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fusion vs ADR

dgardineerddgardineer Posts: 158
edited 06/11/2012 - 7:25 AM in Back Surgery and Neck Surgery
I'm weighing the options of both and wanted to hear some peoples stories good or bad .


  • My doctor and the doctors in my area refuse to do ADRs because of the lack of evidence proving there is any benefit over fusion. They have not been studied enough and performed long enough for them to prove that they reduce the amount of stress on the surrounding discs enough to prevent faster degeneration. ALSO, they have been known to slip around. There are a few people on here with some ADR horror stories. Fusion is the gold standard, and has been done for a while now. If surgery is something you can put off... I would. Wait, and maybe by that time there will be a more definitive set of guidelines for you to go by.

    I had an awesome fusion and would definitely do it again if I need to. Which, I probably will... Being the age I am. Lol. I am one hundred percent for fusions. If I had the choice, I would never go with an ADR. I refuse to take part in something so risky without enough research or information on it. "Enough' is based on opinion, so no need for anyone to reply defending ADR. This is my personal opinion. I, personally, me, just myself, would never do it. I do not find there to be ANYWHERE NEAR enough studies done for me to EVER consider it at ALL. Maybe 50 years from now. Lol.
  • I had a 360 fusion at L4-L5 with the ENDOSKELETON(trademark) titanuim vertebral body replacement device and I feel great. The surgery was 11 days ago and yes the disc was replaced from the front and fused with rods and screws in the back. I walk at least a half mile the first night in the hospital with only incisional pain. My back pain was gone. I went home the next day and have been walking a mile each day since then. I am limited to a mile by the doctor but could walk more. I went out to lunch with my husband 5 days after I got home and felt good. I guess I can say so far so good. Time will tell. I will ask that you get at least two opinions and do your research. Everyone is entitled to their own opinion and they should respected for it. I respect the opinion of Lo, she has her reasons against it. The decision is a personal one and you cannot go back from surgery. Best Wishes on your journey.
  • d- I haven't had any kind of surgery but have done a lot of researched on ADRs. ADRs have been done in Europe since the eightys. That is going on thirty years. ADR trials have been going on in the US since about 2001. They started first on the lumbar and now are being done on the cervical region.

    Research shows the biggest problem with ADRs are spurs. If you go to the FDA web site they have all their research for you to read. It shows very clearly that there is no loss of motion,better recovery and healing, and that the levels above and below the ADR site have less stress. This was shown with the history of the patients disc above and below and if they have needed any surgery since the initial adr surgery.

    What they don't know is how long adrs will last and the risks on taking them out. That is what the problem is. Yes there are risk with everything. It is very clear that your disc above and below a fusion will wear out. It is just up to your body genetics and how much wear and tear you put on them.

    Yes there have been horror stories but so are with fusions. Check out the neck section. Recently there have been a lot of people on there that their levels above and below their fusions are going out. Some of their surgeries are recent other several years. But all the same story level above or below are out due to their fusion.

    Adrs work best on single levels. If you are young most Drs recommend Adrs due to the fact that you have many more years to live. They can only fuse so much of your spine. It is like a domino effect with a fusion. Only time will tell how long your disc will last. At least you have more time with an Adr.

    Everyone has an opinion and you only know what is best for you. If you trust your Dr and what he tells you that is great also. It comes down to what you choose.

    My husband's coworker just got two Adrs in his lumbar on Nov 7. I am going to be following him and his progress. He is said that the first day was pretty bad. On the second he was still in pain but could already feel the difference with the sciatic pain and muscle spasms. Of course it is still early on but only time will tell. I am hoping for the best also.

    Do your research. That is the most important thing. Numbers don't lie. Check out this web site adrsupport. There are people in there with good and bad experiences with adrs.

  • Numbers only tell a fraction of the story.

    The head Neurosurgeon at my surgeon's practice graduated FIRST in his class from Boston University, has authored book chapters, has spoken at meetings nationally AND internationally, has Top Surgeons in The U.S. awards in the area of Neurosurgery... He knows what he is doing. They refuse to do ADR's, so it's not as if the info is CONCLUSIVE and PROVEN, and OBVIOUS. He is not an idiot. It's a matter of opinion, NOT fact.

    I am 22, and Ortho AND Neuro refuse to do an ADR, fusion is, was, and always will be my only choice.

    If you want to talk to about numbers, you should check the rates of slippage between vertebrae with ADR's and how many people have had their spinal cords nearly severed. ANYTHING artificial inside your body changes the natural motion of the spine... ADRs are no exception. ADR function is NOT the same function as a natural, inborn spinal disc... So... It's not a given, it's not a fact, it's not anything but opinion. Bottom line.
  • Not to say there aren't success stories with ADR's.

