Back Surgery and Neck Surgery
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Thu, 11/05/2009 - 19:02
Fusion vs. ADR
I was wondering if anyone has had a fusion and an ADR "hybrid" surgery. I have a decision to make and am not sure which route to take. I can either do a two level fusion at L4-L5 and L5-S1 or a fusion at Level L4-L5 and an artificial disc at L5-S1.
What about an ADR at both levels???
Any advice/help is much appreciated.
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I haven't been through lumbar surgery but do have issues at L4-5. I am surprised they would not do ADR at L4-5 and fuse the L5/S1 area as you would want the movement ADR provides at the upper region with less risk of other disks failing above the site. Since their are no disks to fail later on below S1, that should be the fused area. I hope I am not being too confusing.
I like the ADR concept, but this is a decision you will have to make.
Location - Omaha, Nebraska
1996 - Moderate herniated L4-L5 lumbar disk, treated with med's and PT. ** Numerous occasions of back pain since.
Aug. 2007 - re-herniated disk and injured cervical neck disk from work injury. Had severe pain in lumbar region and left arm numbness. Had back PT twice before neck surgery.
Feb. 2008 - Had neck surgery w/plate and screw implant after injection failed to correct situation.
March 2008 - Anular tear in disk with fluid on nerves while recuperating from neck surgery, also mild stenosis. back to PT in June 2008 with med's.
*** Surgeon advised disk is still a good thickness so no surgery planned for the near future.
October 21, 2008 - 1st Lumbar epidural, attempting to lessen disk pain so tear can heal somewhat.
November 5, 2008 - 2nd Lumbar epidural,first one improved pain about 60%.
Update: 1/8/09, 2nd epidural shot resulted in same pain reduction, no more, no less, no more epidural's scheduled for now, continue to do home PT everyday and still working full time with low level pain.
Feb. 2009 - PC doctor concerned with limited movement capability, ordered PT consisting of 22 therapy sessions at a PT place using the DRX9000 decompression machine and hands-on physical spine manipulation exercises.
May 2009 - Therapy complete with range of motion improvement from 63% to 76%. Decompression stopped after 3X due to severe pain, Therapy continued with exercises.
June 2009 - PC appt., doctor recommended Chiropractor to attempt to loosen mid back muscles and stiffness causing pain with no contact to neck or lower back due to injuries.
*** Still on 1)200MG Celebrex a day and Tramadal as needed.
Just be sure your insurance will cover ADR. Many plans will not (and you can appeal but it's a tough one if the insurance company is not on board with ADR).
C5-C7 PLIF & foraminotomy 5/2008
C5-C7 ACDF 5/2006
L4-S1 PLIF w/hardware 5/1993
L5-S1 PLIF 5/1987
Multiple knee surgeries '82 to present
I just cancelled my fusion of 3 discs today. My neurosurgoen was so against doing a fusion on me, he really wants me to go to France or Germany and do mulit level fusion. He likes the Pro-Disc and is worried that the other artificial discs may leak metals into the blood overtime. My bad ones are L3-S1. It sucks, doesn't it?
Awaiting 3 level Anterior Lumbar Fusion L3-S1.
Car accident at 15yrs old, percutaneous discetomy at 16yrs (L4-L5)
Reinjure in 2000 L3-S1 bulging and torn
Birth of son in 2008, reinjure L3-S1 to point of leg numbness, lots of pain, unable to lift child at times,
Meds- Cymbalta, Baclofen,Celebrex, Vicodin/or Percocet
I'm with Wally. Why would they give you an ADR at L5/S1, when that juncture has so little movement to begin with? Better to have it at L4/5, where it would do some good.
And Kendrak - why in the heck can't you have a fusion in the US if you're going to have one? I think our procedures are just as good as France or Germany for fusion. I have heard about the ADRs possibly leaching metals into the body -- one of the reasons (along with three blown levels, like you) that I didn't investigate it too thoroughly.
