QUESTION:L5/S1 ADR or FUSION?

cls · #1 (**permalink**) 05-22-2009, 03:47 PM

Michelle,

I considered ADR and consulted an Ortho who is very much in favor of ADR and does not like to fuse but I was precluded due to low disc height. I was on the fence with ADR anyway but this sealed the deal. After reading countless threads on those who had ADR at L5/S1 the trends did not seem positive. Overall I did not get the sense that manufacturers have come up with a device that is a long term homerun and I did not like reading the numerous accounts of facet joint problems from those who had radiographically "perfect" facet joints prior to ADR but then developed problems down the road. It is a very tough thing to decide what kind of treatment to undergo but after researching and consulting highly skilled Orthos or NSs you will land on a solution that will feel right for you. The only piece of advice that I can offer is to find a top notch surgeon who is highly skilled in whatever procedure you go with. Surgeons will perfect the procedures that they are best performing. Good luck

One size does not fit all when deciding ADR vs Fusion there are just too many factors weighing these or any other major procedure. Here are some things to consider while researching your options and talking to your doctor:
Your age and general health - Is bone density an issue? Do you have any other health issues? Arthritis?
Your surgeon - what does he/she specialize in, are they known for being a top doc in this specialty? Do you know someone who has had the procedure from this doc that can give a good reference or at least share their experience?
How active are you? - What are your expectations for recovery?
Risk tolerance - Know the risks for any procedure and determine what you can live with.
Hardware/Procedure - With ADR there are more and more devices coming out. Learn what you can about them and understand the pros and cons of each. Which one will you have and why does your surgeon choose the device? With fusion, there are different methods and hardware devices as well. If you went this route would your surgeon perform an ALIF, TLIF, PLIF or XLIF? Would you use donor bone or BMP or your own?

This is just off the top of my head, I am sure there are many more factors to consider. I'm sure others will chime in.

dshobbies · #2 (**permalink**) 05-22-2009, 06:13 PM

MM,

I agree with Runner. Fusion puts a burden on adjacent segments which can lead to further deterioration resulting in more surgery down the line. This does not mean it will definitely happen in your case.

Your choice of surgeon before deciding which way to go is a primary concern. Choosing a doctor who performs both surgeries is more likely to recommend what is best for your circumstances as opposed to what he is more comfortable with himself.

Good luck to you, Dale

Kathy · #3 (**permalink**) 05-23-2009, 01:42 AM

I have an ADR at L4/5 and had a 1 mm herniation at L5/S1 and L3/4, prior to surgery with L4/5 have a grade 4 tear. If I had to have something done on L5/S1, personally, I would have a fusion. I agree with cls, I have heard too many stories of people having problems with too much movement, when they have the lowest level done. This is just my opinion, do your research and pick what is best for you.

Michelle Maree · #4 (**permalink**) 05-23-2009, 02:35 AM

Thanks for your replies..... I am finding the decision very difficult to say the least.
Everyone seems to have a different opinion on this one. And of course it really does depend on the individual case.
I have seen 2 renowned surgeons in Melbourne that use the Charite and both of them said no and recommended a Tlif. I dont know how many they have performed but I dont think it would be many. Their reasons were because of previous surgery,scar tissue, disc height, possible facet issues. I think they like pristine conditions because they may lack the experience but at the same time they may be right in being conservative. These may well be sound contraidications. I will wait on my opinions from Germany and am expecting a completely different opinion. So who do I then trust?

I sometimes try each one on for size and imagine how it would feel in my back to have either of these procedures done. It makes me realise that I do have a certain amount of motion in that segment that I would lose with fusion. For example when you walk you seem to move quite a bit in that area from side to side albeit not as much as above.What I want to know then is Do you completely lose all movement there when you walk? And it then gets transferred above?
Then I imagine having ADR in there. I find it really hard to imagine what having the height back wold feel like and then that extra movement after so long.My back has flattened a bit over th 2 .5 years and I dont know if my facets would cope with the extra lordosis.
If it didnt cause pain then I would be right. If it did cause extra pain then I dont know how id cope.
So maybe thats my answer. I have become more and more intolerant of pain as time goes on. I am just sooo sick of it!!!!
I would dearly love to hear from anyone who has had either procedure at
L5/S1.
But welcome everyones opinion.
Michelle.

dshobbies · #5 (**permalink**) 05-23-2009, 06:49 PM

MM,

I know you're sick of the whole process.

Stop dwelling on this until you hear from Germany. If you get differing opinions, then you start up again but give yourself a break and don't deal with anything you don't have to.

Of course, please let us know what you hear from Germany and we'll all tell you again 'this is what I think'.

Take a break until you hear more. You deserve it!

Dale

Maria · #6 (**permalink**) 05-23-2009, 07:01 PM

This is one of the very reasons I couldn't bring myself to make a decision re surgery .. in '03 I was accepted for clinical trials to do ADR on L4 and L5S1 and then by '06 I have some moderate facet arthopathy at L5S1 and only a one level disc replacement is FDA approved so WC auth'd a disc replacement at L4 and fusion at L5S1.

I'm so freaked about fusion and the possibility of screws that I didn't have the surgery.

I have an elderly father that lives cross country that I need to be on call for and just felt that I couldn't be sure of the recovery w/fusion at any level.

Ok so I procrastinated until now and as I'm aging things aren't getting any better back there/in there!

It's a tough decision to make and I surely understand altho I do hope you won't procrastinate as long as me and can move forward with your life with a sound surgical decision. Good luck from one that understands that rather circular way of thinking..

Michelle Maree · #7 (**permalink**) 05-24-2009, 02:28 AM

Yeah, thanks. I am sorry..... I guess my anxiety is showing.
I am a Gemini and the twins are constantly fighting with opposite opinions neither one gaining the upper hand. I will try and relax untill all the data is available.
It has been an extremely stressful time for me. My partner of 18 years left me late last year. I had to sell our house which I just moved out from and now im at my parents place with my 17 year old. I have other health issues also ....so the list goes.
I am sick of the pain and want to be able to move on with my life but as we all know this surgery thing is no sure garantee of that. I think if I was older than 34 and had lived a bit more I would find it easier and not resent having to take it so slow as much. I will just have to be patient and positive a little while longer.

Thanks for your support,
Runner,cls,Dale,Kathy and Maria.