Results/recovery of hybrids vs. ADR or fusion?

[Kathy]

Katie, Take a deep breath and try to relax (I know, easier said than done). You are in great hands, Dr. Bitan is extremely competent and highly 'decorated', so to speak. The man is a friggin genius from everything I have read and heard. I have absolutely never heard a bad thing about him (which is rare, as even the best dr's have unhappy patients- you can't please everyone.) I, personally, have already decided if I were to need something done with my L5/S1 (which has 1mm herniation, as of 6 months ago), I would have it fused. My L4/L5 has the Active L disc. I also have a small herniation in L3/L4, which if it ever comes to it, I would have another Active L implanted. From everything I have read and heard, in my opinion, people who have the L5/S1, L5/L4 and L4/L3 all with ADR's have problems with too much movement. That's why I would have the bottom one fused, as it sounds like the movement in it is not important (I'm sure that's an understatement).

In the ADR world, all you hear is fusion is awful and evil. It must be remembered that not everyone is a good ADR canidate. Some people have excellent results with fusion and long lasting pain relief, with no continued problems. We do know the good, bad and ugly of fusion, it's been around for a long time. With ADR, we really don't know. Why do some people have ADR, get relief and are back to square one in 5 years? We don't know the long, long term results... it's a gamble. I think with a hybrid, you are getting the best of both worlds. You get the movement, the known pain relief and longevity of fusion, and MOST important, what you and your surgeon think is BEST for YOUR BODY.

I'm sure it is very scary, facing the fusion, the very thing you had dig up all the hideous, awful research on. Now, you are trying to get one. The thing is, you aren't just getting a fusion. You are getting both, 'meeting in the middle' so to speak. A hybrid makes perfect sense to me, in theory at least and it does to seem to have extremely promising results.

Another thing, Dr. Bitan may want to do two fusions and one ADR based on something he sees in your MRI? Maybe something about your anatomy that leads him to believe this would benefit you the most? One thing that I also firmly believe and have heard repeatedly is that, the single most important factor of succesful ADR surgery is you surgeon and their skill (other than you being a good canidate, which a good surgeon is going to screen out the clinically 'bad' canidates). The device implanted is not as important as the surgeon; that's why I felt safe going into a clinical trial. I trusted my surgeons skill and knew that I was in awesome hands. I wasn't crazy about getting the Charite, as all the bad press out there; but it's also been around the longest- so there is more information on it. These new discs, we don't know, the information is not there.

I got the Active L, which is the only disc ( from what my surgeon said) that the surgeon can not only choose the implant size based on anatomy; but can also choose if it will have the smaller keels or the large center keel. It is also kinda a hybrid in it's own right, in that it is kinda both restrained and unrestrained. Meaning, the top piece is only connected to bone, the bottom piece has the plastic (whatever you call it) core connected to it and is connected to bone on the other side. So, there is no fear of the plastic coming loose; but also no fear of it being too rigid by being a one piece unitl. Is that clear as mud? Anyhow, my surgeon felt the smaller keels were best for my anatomy and I trust his decision. He also made it clear that even though the control in the trial was the Charite or ProDisc, that if he got in there and didn't feel I was suited for ADR, he would do a fusion. I liked this because he wasn't going to just do ADR, regardless, that he would do what he felt was best for me.

You could have the most amazing device implanted; but if it is not done by a skilled and experienced surgeon, it's not gonna make a difference.

Sorry so long; but I am passionate about spines Keep us updated and know that you are in good hands! Have you watched the video on the Charite site of Dr. Bitan doing ADR surgery? At first, I didn't think I could stomach watching it, knowing it was going to happen to me. But, I also wanted to know exactly what was going to happen to me. It was very informative and extremely interesting. I would suggest anyone thinking about ADR to watch it.
Here is the link:
Beth Israel Medical Center

You are in my prayers,
Kathy

[Katie]

Dale, no date yet...I am still sending in more information to the Appeal board and waiting for a decision between them and the Insurance company. It is a bad time to be away when I have so much work to do, but it couldn't be helped. The Appeal date is April 30, but if I can get everything in soon enough, the Insurance could agree to just drop their objections and approve the new treatment plan within weeks. Then off I go

Kathy, I am going to hire you as my therapist or guru who is able to settle my nerves. You state the obvious of course, and I thank you for that.

