Summer of surgery ahead!

[longroadahead]

I am by no means a doctor but a ADR at L5/S1 and a fusion at L4/5 doesn't make sense to me. From what I have read the L5/S1 has the least amount of movement and the safest to fuse so you would want to fuse that and have the L4/5 ADR.

Understand you have complicating factors that rule that out but the 2 surgeries so close together would not be an option for me. I would try to find a one surgery solution.

Is the L4/5 so bad that you couldn't have dynamic stablization and have the surgery all at once?

[Maria]

I had thought the same as others are stating here re fusing L4 and ADR at L5S1 which supposedly has less motion/movement so usually if hybrid is suggested it seems to be the other way around but don't know what your facets look like or other surrouding structures at those levels however you're pretty young so would imagine things should look much better on you than many of us that have been offered ADR at L4 and L5 S1 or hybrid surgery w/ADR at L4 and fusion at L5S1.

Now that being said I'm not a doctor either but have had spine problems since I was 28 and am 57 now. Have had 2 discectomies (L4 and L5S1). Have had doctors recommend 3 level fusion at L3,L4, and L5 S1.

Have had 2 level ADR recommended then when didn't to that and a few years passed my facets were a factor to not recommend ADR at L5S1 as well as no FDA approval for 2 level ADRs here in US yet.

Anyway about 6 opinions later and pretty much everyone was agreeing I didn't do anything more however Mark was of great help to me and I can't recommend at least talking to him enough. Check out the website Dale has posted.

Not trying to push you into anything however really want a young person like you to make as good a decision as you're able with surgeons that really know the newer technology and with the experience so that they can offer you what they think will really work for you vs. the only thing they might know how to do well.

And again.. not trying to nag you. Just wish things had been different when I was in my 20's and even 30's and there had been as much exchange of information available as well as access to it.

[jsewell]

I know nothing about ADR's. I am almost a totally fused spine except the upper 3 cervical levels and the lower 3 lumbar.
What i am writing about is the length of time between surgeries. I had a major reconstrucion of my thoracic spine on Sept 24th. T2 thru L2. Then at my first follup visit it was discovered that i had vertebral fractures on 2 thoracic vertebra and i had surgery on those on Nov. 4th. Then my first post op on that one, my neck was in trouble and on Jan 7th i had major reconstruction including breaking my neck (osteotomy's) in the cervical/upper thoracic area. C4thru T5? I am 53 and recovered fine from all of this , so at 23 i think it might not be the most pleasant experience, but you can do it. If it comes to that.

[on pause]

Hi everyone, thanks for all for replies.
This is a lot to take in! I'm feeling really confused and sort of having a panic attack right now! Sorry if my reply isn't entirely coherent, but I'm having a hard time sorting out my though process. I do feel rushed in all this as I need to get on with my life!

I've been living with all this for 10 years and have had to missed so much schooling, both high school and especially university. Once I'm out of school (though for medical reasons and not by choice) for 6 months I won't qualify for my parent's insurance any more and will have to then pay for all my physio and medications. I will also have to start paying back my student loan, and since I'm not working this will be impossible! This is why the surgeries need to happen soon so I can get back to school and try and finish my undergrad (which will have taken 7 years to get if I'm lucky).

I thought I had finally found my doctor after years of searching, and now I'm starting to question that. I have to have seen 20+ docs in the past 6 years, from neurologists, neurosurgeons, pain specialists, and orthopedic surgeons. I am even a part of something called Best Doctors, where they try to match patients with doctors that meet their criteria. I feel a little under the gun time wise, and it takes a long time to even meet with a doctor, my surgeon has a wait of 2 years normally! It seems most of the best are not accepting new patients, I've tried. Then even if I feel comfortable with the doctor (a rarity in my experience), then I'd have to wait longer still for a surgery date, and many of those are a year at least later. I can't live the way I have been living for much longer. Schooling aside, the constant pain, the sleeplessness and the lack of any real life are driving me mad! I can't take my dog for a walk, I can't hold my baby nephew, I have no life and haven't for a long time.

I'm new to the whole idea of ADR and fusions, and thought I had done a lot of research, but am starting to doubt what I thought I knew too! The reason for the two surgeries was that my doctor wanted to see if just the fusion made me feel better enough to get on with my life for the time being, and to postpone the ADR for later. If it didn't greatly improve things, then the second surgery would go ahead.

I'm not 100% sure why my doctor doesn't want to do the ADR at L4/L5. I had a CT scan done and he said it would be risky with the way it looked on the scan. He said there would be too great a chance of tearing a major artery. He was very hesitant to do a fusion at all, and he explained the risks that it may affect the L3/L4, but that all my other discs looked very healthy. Apparently nothing was blocking my L5/S1 though, and he could go ahead with an ADR at that level. He advised against fusing it all due to my age.

I'm not so great with the acronyms...what is STALIF, TILF and PILF?

I know for the fusion there will be some sort of cage involved. Are there some that are better than others? I meet with my doctor again for all the pre-op stuff, what should I be asking him to make this the best informed decision?

I will think of more replies to all you have given me, I just need my head to stop reeling.

Thanks

[mmglobal]

I'm getting ready to go for my discogram and possible thoracic discectomy... don't have much time.

All the "LIF's" above are lumbar interbody fusions. STALIF is Stand Alone, which is done from the front and does not require posterior screws and rods (hence stand alone). Many surgeons will still add postior hardware saying 'to be safe'. The ones that don't say you don't need a belt AND suspenders.

PLIF is posterior. TLIF is transforaminal or kind of a modified posterior approach. Both are from the back and include screws and rods.

Many don't understand that your surgeon not doing ADR at L4-5 is his choosing that level for fusion... it is his feeling that there is a contraindication for ADR at that level. MY guess (remember that I am not a doctor) is that he is not comfortable with the approach. Unless you have something really weird going on, that would be HIS comfort with the approach and a very experienced ADR surgeon would not even pause.

It sucks that you have the external pressures of timing and insurance. I'll be home next week... call me (number on my website linked below) or private message your phone number and I'll call you when I can. The long travel days (hopefully tomorrow) give me time to catch up on phone calls. Of course... no charge.

Mark