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Total disk replacement after microdiscectomy

AnonymousUserAAnonymousUser Posts: 49,578
edited 06/11/2012 - 7:37 AM in Back Surgery and Neck Surgery
Hello everyone,

I hope you are all well.

I am a 24 year old male, previously very active and had been a competitive swimmer for 11 years up until 20 years old.

I also spent allot of time in the gym weightlifting and playing other sports like football and basket ball. Then all of a sudden about a year and a half ago when I was lifting weights in the gym I felt my back pop and immediately felt pain down my left leg.

4 months later I had an MRI scan which showed a bulging L4/5 disk and the 2 levels above had become black and degenerated. I tried to cope with it for a year but couldn't take it any more. I went to see my surgeon who recommended a three level disk replacement. I was scared of such a big surgery so my surgeon suggested I try some physio to see if we can resolve the pain. I went back to see him but the leg pain was still there, the back pain had reduced significantly so we decided to go for a microdiscectomy on L4/5. 2 weeks after the surgery I went back for an MRI scan as the pain came back and it seems that the disk has re-bulged and is still pressing on the nerves. Even worse the two levels above seem to have bulged also.

Now 4 weeks after microdiscectomy I finally plucked up the courage to tell my surgeon I want the three level disk replacement. He is now telling me that because I have had microdiscectomy on the L4/5 disk it cannot be replaced only fused. This is not an option for me as I cant live my life with a fused back due to the work I do and the fear of causing degeneration on other leves below. Has anyone heard such a thing before or has anyone had a disk replacement after having discectomy or microd? If yes what was the outcome?

I thank you in advance for your time.

Best Regards,



  • as you- only I had a laminectomy on L5-SI - they have to really be selective in choosing the right canidate for ADR. In addition, your insurance may not even approve a level 1 ADR much less a level 3 ADR. If you are not happy with what your surgeon has told you, get a second opinion. Research ADR (as I am sure have) Not everyone is right for this type of surgery. Only you can decide what you want to do - weighing the options of dealing with unbearable pain or get the fusion and make the needed changes for you lifestyle. Either way may end up needing to change you work you do. Who is to say that DDD won't happen no matter what??

    Best of luck to you and keep us posted.

  • Hi Leo,

    Thank you for your reply. May I ask what you did eventually? Did you go for fusion and what was the outcome?

    I am aware of the selectivity of candidates for ADR. I was one up until I was told that because I had microdiscectomy I am no longer a candidate. It doesn't make any sense because for ADR the surgeon enters from the front not from the back so I don't see how the the microdiscectomy could affect that. In addition discectomy will take place during ADR surgery so effectively we could say that the microdiscectomy actually helps as there is less disk to remove when undergoing ADR..

    It makes more sense for laminectomy to be a factor as there is bone removed but not so much for microdiscectomy as it is the least invasive of all surgeries.

    Is anyone aware of any explanations for this?

    Thank you
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  • It makes no sense as to whether you do a fusion or ADR. A micro takes a very small piece of the disc away. Now you are talking about completely removing it. You shouldn't have too much scar tissue around the disc since a micro makes such a tiny incision and does not cut muscle or nerve. It was my understanding the scar tissue is only on the disc itself.

    I'd see another surgeon and get at least 1 more opinion. Getting approved for a 3 level ADR by any insurance will be a 1 in a million shot.
  • There are different versions of microdiscectomies.
    One involves removing bone from the vertebrate in order for the surgeon to have a "window" to go thru and get at the herniation.

    I have heard that this window weakens the vertebrate.
    The term used for that was "destabilize".

    Maybe that is enough to exclude a person from ADR installation.

    Keep looking into it. Find out what exactly was done to your vertebrate, disc, and legaments.

    Go with that info to a surgeon who has done ADR's.

    Good luck.
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • I'm new to this so please bear with me...my girlfriend is 50 y/o and has chronic back pain. She has gone through endless conservative measures and most recently back surgery with Xstop placement.
    All has failed so far. Her quality of life(therefore mine) has decreased tremedously. She is in constant pain and has fear of narcotic addiction. All this makes her very irritable and moody. I can understand this part very well. Does anyone have experience with disk replacement? Could this be an option to help us out?
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  • It sounds rediculious for a surgeon to dismiss a potential ADR candidate based soley on having had a Micro-d before on that level.

    Makes NO senso.

    Get a second opinion. A 3 level ADR is a big surgery. Germany (Stenum) or that guy in Cali are the only two places I would go for that, anyway...

  • From what I understand, it depends on where the window is placed. Taking out a small piece of lamina may not neccessarily "destabilize" the back. Sure, it's better to have it all.

    For the record, I think the gold standard of "cutting out stuff" to fix the back is a perpetual disaster in the long run. Newly injured patients MUST look for less invasive, alternate remedies. The word fusion should only be introduced if the patient is crawling into the office and has tried everything else...in my opinion, of course.
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