases and is working somewhere where he/she can still do ADR. Because of reimbursement and lawsuit issues, some hospitals are not allowing surgeons to do ADR. Because of reimbursement issues, some surgeons are giving up and are no longer fighting the good fight. Because of experience issues, it may be the case that HE can't or shouldn't do ADR in borderline cases. Possibly surgeons with much more experience would look at your case and say, 'no problem'.

I am not suggesting that I know what is appropriate for you. It may very well be that fusion is your best option. However, I'd recommend that you get recommendations about ADR from surgeons who have the experience and have the options.

If your problem is degenerative instability, where the collapsing disc space causes some instability, then you may very well still be a candidate. (Think of a tire, losing it's air, laying on it's side. It becomes wobbley. Restoring disc height will 'retension' the system.) If your problem is a structural issue like a pars fracture, you may not be a candidate. However, I do know people who've elected to do ADR even with some instability, understanding the limitations... with good result. (I'm not sure I'd recommend that... but I'd still want to be evaluated by someone with experience in these types of cases.)

Whatever you decide... all the best and please, keep us posted.

Mark