a few weeks ago, I attended SAS11 in Las Vegas. The discussions of hybrid surgeries and the concept that "L5-S1 doesn't move much anyway, so it should be fused" were quite amusing. Rick Guyer of TBI presented data about movement of L5-S1 completely blowing away the concept of it not moving enough to justify ADR there. Other discussions about hybrid surgeries all came back to the same conclusion. REIMBURSEMENT ISSUES are the primary factor... remove consideration about payment for surgery and the frequency of hybrid ADR/fusion surgeries would be tiny compared to what it is today.
There may be true contraindications for ADR at the fractured level. Each case is unique and IMHO, a more serious case like this should be evaluated by someone with a great deal of experience with the more complex cases. "you are not a candicate" from someone without that great experience might be more accurately described by, "you are not a candicate for a surgeon at my experience level." (maybe you need to change experience level to 'risk tolerance', or 'at my hospital', or....)
Mark
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