Pre-emptive ADR?

[fortitudine]

In the "to fuse or not to fuse" post, Allan/ans asks about "pre-emptive ADR" at a level above current damaged levels. That's an interesting concept - has anyone seen any studies or discussion? I know that my NS here wanted to do a pre-emptive cervical fusion - fuse the perfectly healthy level above while they were in there because it "would probably go eventually and it would be too hard to fuse it later", and I don't really see that there is much difference, conceptually.

[dshobbies]

I'm not sure a doctor would remove a healthy disc just in case. While fusion does hasten the deterioration of adjacent discs, and a multi level lumbar fusion may actually be contra indicated, would it be prudent to stabalize the fused segments with an ADR? Good question.

Unfortunately for me, Dr. B would not remove my heriated L2/3 because it was not a pain generator but has since become one. He did not want to do a four level and if necessary was considering dividing it into two surgeries, something I was not willing to do so I did not protest, insist or question his three level decision. Would he have if I did? Too late but an interesting question.

Again, I enlist the help of Mark. Have you ever encountered a healthy disc being removed preemptively? Has the question ever arisen?

[Maria]

I can't see removing a healthy disc tho what do I know ...however I know that I'm real concerned about leaving my disrupted disc at L3 just hanging out to pick up the slack even tho it's not a pain generator "now" according to last discogram which has been months since now.

I'm afraid from experience I will learn that working on only symptomatic levels and leaving a potentially problematic level will later lead me back into more back surgery.

Just thinking about this keeps me from moving forward quite honestly. Sort of like better the devil I know than the devil I don't. My 2nd failed surgery really left me with horrific lingering burning pain bilat from waist down pretty much (groin symptoms did disappear within first month, buttocks and legs took up to 5 years to mostly resolve while some lingering pain exists).

But to work on healthy discs to me would be like planning on doing a fusion on L3-L5S1 but just to be sure that the domino effect doesn't hit L2, then fuse that and L1 as well.

I guess the idea might be that topping off a necessary fusion with ADR will prevent the demise of the rest of the spine... maybe science/data would bear this out if it were performed tho surely insurance wouldn't pay for this as it's hardly paying for what's necessary re ADR here in US ~ so we are looking to Europe and other places where ADR has been performed for years and all kinds of cases?

[ans]

Thanks Fortitudine for bringing this odd topic up. I'm thinking of a level higher than my two damaged ones that w/get a discogram this Sept. The disc shows a mild herniation, some DDD, and other deragement. Wouldn't it be great to stop the "domino effect" in its tracks!

[fortitudine]

Perhaps I should have been a bit more specific regarding pre-emptive ADR and my own case. I need ADR/fusion at c3/4 and 4/5. My NS said c2/3 would probably go eventually, and it would be a lot easier to fuse it now with the other 2 levels than to try and go in - I think he said through the mouth - later.
Anyway - it was that comment that terrified me and led me to the internet these great forums.

Mark, have you ever talked to Dr. Bertagnoli or Zeegers about this? I would guess not, since most of what they are doing is ADR at the damaged levels, and supposedly that will prevent adjacent-level problems. Still, there are times when a fusion is required, and I wonder if there stats being kept on the rate of adjacent level disease that would reveal that there is some value in pre-emptive ADR?

[fireyangel76]

I agree the through the mouth thing would have scared the heck out of me. That is unless they could give me some nice straight white teeth and pull my tonsils while they were there. I am just a whimp...that's why I did not get an ADR...going through the abdomen to fix my back just didn't sound so great to me. It looks like I may have to consider that at a later time though.

[paindoc]

I can't imagine putting a patient through a very risky procedure and removing a perfectly healthy disc for preemptive reasons. The theory is a good one though. If something were to go wrong, the lawyers would have a field day!