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Spinal Roundtable Discuss Lumbar fusion in two months in the General Discussion forums; I saw my neurosurgeon today, and we decided it's finally time to do a two level fusion at L4-L5-S1. I ...

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  #1  
Old 04-25-2013, 11:33 PM
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Default Lumbar fusion in two months

I saw my neurosurgeon today, and we decided it's finally time to do a two level fusion at L4-L5-S1.

I asked about the prospects of a hybrid with an ADR on top, but he said that almost every lumbar ADR he's done needed an eventual revision to fusion as the implants all failed, either by subsiding or the device breaking apart. I didn't ask numbers, but I know he's done around 400 cervical ADRs, so he should know what he's talking about. He also said the neurosurgical community is starting to cool off on the lumbar ADR idea and go back to fusions. Even when I hypotheticaly said "What if I pay cash without insurance?" he still said ADR was not the right thing for me. This is the same doc that did my cervical ADR, and I trust his professional judgment completely.

So, a two level TLIF is in my near future. I know it's not really in the scope of this board, so what's a good place to sort out my con-fusion?
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April '98 - Injured @ work
Oct '98 - Declared "permanent and stationary" by workers' comp docs
10 years of PT and chiropractic...
Oct '08 - Sudden incapacitating lumbar / sciatic pain with foot drop
April '09 - L5-S1 microdiscectomy fixes foot drop and most of the pain
May '11 Hey doc, I'm tired of my neck hurting...
Dec '11 - C5-6 Prodisc-C
July '12 - Neck is still doing well. L5-S1 is "done" - bone on bone
July '13 - L4-L5-S1 TLIF
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  #2  
Old 04-26-2013, 09:52 PM
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Sorry about this complex issue facing you. It could be that the neuro has in fact seen all these failures...have you seen this multi-page topic?

Spine Osteoporosis

If you already posted your DEXA scan scores, I did not see them...sorry. Are your spinal bones strong enough for both ADR and fusion?
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  #3  
Old 04-27-2013, 12:11 AM
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SpineInSecurity,

Condolences on your lumbar issues. It seems like one tragic spine issue per patient should be enough!

I can't argue that your surgeon is or isn't correct on the current leanings toward lumbar ADR by US surgeons. I would suggest a few thoughts though... Lumbar ADR in the US will mean ProDisc most of the time. While there are a great many lumbar ProDisc recipients that are doing great a decade later, the problems with the ProDisc are well documented. Before closing the door to the possibility of ADR I would encourage you to research other implants. Only the Charite, discontinued because of problems, has been around as long at the ProDisc; so no other implant will have the amount of data that you're going to find on the ProDisc.

If you do decide to reconsider, I would encourage a visit to Dr Zigler in Plano, TX (suburban Dallas). He was one of the IDE team for the ProDisc and has turned out as impressive a record with that implant as anyone.

Not everyone is a candidate for ADR; and if you're not, then it's best not to pursue ADR.

Good luck, Jeff
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Old 04-29-2013, 11:27 PM
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Never had a bone density test, but based on how well my cervical Prodisc is doing, I'd probably do well with lumbar ADR. However, BCBS-NC doesn't cover ADR, and I have no international coverage, so we can ask questions all day long, but they'll be purely academic.

I certainly don't have the $50,000 or whatever it would cost to go overseas for a 2-level. A year and a half ago, I was fortunate to snag a two-month window between UHC deciding to allow cervical ADR and losing coverage with them when my employer switched us to BCBS. I had met with the surgeon and we had done everything except book a date for cervical fusion, then I saw UHC changed their policy, which kicked off a madcap rush to get in with the ADR surgeon before the year ended.

I just can't wait any longer. My leg has gone somewhat dead and I'm not sure what's worse - the sciatica and pain, or the having trouble with walking. Will there be a Prodisc2 in the future? Will M6 be allowed in the US? By the time that happens, will they be up to M9? Will BCBS allow any of them? I need something here, today, now.

