QUESTION:L5/S1 ADR or FUSION?

Michelle Maree · #1 (**permalink**) 05-23-2009, 01:35 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 · #2 (**permalink**) 05-23-2009, 05:49 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 · #3 (**permalink**) 05-23-2009, 06:01 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 · #4 (**permalink**) 05-24-2009, 01:28 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.

guymontag · #5 (**permalink**) 05-25-2009, 06:45 AM

I can't really say what would be best for you MM, but since I have a dodgy L5/S1 and if I had a choice of Fusion or ADR. I'd go fusion. I am way too scared of an improper placement or device failure or facet stress. Just reading about Phylly and Mark from Perth and quite a few others, I realise its complicated to get the ADR out.

I've also spoken to a few people who have had fusion at l5/s1 and they have not had much movement limitations. I emailed one lady who works on her farm all day, lifting bales of hay etc, horseriding and she's feeling great. I think the kicker is that any fusion these days must consist or removing the entire disc inserting a interbody and then using bone, preferably donor. Not excising the disc and just fusing with rods and screws will lead to a lot more pain as they disc is still leaking chemical irritant. see MartyUSA blog

Fusion surgery over.....

I'm also now a little wary of BMP from what Mark Mintzer wrote Mimally invasive TLIF w/Hydrocision (interesting BMP data too) I honestly don't know if BMP is the problem or not. But I'd prefer if my doc didn't use it.

I'm not too concerned of adjacent disc degeneration. I wouldn't be planning to do any heavly lifting, I just want to be pain free. So if L4/L5 did degenerate, I'll deall with it then. Perhaps after another 10 years they would have improved on the ADR and you would then assess the options.

probably the hardest part of fusion is to constantly remind yourself that you are still fusing and musn't stuff up that fusion process. Its easy to forget if you are 4 months in and semi fusing and you start bending.

But as you rightly said. There is definitely no guarantees and sometimes just dumb luck can play a part.

hope you can navigate to a pain free existence Michelle.

Michelle Maree · #6 (**permalink**) 05-25-2009, 08:14 AM

Hi Guy,

Yeah, I agree with you and i have decided to have a fusion. I am too far gone for ADR. I have facet problems and Im not going to take the risk of them getting worse.
I am just waiting on an appointment with a spine ortho in Melbourne and will go ahead with it ASAP.

wish me luck,
Michelle.

dshobbies · #7 (**permalink**) 05-25-2009, 06:08 PM

Once you reach a decision you are ready and anxious to move forward. I hope you can get scheduled quickly since your relief is now just around the corner.

I wish you every luck and hope your dreams of a pain free life are realized.

Dale

Cindylou · #8 (**permalink**) 05-28-2009, 12:11 PM

Michelle, you've received alot of helpful insight from all these folks. Bottom line, wait for the Germany results so you have more "muscle" for your decision making. It sounds like you have had major life stressors on top of the pain issues, and that is not an easy path to navigate. I personally have had a fusion at L6-S1 (I have an extra vertebra) last July. I also have 3 lumbar discs above the fusion. My decision was mostly a no brainer due to my pars defect and facet issues at that level. I have to say I do not notice much restriction physically with it. About the only thing that comes to mind is when I am standing and lifting a leg to put on my panties, sometimes I have trouble on one side, lifting my leg high enough to step through the hole. That's about it. Good luck Michelle. You'll come to the right decision.

Michelle Maree · #9 (**permalink**) 05-30-2009, 08:20 AM

I just heard word back from stenum after sending them my information and they are recommending the Maverick ADR. This is probably because on MRI my facet joints dont show anything wrong except mild hypertrophy.
I have decide to make sure first before going ahead with the fusion and will get a facet block booked for 12th June. I think id best make sure.

Michelle.