You both might want to do a lot more reading here before seeing your docs again. Things seem a bit topsy turvy.
Linda
Ruptured discs L3/4, L4/5, L5/S1 May 2007
One ESI in 2007 with lots of PT
Microdiscectomy and foraminotomy L5/S1 December 2007
Worsening of symptoms (back pain, sciatica, right leg weakness) June 2008
New MRI and Discogram show all three discs torn through the annulus, left to right, all three levels
2 ESIs unsuccessful in managing pain
PT, Duragesic pain patch and percocet for break-through
Was told nothing could be done for me because I had three levels and DDD
Given option of three-level fusion after being told nothing could be done
Surgery was November 19, 2008 fusing L3/4 to S1
Attempted PLIF (from both sides) on November 19th.
Rods and pins were placed, but scar tissues prohibited removal of the old discs.
On November 24th, I had ALIF (opened from top of pubic bone to the bottom of my left ribcage) and removed the torn discs, placed dowels with cadaver bone, and some of my own bone marrow mixed with BMP. I left the hospital on the 26th of November.
Currently suffering temporary (hopefully) nerve damage of both legs and total numbness of right foot. Strange tingling in both feet at 4.5 months out of surgery. Numbness still exists in right foot at almost 9 months out.
Weaned off Fentanyl patches and only take occasional percocet for pain.
You seem to be doing your homework regarding ADR, which is very good. ADR is not for everyone and careful patient selection is necessary to determine whether it would be good for you. Also as SPineAZ suggested please check out whether your insurance carrier covers ADRs as some don't.
There have been some ADR success stories on this site, and some failures too. I can't recall ever seeing a double ADR patient here.
All the best... Bruce
Severe Degenerative Disk Disease and severe bilateral foraminal stenosis at L5-S1. Laminectomy & fusion in Dec 2006. Hardware removed due to issues, in July 2007. Now living a back pain free life.
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Important: My comments here and comments from other members reflect personal opinions only. You should not act on any advice or opinion posted in these forums without seeking proper medical advice from a qualified doctor. Please, ALWAYS check with your personal physician before taking any action regarding your health!
I agree that there have been successes and some failures with ADR. I had 3 level ADR in Germany in Feb 2009 and then experienced ADR subsiding at least at one level , probably 2 levels. Soonafter I had a staph infection that I must have picked up during surgery in Germany. There are always a certain number of patients who will get staph during any type of back surgery and if you get a staph with ADR's in you, you have to get them pulled out because the staph bugs can hide in the corners and crevices of the ADR's and so the antibiotics will never be able t o kill them. For cervical patients, ADR removal is no big deal in the hands of a experienced ADR surgeon. But if you have to remove lumbar ADR, I heard it is always possibly life threatening due to scar tissue issues.
Anyways, I was immediately pain free after my 3 level ADR (other than normal surgery type pain), and felt great. But then I started having some nerve type pain right where the ADR was subsiding. Little did I know that pain was due to the staph infection literaly eating away my bone. Well, after my Spet 22, 2009 surgery removing the 3 ADR's (c4-7), and converting them to 3 level fusion and partial corpectemy (the bugs ate half of my vertebrae so they had to clean out the dead bone and insert fresh bone from my hip) Immediatley following surgery I was once again pain free. Im now 5 weeks out and have no pain. Its been great so far.
Based on my extensive reading on 3 back boards, I personally believe that fusion or ADR are both equally successful surgeries with equally successful outcomes. The benefit of ADR is much faster recovery and the theory (yet to be proved) that it will lessen the likelihood of adjacent level degeneration. And this is what all my doctors have told me too. What determines the outcome in both fusion and ADR is whether or not the surgeon does a good job decompressing the nerves and proper ADR placement . Some ADR patients are still in pain afterwards because the doctor did'nt spend the right time to focus on decompressing the nerves (i.e. removing bone spurs and other bone pressing on the nerves).SOme focus more on the insert of the ADR's instead of decompression.
