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Fusion or Disc Replacement? Anyone have input?

AnonymousUserAAnonymousUser Posts: 49,322
edited 06/11/2012 - 7:29 AM in Back Surgery and Neck Surgery
Hey there,

I used to be a member on the old forum and just re-registered today.

Quick history.

34 year old male. Played impact sports when I was younger (football). Herniated disc at L4/L5 about 2 years ago with full left leg numbnes and loss of bladder control.

Had first "MicroD" on L4/L5 in March 2007
Had second "MicroD" on L4/L5 in July 2008

Past few weeks I've been feeling numbness in left leg and foot with some pain in my left side. Also have some throbbing pains in my left groin which is not good because that was the major problem before the 2nd surgery.

Had an MRI today and got the images burned to a CD Rom. Looked at the pics and it appears that there is a herniation again at L4/L5. I'm no radiologist....but it's quite easy to see. The herniation isn't as big as prior ones (perhaps that's because there isn't enough disc left to protrude) bit even a layman like me can see it.

My surgeon hasn't seen the images yet, but I have an appointment with him on April 20th...so we will see what the deal is then.

In the meantime, I figure I better start preparing mentally for the 3rd surgery. Surgeon told me if I herniate again, we can't do another microdisectomy and it's going to have to be a fusion or artificial disc replacement.

What's the general consensus on these ADRs? I've accepted the fact that I'll never play golf or other sports again, so I'm not too concerned with the reduced range of motion with a fusion. As long as I can walk and perhaps swim I would be a happy fellow.

Most doctors I talk to (I'm a sales rep that visits with doctors on a daily basis) tell me to go for the artificial disc....but I'm worried that it could dis-lodge and going in to correct it could be a major surgery in itself.

Is a fusion really that bad? Anyone on here with a fusion that has trouble bending over to put on shoes and underwear due to fusing the joint?

Any input is appreciated.



  • I had PLIF at L4-5 a year ago January with a cage, rods, pedicle screws and BMP. I do not feel there is any problem with mobility when you just have a one level fusion. I can do everything I could do before -- including putting my palms on the floor, arching my back, and twisting. I do not make a habit of doing these particular things often, but there is no issue with my "flexibility."

    I was not a candidate for ADR so I didn't do any research on the topic. If you plan on staying with your current surgeon, you should do whichever procedure he is most comfortable with, which he thinks is best for you. However, I have found that most surgeons will do what they are used to doing, not necessarily what is best for a particular patient....

    There are a number of people on the board who have had ADR. You can run a search for their threads and read about their experiences....
  • You'll no doubt find some patients with good fusion outcomes. But to me they represent about 30 to at best 40% of the fusions. Seems to me the other 50-60% have difficult recoveries of 6 to 18 months of pain until reaching some level of improvement. Seems to me that the bottom 30% either dont improve much or are worse off. This is just my best guess at the %'s based on 1 yr of extensive patient outcome research. So what i say may not carry much weight . But I see way too many bad fusion stories on this board alone to terrify me of risking my back on that. On the other hand, if you read the same number of ADR patient outcome stories, seems to me that 90 to 95% turn out successful with much faster recovery times and faster return times to work. Though if the disc ever needs replacement in the lumbar area , it can be considered life threatening due to scar tissue hiding the big blood veins. So, it isn't all 100% positive or risk free, it's just that for me personally, fusion has a far less success rate and a super high difficult recovery process. This is my opinion only. Like I said, there are those on here who have had great fusion experiences. Keep in mind, insurance extremely rarely ever pays for adr unless its a 1 level and you have cigna or aetna. It will cost you about half as much to get the adr done in germany than here in the us. And the german doctors are far more experienced than the us doctors too. Good luck with whichever route you decide to go.
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  • Hello There James, I am a survivor of a Three Level ADR. L-3 to S-1. And I have really never been better the discomfort immediately transfered from my lower back to the incision site which for my procedure was performed anterior. (through stomach). Dont get me wrong I did my homework on this one and for me there was no question, I wanted an ADR and not a fusion. But keep in mind you have to be a candidate for it. That is something you and your Doc to decide. There are some variables, bone density is a concern, amongst some others. As far as range of motion, I personally believe there is a tremendous difference. Not many folks that have had back surgery can touch there toes. Bt all kidding aside just due to the fact that the adjacent levels will not endure such a strain as they would with a fusion, is a major deciding factor. In addition to the fact that my Doc told me if i do a fusion, i would be back in a number of years doing it again. And that wasnt for me. I wanted it done and over with. And thus far i am at that point. it has been almost a year post op and im only dealing with some pain in leg due to nerve damage. but hopefully that will soon subside. In the meantime Doc is doing all he could to keep me comfy as far as that is concerned.

    Well i wish you the best of luck in whatever your latest endeavor may be,
    Keep in mind that what i have posted above is my own personal experience. As for we are all so different, and what is good for some may not be the case for others.

    Fell free to contact me if you should have further questions or concerns as I would be happy to share. Take Care and God Bless.....
  • Hello James I had two adr's in the L4L5 and L5S1 put in and have been 100% pain free for 15 months. No limitations and I play golf and ride my bike weekly. I had some serious discussions with my surgeon before surgery about adr movement. He no longer installs Charite disks because of that problem. The keel design of the ProDisc prevents that problem from happening. He has had zero problems since using the ProDisc. Not all adr's are the same and make sure you know about the adr that you choose.
  • Hello James,

    It is great that you do your homework before you see the surgeon. Several people responded regarding ADR, that is good, because I am quite ignorant regarding that. I had a three level fusion (L3-S1) eleven months ago, and I am very please with the results. Previous numbness, pain are gone, and as far as limitations, I learned how to do things properly at PT, so I don't have any problems. Maybe I can't lift 100 lbs, but then I could never do it. Putting shoes on, dressing, etc. are activities they taught me during my week stay at a rehab after the surgery. The most important thing is to select a surgeon who is not only qualified but who has a lot of experience in your kind of surgery. If you could talk to some of his former patients, that would be the best, but other doctors and nurses opinions are important too.

    Good luck in your decision,

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  • I had a 3 level fusion w/hardware and interbody spacer placed at L4-L5, and I can bend over just fine now and it has been 2.5 months.

    You have to be careful of course, I am extremely careful whenever I bend. And I still can not lift more then 10-15 pounds or push or pull.

    My restrictions will be lifted April 24th if all is well on the x-rays.

    Overall I am very pleased with having a fusion done, of course no back surgery is ideal but it resolved my pain issues immediately and I am pretty much normal now, other then a few minor annoyances that will go away with time.

    Mobility is taken away at first but it comes back. Physical therapy helps, following the surgeons orders DISACTLY as given is the biggest help.

    The younger you are the better outcome you will have with any surgery, especially spine.

    Honestly if my discs were not as bad as they were and had I been able to qualify for ADR I wouldof went that route, but I had multi level buldges which would had caused me issues later on, L4-L5 being the main cause of my pain.

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