Rate of adjacent disc disease after fusion?

Adrienne · #1 12-05-2008, 07:24 PM

Even though I've been cleared for an ADR at UCSF, I'm still considering a fusion because no one can say for sure what's causing the numbness in both legs. Everyone is almost certain of the level of the problem (L5/S1) but there's a question of weather or not a tear with no nerve root compression can cause numbness.

Anyhow, my doctors are 50/50 each way; there are advantages to the fusion as well as the ADR. My quesion is:
What is the rate of adjacent disc failure after a fusion?

Adrienne

trkdoc714 · #2 12-05-2008, 08:00 PM

Adrienne,

I've read a several different articles, but most agree that adjacent level discs do about 110% of the normal workload after fusion.

I also have the numbness in both feet and segments of the legs. Again from a lot of reading, both ALIF and ADR surgeries are nearly identical. To me, that would mean regardless of which surgery I have the numbness may or may not remain. As long as the pain is reduced, I can live with the numbness.

I'm leaning toward the ADR mainly because of the range of motion plus the "normalized" wear factors.

Good luck with your decision and surgery,

Bob

Harrison · #3 12-05-2008, 08:06 PM

This is a good question. Unfortunately, there are no concrete answers for a long list of reasons.

I know we’ve talked about this many times, so I used the advanced search function and found a number of topics for you on this subject; here are a few. Some of them include stats, though they are just part of the calculus!

Adjacent segment degeneration question
http://www.adrsupport.org/forums/showthread.php?t=7320&highlight=adjacent+disc+dise ase

Any ADRs easier on facets?
http://www.adrsupport.org/forums/showthread.php?t=8574&highlight=adjacent+disc+dise ase

Reoperation Rate Lumbar (Fusion, Non-Fusion)Surgery, 11 Yr Results: Spine 2007 Mirza
http://www.adrsupport.org/forums/showthread.php?t=5908

Why so many people refuse fusion?
http://www.adrsupport.org/forums/showthread.php?t=6574&highlight=adjacent+disc+dise ase

Adrienne · #4 12-07-2008, 02:33 PM

Thanks, Bob and Harrison, for the replies. I keep hoping to find the defining article or opinion to make my decision, but I'm beginning to see it doesn't exist. I suppose, though, we should consider ourselves lucky to have choices.

110% doesn't sound so bad but I guess over the years it adds up. I'm curious, Bob. What do they think is causing your numbness? Could it be something separate from what's causing the pain?

Adrienne

trkdoc714 · #5 12-07-2008, 08:24 PM

Adrienne,

The original surgeon originally told me what I progressed to after one year post surgery was what I was going to have to live with. The pain and numbness both abated until the disc shed a few fragments. Both pain and numbness increased (not as bad as original levels) and abated again after the recurrent disc surgery.

Since the original surgeon moved to open his own office 300 miles away, I've been seen by ortho and neurosurgeons that make assumptions and diagnosis without reviewing my entire file. They order epidurals and nerve blocks on the level that had the surgeries even though all MRIs, CT Scans, Myleogram and EMG indicate that level is "patent" with only dessication and mild bulging.

As for your numbness, I'd get as many opinions as reasonable to make sure nobody is overlooking another possibility such as facet or stenosis issues. Terry is a good source of advice on this too. Although the ADRs took care of his critical issues, he has ongoing facet related pain. Don't be afraid to ask the doctors questions. After all, it is your body and your future you're entrusting in their hands. If they were to get insulted because you asked pointed questions and a lot of them, maybe they're not the surgeon(s) you need performing this critical procedure.

At the end of the day, if they make a mistake in judgement, you're the one that pays for it. They'll be on the golf course or tennis courts next Wednesday.

My hopes and thoughts are with you,

Bob

Terry · #6 12-07-2008, 08:56 PM

I am experiencing a bump in the road presently. I am over two years past my four-level ADR surgery. I had difficulties for the first year of recovery and required facet injections every three months for a year. I have done very well for the last year except the past month or so. I am having some of the same pain that caused me to get the SI and facet injections before. My last ones were in December of last year. I am hoping that once I get another SI and facet injection that this lasts for another year and may become a once a year routine. I have felt great with my cycling and rode 2,300 miles last year and 2,100 miles this year.

So I am hoping this is nothing more than a bump in the road and easily resolvable.

Facet issues are defintely something to take in to consideration. My MRI's showed mild to moderate facet issues prior to my ADR surgery.

Terry Newton

#7 12-07-2008, 08:57 PM

Hi Adrienne

I guess a fusion last a life time, how long does a ADR last? If your fusion is at L5-S1 not much motion at that level, If ADR is performed how long will it take to fail, wear out ,etc??
I am postponing any surgery as long as I can. There are great things down the pipe line, may be better or worse.
I wish spine issues were cut and dry. Hang in there.

Best wishes

Gil

Adrienne · #8 12-08-2008, 01:55 AM

Terry, Bob and Gil

Thanks Terry Bob and Gil for your kind replies. Agreed about getting as much input as possible and got copies of MRI's, etc. down at Kinko's today. Going to send them around the world.

I do have slight facet hypertrophy at that level, as well as 'a slight suggestion' of stenosis but I'm told it's not enough to cause my symptoms.

One problem is that 90% of my symptoms go away when I lie down on a flat surface, such as an MRI table. This must be a common problem as it seems most of us spineys feel better lying down.

One more question: Would a fusion get rid of stenosis? Mine, if it exists, is caused by the foremen(sp?). Would a fusion take care of that too?

I can picture it. The day will come when I have to make a decision and I'll be saying: One potato, two potato, three potato, four....

Adrienne

PS Terry, 2100 hundred miles on a bike and 1 injection/year? I'd consider that surgery an unqualified success. Congratulations!

soljagirl · #9 12-08-2008, 02:39 AM

Here's an old article just ran across (probably already posted somewhere here) on disc height reduction, comparing ADR to fusion :

http://www.pubmedcentral.nih.gov/art...?artid=2140131

More potatoes....

phylly · #10 12-08-2008, 12:13 PM

Adrienne,
For me personally, having both ADR and fusion, I would not do ADR again. My neck fusion although not perfect was not nearly the roller coaster in pain that that lumbar ADR is. I do have some adjacent neck problems from my neck and that is why I picked the ADR the second time around. I expected to get slowly better over the course of a year. I did not expect the amount of pain and the problems that I have encountered. I know that fusions have their own problems but they were minimal compared to what I have encountered this time around. Good luck with your decision.

Terry, I am so sorry for your new problems, I hope you can take care of those and you will be back on your bike.
Phylly