I have limited access to the internet right now, so could you remind me who makes the Active L? Is it a model of the Charite or ProDisc?

Can anyone give me the answers to my questions above, about the difference in recovery times and situations? I have been stressing about the added recovery time and the possible increase in pain that I may not be able to control.

Also, how often should I be travelling back to see Dr. Bitan for follow-up appointments? I have been told by the local neurologist to not expect any doctor here to want to see me, let alone 'fix' anything that may come up, so I will be facing an eight hour drive each time. What is the 'norm'?

Thanks again...you really have helped calm my over active imagination. To use a Newfoundland expression...."oh me nerves"!!! (Our easternmost province which is a country all on its own )

Is there any information out there on patients' allergies to the disc materials, the polyethelene centres, etc? I have a lot of allergies, but mainly to the more common metals and chemicals...wish I could test for the titanium, etc. before they are inserted.

Thanks again. You are a calming influence....ummmmmmmmmmm....I'm off to chant some mantras now

[fuzzy]

I had a fusion at s1l5 with adr (activ-l) on top at l4/5 and the recovery is said to be and was the same as a 2 level adr. Anterior approach together with the adr, nothing was done from the back. The STALIF fusion parts are designed for up to 3 screws and my surgeon only used 2. He used my own bone rather then artificial as in his opinion it works and there was less chance of problems with the adr autofusing then when using the artifical bone graft. The most post op pain I had came from the graft site at my hip for the first 3 weeks or so after that the hip calmed down and it was the usual post op abdominal issues. I was given the same recovery guidelines as a adr surgery with no restrictions after 6 weeks. After one year the bone was nicely grown into. According to the surgeon the screws are only here to hold it together until it fuses and now they have no use as its now fused. I think his strategy was a good one as the adr moves a lot more then my worn out natural disk did and seems to make up for the fusion below so I don't notice any limits in my abilty to move but then I am glad to have less pain now and no more severe pain attacks coming from my low back.

[mmglobal]

For me, the decision to have ADR at T1-T2 had nothing to do with the theory of motion preservation versus fusion. I would not object to fusion at this level because it is largely immobile anyway. I had to have surgery at this level because of the substantial disc herniation there, substantial spinal cord compression and the resulting symptoms. For me, the ADR at T1-2 is simply an inexpensive interbody device. Why use this instead of a less expensive fusion cage???? BECAUSE IT DOESN'T HAVE TO FUSE!!!

There is a failure mode of fusion that I don't have to worry about because I am not needing to fusion to occur. Yes, there are potential issues with the ADR, but I am less worried about those than I am about the potential for the problems associated with fusion.

Based on the rationale presented for the hybrid, it would seem that if the same case were presented with a healthy L4-5, then fusion at L5-S1 would be indicated. I would venture a guess that the selection would really be ADR at L5-S1 because of the positive trade-off of risks/benefits for adr vs. fusion in good candidates. IMHO, you either embrace these theories or you don't.

If reimbursement issues are paramount, that should be a substantial part of the discussion. These issues may be a driving force and more or less important based patients (financial realities), insurance companies, different surgeons, different hospitals, etc...

I have a tough time considering 360 fusion when the anterior surgery must be done for the ADR. I suppose that anterior plates, STALIF, or similar anterior only fusion techniques may not be quite as solid as a 360 fusion, but how solid is solid enough? What are the issues that would make STALIF OK in some patients, not in others? The posterior surgery and posterior instrumentation are no small deal.

Gotta run... wish I could write more now...

Mark