    BTW, there have been way more failed fusions than failed ADR surgeries.
    Coincidence? I think not.
    ( LOL that was a joke )

    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • If fusion was the gold standard why is there any need improvement. Why would there be any need for any research or new technology for spinal disc?

    There are risk for everything. Fusions have the potential for the bone not fusioning. Rods migrate and break. Screws come lose. I am sure that when fusions where first done doctors made mistake and learned from trial and error. But with time they where improved.

    Yes there have been serious problems with adrs. And unfortunaly there are individuals who have experienced horrible pain and side effects when an adr doesn't work or isn't placed the way it should be. Nobody is hiding that. But that is with every and any type of surgery. The risks. And especially with new procedures.

    Adrs are new compared to fusions and need a lot more improvements. That is a given.

    I am interested in something that is going to correct my problem as much and as best as possible. I know that there is nothing better than my natural God given disc but apparently they aren't doing the job they are suppose to. So I am going to look and research for what is best for ME.

    That is what this forum is all about. Helping others that are in the same situation as you. Everyone here is looking for help, support, knowledge and experiences of what others have been through.

    What is good for you isn't neccassary good for everyone and that is OK. This is all about helping others.

    Technology and science are improving everyday. Doctors increase their knowledge and experience with every surgery. There are a lot of great doctors who are competent, know what they are doing, and have experience with the spine and are still moving forward with adrs. My neuro who is also a wonderful doctor has told me that adrs are improving and getting better everyday. He has in no way every hiden that.

    To everyone who has had a bad experience with adrs or fusions I have great admiration and respect for you for contiuing to go on and live the best life as possible for yourself. In no way have I every disrespected anyone's personal decision.

    I have shared only the information that I have gained through my own personal experiences and research. What I will choose when I need my own surgery will depend on what I feel is best for me.

  • It's called the effort for technological advancement. That's it. Looking for an improvement doesn't mean the first attempts at improvement are better than the previous standard... And gold standard means the typical, tried and true, successful way to go. That's it. It doesn't mean perfect.

    Nobody is telling YOU what to do, so no need to get so freakin' defensive. You do what you want. We all have the right to our opinion, but that's my exact point. There are no FACTS or PROOF ADR is any better than fusion. It has NOT been studied enough with ENOUGH clinical trials through ENOUGH time to determine whether or not the benefits outweigh the risks. And that is the truth. Therefore, it's still up in the air. While it's up in the air, it's based on OPINION. If you are trying to say that ADR is the right thing, and is SO much better than fusion, and the facts exist to prove such, then you are insulting everyone's surgeon here, because our surgeon's who have performed fusions did what THEY believe is best, and THEY happen to be doctors.

    So leave it at opinion. You do what you want, but don't pretend like there are existing facts and proof of something that there isn't. You know how long they've been doing fusions? And how long they've been doing ADRs? Yeah. Exactly. There will not be any TRUE EVIDENCE for decades, scores, etc. So there is no definitive source, it doesn't matter what the FDA approved in the early 2000's.

    It IS ONLY opinion... And the experiences of both fusion patients and ADR patients are what the original poster will find helpful. Nothing in life is 100 percent. NOTHING. So if someone is looking for that, they will be looking forever.
  • Deciding factor for me

    I went with 2 level TLIF/Lamedectomy w/HW.

    I had advanced facet joint arthritis and needed 2 levels for the blown discs. ADR would still allow the joints to bang together, and is not best practice for more than one level, although it is commonly done.
  • my L5-S1 is pretty much shot its herniated 3 times in 2 yrs and my L4-L5 disc is showing signs of breaking down it's not herniated yet but it's buldging so after reading all the info here and reading the requirements for the adr I don't think I qualify since my spine is unstable and that is a big qualification .Thanks to all of you for your stories and opinions i'll keep you all informed.
  • I was unable to consider and ADR in my neck because I needed surgery RIGHT NOW!

    However, my NS has some friends who are NS in the army and work out of Walter Reed. They do ADRs all the time for military folks and their success rate is extremely good. Matter-o-fact, the soldiers are back in Iraq most of the time within TWO WEEKS (limited duty, but still way better off than if they had a fusion done).

    There is plenty of information out there to show that ADR's are doing very well.

  • I just had L5/S1 fused--four weeks post-op. You've probably seen my sob story on one of the threads. I did tons of research before deciding on the fusion. Actually, at the last minute, I told the doc that if he got in there and saw that I was a perfect candidate for the ADR, then go ahead with it. The PA really didn't want to do the ADR and told me there was only a 20 percent chance he could get the ADR in. The doc said 50 percent. Well, when they got in they said because of the way my bone was curved ADR wouldn't work. I was told by a PM doc that she would go with ADR because it leaves options open later--if the ADR fails, you can do a posterior fusion.

