T12 to L1 - ADR or XLIF?

[rickz68]

Hi all.

I am trying to get some information regarding a two-level ADR (@T12/L1 and L1/L2) versus a two-level XLIF.

I had surgery scheduled in April for my XLIF but canceled it because I am not a big fan of getting a fusion. I just believe it doesn't make sense to make two movable joints permanently static.

I've had a CHARITE implanted in 2005 and don't have any pain in that area. I was running, swimming and biking but maybe too soon or two much. It appears that I have two more discs that are not cooperating with my lifestyle plans.

Does anyone know a surgeon (US or Europe) that will implant either Freedom or M6-L disc at these two levels (or maybe one ADR and a fusion)?. If not, has anyone had a two-level XLIF at these levels and has returned to an active life (running, cycling, swimming, etc)?

Thanks

[Harrison]

Rick, a little bit more info please...how did these spine levels get in such tough shape? Was it trauma? Can you paraphrase what the imaging studies describe?

As you know, surgery at these levels is rare, and there are good reasons for that...

[rickz68]

I couldn't really tell you how they got into such bad shape. All I know is I was doing extremely well after my ADR surgery in '05. I was able to run, bike and swim pain free (with my surgeon's permission). But during one of my runs (in '07) my back began to lock up. Subsequently, I would get sharp pains due to the spasms that have transformed into a constant pain.

Since then, I've had multiple MRI, multiple epidurals and facet blocks and a discogram (12/09). The MRI indicates a broad based disc bulge at L1/L2 and the discogram is positive for discogenic pain at T12/L1 and L1/L2 with pain level of 10 on a 10 scale.

Currently, I am experiencing intense spasms (over a week) and it's more painful than my L5/S1 pain of the past. It appears that when my discs begin to desiccate they are extremely painful.

[CharlesinCharge]

I have never personally heard or read about anyone having ADR at T-12/L-1. Because ADR uses a anterior approach, when you get that high up you are looking at the possibility of having to move aside major organs (liver, lungs, etc.) to get at that portion of the spine. Obviously that is probably not possible, at the lower lumbar levels you are only moving aside the bowels and abdominal cavity. You should research it, but I would not be surprised if ADR is simply not done at spine levels that high up. If you do have to go with a fusion, look into the XLIF fusion. It is the most minimally invasive one available today, and has had excellent results. Some MMA fighters have had it done and come back to fight in the cage, which has to put a lot of stress on someone's spine!

Good luck,

[rickz68]

Charles,

Thanks for the info. I have reviewed all the treatments and just canceled a two-level XLIF that was scheduled for April.

There have been ADR's implanted at that level, but not very often because of the anatomy. There is also an XL TDR (Total Disc Replacement) in trial currently that uses the same approach as the XLIF. Unfortunately, I am not a candidate since I have a CHARITE disc and have two DDD levels that are symptomatic.

I am just trying to learn if someone out there is willing to perform an ADR at one or both of these levels. I am really against having a fusion.