So, how is the recovery? I've heard of some people being back to work in a month or less, and others saying it's horrible and they were out of work for six months.
__________________
April '98 - Injured @ work
Oct '98 - Declared "permanent and stationary" by workers' comp docs
10 years of PT and chiropractic...
Oct '08 - Sudden incapacitating lumbar / sciatic pain with foot drop
April '09 - L5-S1 microdiscectomy fixes foot drop and most of the pain
May '11 Hey doc, I'm tired of my neck hurting...
Dec '11 - C5-6 Prodisc-C
July '12 - Neck is still doing well. L5-S1 is "done" - bone on bone
July '13 - L4-L5-S1 TLIF
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Old 04-30-2013, 06:26 AM
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If you are sure about fusion over adr have you discussed axialif for the S1/L5 and xlif(far lateral approach) for L5/L4? These methods cause less damage to your spinal muscles. If your doctor does not perform you could look into finding a doctor affiliated with AIMIS.
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*12/28/11 ESI L L4/L5 - 1/13/12 ESI R L4/L5 - 1/24/12 L SI joint capsule - 3/8/12 TPI - 3/23/12 L L5/S1 - 4/11/12 ESI caudal - 5/23/12 TPI - 7/10/12 Facet inj L3/L4, L4/L5, L5/S1
*9/12/12: 30 - DRX9000
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Old 04-30-2013, 06:25 PM
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It's an interesting looking method, but BCBS calls AxiaLIF investigational, so there's a vanishingly small chance of that happening.

At best, I might get an XLIF at L4-L5, and TLIF below. Is XLIF sufficiently better that TLIF to be worth whatever difficulty may be involved in doing different techniques at adjacent levels?
__________________
April '98 - Injured @ work
Oct '98 - Declared "permanent and stationary" by workers' comp docs
10 years of PT and chiropractic...
Oct '08 - Sudden incapacitating lumbar / sciatic pain with foot drop
April '09 - L5-S1 microdiscectomy fixes foot drop and most of the pain
May '11 Hey doc, I'm tired of my neck hurting...
Dec '11 - C5-6 Prodisc-C
July '12 - Neck is still doing well. L5-S1 is "done" - bone on bone
July '13 - L4-L5-S1 TLIF
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  #7  
Old 06-10-2013, 03:55 AM
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Hi there, this is my first post so please be gentle!!

I live in the UK and ADR is no where near as common over here especially for lumbar procedures. I had a two level posterior lumbar fusion L4-S1 just under two years ago using DePuy Expedium pedicle screws and the sabre cages as I was not suitable for a disc replacement. I was off work for three months and even with the daily PT excerises and two sessions a week in the clinic I still couldn't have gone back any sooner than that.
The posterior approach is quite destructive to the soft tissues but gives good visualisation for the surgeon and for me it's worked enormously well. I've gone from morphine and diazepam for the pain to OTC cocodamol as and when needed, my limp has gone and now walking 3-5 miles is easy. Before the op I could manage about 100yrds at best.

So if you aren't a candidate for ADR and fusion is what you need that's what my experience was like. I might add that I worked for a bone grafting company at the time and as such I saw in excess of 300 spinal fusions being performed and saw the good the bad and the downright ugly results wise. The quoted success rates vary dramatically from 30% upto 70% for fusions but I found the patients with the right mental attitude did the best. Don't expect to be healed 100%, anything above a 50% decrease in pain is great!
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  #8  
Old 06-14-2013, 09:39 AM
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I've had a bone density scan now, but I can't pretend to comprehend the scaling. At L1-L4, they report T -0.5 and Z -1.2, and describe it as within expected range for age.

My L5 moves around too much, so ADR isn't really an option, regardless of insurance.

Speaking of L5, the L5-S1 disc space is gone - it almost looks like the nerves are all that are holding the foramen open. I know it's going to be many months, if not years for the damage to be repaired, so I'm not expecting a quick fix.

Unrelated to the spine, I've recently been checked for sleep apnea, and I've got a severe case of it - AHI is over 34. I should be getting a CPAP machine in the next couple of days, so that cheering noise you'll hear at night is all the cells in my body getting oxygen.
__________________
April '98 - Injured @ work
Oct '98 - Declared "permanent and stationary" by workers' comp docs
10 years of PT and chiropractic...
Oct '08 - Sudden incapacitating lumbar / sciatic pain with foot drop
April '09 - L5-S1 microdiscectomy fixes foot drop and most of the pain
May '11 Hey doc, I'm tired of my neck hurting...
Dec '11 - C5-6 Prodisc-C
July '12 - Neck is still doing well. L5-S1 is "done" - bone on bone
July '13 - L4-L5-S1 TLIF
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