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| Spinal Roundtable Discuss Fusion vs. ADR in the General Discussion forums; Hi Everyone, I have now seen 2 neurosurgeons regarding my DDD/herniated disc at L5S1. The first physician first recommended TLIF ... |
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#1
12-01-2008, 04:32 PM
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Fusion vs. ADR
Hi Everyone,
I have now seen 2 neurosurgeons regarding my DDD/herniated disc at L5S1. The first physician first recommended TLIF and then told me I should also consider Trans1 which he does not do. He is referring me to another physician who I see tomorrow. The 2nd physician does both ADR (Charite) and fusion and is also recommending TLIF as his choice for me. I'm having a lot of trouble making a decision as to what to do. The main reasons why the 2nd physician is somewhat steering me against ADR: 1) doesn't think my insurance will cover it (I have a Cigna open access plan) 2) feels that ADR at that low level may not be super successful as it is the lowest part of the spine and weight it must bear (I am only 125 lbs and 5'8"). 3) states that since we know the disc will not last a life time it will have to be redone and he says there is a 30-40% chance that a redone surgery may have to be aborted because of the very good chance that important vessels/veins may attach themselves to the new disc. 4) he feels TLIF should be done and if I have problems with other discs in the future he feels technology will be way advanced by then offering better options Does anyone have any thoughts on this? When he told me about the vessel/vein issue it was the first time I had heard of this. Help! How does one make a decision!?!  Teressa DDD/herniated disc at L5S1 Pain for at least past 2 years Have had multiple epidural injections, facet joint injections, PT, accupuncture, Muscle Stimulater and TENS unit therapy     
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#2
12-01-2008, 05:34 PM
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valid question, patient perspective
Quote:
1) CIGNA insurance coverage position on ADR covers one (1) level. Check your policy and the cigna website for a print-out. 2) L5-S1, lowest level, there is more shear force than L4-L5. No research seen excludes this level or points to worse results. There is a biomechanical line of reasoning, though not born out in clinical results to my limited knowledge. 3) Re-operation at the same level (index level) is challenging because scar tissue forms with fusion or ADR / TDR. There are more re-operations to date with fusion than ADR / TDR, so ... 4) TLIF & wait for L4-L5 to get ALE (adjacent level effect) and possibly demonstrate ALD (adjacent level disease), if it ever does and it often does not, and then use the current ADR / TDR. Understand the view. You wrote facet injections. How did they determine you needed those? Facet condition is an indicator for exclusion or inclusion of ADR surgeries. There are contradictory statements in the FDA IDE trials. You are in TN. Surgical procedures for the same symptoms and indications may vary by geography, the surgeons' practice and I also suggest by what the local surgical community supports based on their group experiences. May I please suggest thinking about a third surgical opinon that may be related to the Activ-L™ Artificial Disc Replacement. Activ-L is in an FDA Clinical Trial, reference. The closest surgeon, "investigator", surgical group near you in the FDA trial, I think is: Domagoj Coric, M.D. Carolina Medical Group saw the above medical gentleman's name this morning doing research. The above gentleman will need copies of your medical records, doctor's reports, medications by prescription #, MRI's, other tests, blah blah blah. Be prepared for more paperwork. For your comparison, input rec'ed on my side varied : 1st Surgeon: two-level fusion (wrote two-level surgical outcome article) 2nd Surgeon: preferred Fusion or no operation, wait on ADR (regional medical center) 3rd Surgeon: microdiscectomy (website with same) 4th Surgeon: 50-50 ADR or Fusion, ADR qualified I can ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ slackwater_sf 2004 mva, 2-level surgical candidate ADR
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#5
12-03-2008, 04:20 AM
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Talaine, Hi.
About the vessels sticking to the vertebrae. I found out from my vascular surgeon that they put a dacron (or something else) patch between the vertebrae and the vessels to prevent the sticking. I spoke to my vasular surgeon about this, but I have not gotten the operative report to see if it was really done. I also found doctors opinions to be contradictory and it made me very confused about what to do. That confusion was eased by me asking questions after doing extensive research. Kimmers
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hurt back lifting, herniated disc at L4/L5. DDD
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#6
12-03-2008, 05:36 AM
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the main risk for anterior reoperation of the same level is when the aorta and inferior vena cava have to be moved for a 2nd time to gain access to the anterior interspace - the vessels lie immediately infront of the vertebral bodies (1st move can lead to scar tissue formation, scr tissue can rip very easily if the vessels have to be moved). The L5/S1 level is in most instances below the bifurcation of these vessels so they don't have to move them out of the way and they are no longer sitting in front of the intervertebral space at this level (the L4/5 level (and above) are the levels that carry this risk unless your vessels bifurcate very low - should be observed on mri). Im not saying there is no risk but you should check into this rationale / explanation more
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L4/5, L5/S1 disc prolapses post wakeboarding accident Oct 06 (grade 5 and grade 4 annular disruption, repectively). 2X epidural steroid injections, lots of drugs and conservative treatment, positive discogram. Surgery May 08 (L4/5 A-Mav disc replacement and L5/S1 ALIF)
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