    My doc was also one of the trial guys for the early ADRS--he said "the data sucked"--his words not mine. However, he likes the ProDisc. Even though I had authorized him to put in the ProDisc--I kind of knew it would be a fusion based on the PA. The doc did say that the ProDisc seems to be the real deal. The Charite had all kinds of problems. My doc and the PA especially kept reminding me that the "fusion is the gold standard." I am thankful I sitting here today with a fusion rather then the uncertainty of the ADR. I know I could have all kinds of problems with the fusion--but now that I am into this thing and experiencing all the uncertainty of my future--I am glad I don't have to worry about having an ADR on top of it.

    Just got off the phone with the PA while writing this--I had been having increased pain--back locking up, etc. I had been constipated and was afraid with the straining I had caused something to break or move. She said that with increased activity, you get more inflammation which is what I'm feeling. She wants to put me on a predisone pack and soma and said I'm fine, this is very normal. I have an appt. Monday and they'll do an X-RAY--although when I asked the PA if it was possible it moved she said "no, I have NEVER seen an implant move or break." This in 15 years. Folks, these people are an assembly line for low back surgeries. Soooooooo, be encouraged those of you who like me, are scared too death that something may break or move. After reading all the horror stories of things breaking with fusions, it was re-assuring to hear from someone who does these every day, for 15 years, that she hasn't ever seen a breakage. We have to remember they do like 200,000 fusions a year.

    "Shelter me O Lord, I trust in you."

  • I didn't mean that my doc does 200,000 a year--I meant that the US does 200,000 a year (I read that somewhere).

    Also--I learned that a lot of docs are doing the ADRS and having very good results. SHORT TERM. The patients are up and around very quickly and feel great. The problem is--what about 10 years from now? Also, my own doc told me that fusion patients catch up with ADR patients--it just takes more time. So, ask yourself this: 6 months from now, do you want to be sitting there with a fused segment that doesn't really change your flexibility (if it is L5/S1) or do you want to be sitting there with a plastic disc in your back?

    Remember finally that a lot of these docs are doing ADRS because it is cutting edge--there is a business side to it that I cringe to consider.

    I'll shut up now.

  • thanks man thats the kinda feed back I was looking for .good luck with your fusion
  • Hello d.g.,

    I was just surfing around tonight and saw this post. I might be a couple of months late but hey, better, late than never.
    I am one of those people with ADRs. Got mine on March 11, 2008. So almost out a year.
    I had ProDisc at L4/L5. I can tell you this: I wouldn't have any surgery unless I absolutely without a doubt needed it. Spine surgery is no piece of cake.

    I, too, heard the horror stories about ADR before my surgery. This was from two doctors (pain doctor plus an ortho spine surgeon) that were not well-informed. Since surgery, I have not had any problem with subsisdence or the device moving. It is stuck where it is and isn't going anywhere according to my neurosurgeon.
    My ADR is placed great and moves with me. It amazes me when I see it on the films. I cannot feel it but know it is there. That freaked me out at first, especially, in the beginning, right after surgery.

    I have told many people that the most important thing in spine surgery is finding an experienced, awesome doctor.
    My doc is great and I haven't regretted getting my ADR for one second.

    Now, not everyone qualifies for one. If you have moderate or severe facet hypertrophy, then you are not supposed to get ADR. There have been some problems when surgeons put ADRs in people with this and the results have not been fabulous. This is because some ADRs like the ProDisc can transfer forces to the facets and lead to facet problems. Luckily, I had very minimal "minor" facet hypertrophy. I also had no osteoporosis or osteopenia or spondylothesis (slippage of vertebrae).

    The FDA studies of the ProDisc and the Charite (approved in 2004) were noninferiority studies. This means the two ADRs were proved to be just as good as fusion.
    These were not studies to show ADR as better.

    I think there are better things in the horizon for patients with DDD, including nucleus replacements and fibrin injections. Time will tell.
    Some doctors may still call fusion "the gold standard", but I can only tell you what my doctor told me.
    If I was 70, he would have done fusion. But since I was 46, an ADR would most likely do better at preventing adjacent disc disease than fusion. That is why he did ADR on me, to prevent adjacent disc disease.

    That was good enough for me. But of course this is my opinion. Everyone is different and what works for some does not work for others. I have spiney friends with fusion and ADR and some are doing well and others aren't.

    I suggest that whoever is thinking about getting spine surgery, that they get a second opinion, and preferably, a third opinion. I got at least 4-5 opinions and then was able to sort out what was best for me.

    Good luck with your decision.


  • Still feeling good, I hope!
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