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Fusion vs. ADR

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:38 AM in Back Surgery and Neck Surgery
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.
This is a great forum. :D


  • 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.

  • SpineAZSpineAZ WiscPosts: 1,084
    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).
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • 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?
  • 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.

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • 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
    Keep positive!


    ...an old timer here and ex-moderator

  • 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:



    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. "


    "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. "
  • 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?
  • Here is the link on Steve's thread about having the ADR removed, and replaced with Fusion:


    Just food for thought. (food? must be lunch time!!)
  • 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........

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