One more interesting note:
Link:
http://books.google.com/books?id=Dnb29aSZpNUC&pg=PA43&lpg=PA43&dq=3+leve...
Pg 44 It says:
"In the long term , successful ACDF eliminates motion and thus halts progression of Spondylotic spurs. IN fact, fusion often leads to spur reabsoprtion. With motion preserved in C-TDR, spondylotic spurs may recur leading to late symptom recurrence at the same level. Further follow up may reveal that we have traded a relatively low incidence of adjacent level degeneration for a higher incidence of same level disease. "
ALso,
"With ACDF, the room for error in performing a decompression is high. With C- TDR, performing a decompression may be more critical in achieving succesful short term outcomes. Reports of C-TDR revisions for inadequate decompression have already begun to surface. "
2000- Start of off and on back pain.
4/08 - MRI shows portruding disc at C6/C7, slightly
bulging disc at at C5/6. DDD present at both levels.
5/08 - Had c6/C7 epidural injections, significant but
temporary relief.
6/08 -Discogram painful at C6/7 , C5/6 not painful
but pop rock type noises occurred upon disc
inlfation
7/08- Had Plasma disc decompression for C5/6 & C6/7-
Very Significant pain reduction achieved.MRI shows
portrusion gone.
10/08- Pain starting to come back
12/08 - Pain almost as bad as pre surgery again. Getting grinding noises for the first time. Cant sleep without Hydrcordone and alleve.Currently looking into ADR with Tx Back Inst but being told I might not be a candidate for surgery with them due to failing their Psyche tests.
1/09 -My doc at the Tx back inst cleared me past the psyche issues (I dont think his psychologist was too happy about that-wont explain why here). Discogram shows 2 levels causing pain. BUt I decided to go the cheaper route and to go with one of the best multi level adr surgeons IN THE WORLD,Dr B. in Bogen , Germany. Dr B. has performed 3000 ADR surgeries so far!
2/26/09- 3 level ADR Surgery with Dr B. (Interop it was determined that I needed 3 levels as the 3rd suspect disc was leaking dye into the spinal channel).
SUCCESS!! All the old deep pain is gone!!
5/18/09- X ray shows that my top plate of my C6/7 proDisc is s sinking causing subsidence of the bottom plate. Fusion recommended at this level now.
9/22/09- Revision surgery with Dr B. in Wisconsin to have all 3 ADR's removed and converted to 3 level fusion due to staph infection in the ADR's. Apparently, ADR's(or any implants) usually have to be removed if a infection parks itself on them. Two weeks post op pain free and doing well so far.I just hope that I fuse at all 3 levels.
BUT as I have some damage to the edges of the vertebrae, does anyone know if that means I'm not a candidate for this type of surgery?
2006 - Herniation of L4/L5, MRI showed degeneration of disc, Treated with Physiotheraphy
2007 - BAck pain similar to 2006, herniation not confirmed by scans, treatment physiotherapy and traction
Jan 2009 Herniation of L4/L5 following fall on some ice, MRI shows degeneration of L4/L5 and L5/S1 plus some damage to the vertebrae
April 2009 Lumbar epidural injection
May 2009 Microdiscectomy
August 2009 Sacral epidural injection
4 Nov 2009 Felt something go in my back. Now have bad sciatica, leg weakness and patchy numbness
Waiting for follow up appointment with surgeon 18 Nov
Here is the link on Steve's thread about having the ADR removed, and replaced with Fusion:
http://www.spine-health.com/forum/back-surgery-and-neck-surgery/removal-...
Just food for thought. (food? must be lunch time!!)
JEAUX
I am not a medical professional. BUT, I DID stay in a Holiday Inn last week...
Don't get your knickers in a knot; it solves nothing and makes you walk funny.
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Thank you to all for your responses.
wally2 and lsteller are correct, it's an ADR at L4-L5 and fusion at L5-S1.
Most likely my insurance will deny the procedure, so then my Dr. would need to appeal. I don't think I want to go through that process.
Decisions, decisions........