adjacent segment syndrome

[Julaine]

has anyone ever hear of this, apparently it is caused by having a fusion and then it affects your discs above or below the fusin site?


thanks

[LBP]

This is exactly why ADR promotes "motion preservation" Theoretically the ADR device is supposed to allow for less stress on adjacent levels by maintaining motion. The problem is how much motion is good and it which ways to avoid too much motion and stress on our facets.

the debate about fusion is the need for additional surgery due t: 1) failed union/or nonunion, 2) migrating or malfunctioning fusion devices, broken screws etc... and 3) accelerated adjacent level disc degeneration.

[Harrison]

Good question. Many (not all!) studies show that ADR is more effective in preserving facets than fusion. See the second topic in this forum, which is a 10 year study. This study shows less than 3% of the patients had adj. level degeneration:

Publication: Long-term Results of One-Level Lumbar Arthroplasty

Think of the "tripod" argument this way. A healthy disc has many dimensions of movement (poorly described here, but...), including the 2 facets joints, and the (3rd leg of the tripod) entire disc range of motion. The artificial disc design aims to mimic that entire, complex range of motion. The fusion ARRESTS all of it, thereby "loading" upper and/or lower segments. BTW: this is an absurdly simplified description, to the point of innacuracy. Models of the actual disc joint, with all its complexities, are still in development, tested and argued.

Fusion is still a viable, appropriate choice for many patients. ADR is just another option for highly qualified patients. The majority of ADR patients do exceptionally well, but thankfully, the ones that do not are kind enough to share their experiences here.

Make sense?

[Lisibug]

I had adjacent segment syndrome after my 1 level C5-6 fusion 3 years ago. C3-4, C4-5 and C6-7 all 'blew' and in March just had ADR surgery at these 3 levels. The fused level looked fine and the plate and screws were taken off. I chose ADR surgery for just the reasons indicated above.

[fritz925]

Me too.

I had C6-7 fused in July 2005. We knew C5-6 was bulging at the time, but hoped it would be reabsorbed when the mess at C6-7 was corrected.

All was great for five months and then C5-6 blew. I got ADR at C5-6 in July 2006 as part of the PCM study in Beverly Hills. As of my last x-ray, June 8, everything's lookin' good.

ADR was a great solution for me. I love it. Honestly feels like nothing was ever wrong in there.

I don't know that many people have adjacent disc disease...but, like I said, mine was already out a little...so if anybody was gonna have it, it was gonna be me. I feel very fortunate to have avoided a double level fusion. Though I know there are lots of people out there with 'em who are doin' just fine.
Emily

[marilyn michalak]

It is also called "the domino effect", unfortunately fusion is not only dangerous and not very successful in releiving pain, it causes stiffness at the level involved and an eventual likelyhood of ruining the rest of your back, one disk at a time.

Originally posted by Julaine:
has anyone ever hear of this, apparently it is caused by having a fusion and then it affects your discs above or below the fusin site?


thanks

[fritz925]

Yikes! Sometimes, fusion is the only viable option. And adjacent disc disease is supposed to be pretty rare.

My fusions did relieve my pain. Yeah, I would prefer to have three ADRs in my back rather than fusions--but it wasn't a responsible option for my situation.

[annapurna]

Adjacent disk effects from fusion are predictable and expected; the only question is the timeframe. Obviously, the younger you are the more likely the problem of problems further down the road. We heard 50% chance of adjacent level problems in 10 years, but I've not seen anything that would substantiate that number.

[fritz925]

Seriously?

The number I was given was nowhere near half--it was very small. And I'm only 29. Every opinion I got, including two incredible surgeons who do ADR and are frequently mentioned on this board, told me to go with the fusion for one level--because it was the gold standard. And that we'd do ADR if the second level went (which was already on its way at the time of the fusion).

That's exactly what I did. But there are times, like my lower back, where there was simply no option but fusion. And it really did relieve my pain!

[berry]

Hi

I have adjacent segment degeneration in my lumbar spine following TDR. It was picked up on x-ray two years after having Prodiscs at L4/5 & L5/S1. When it was detected (2006) I was asymptomatic but more recently I have had mild back and right leg pain. The situation is being monitored by my surgeon and I can live with the current level of pain it causes.

I also have cervical DDD and was being considered for fusion when I was diagnosed with a frontal lobe tumour. This took priority and was successfully surgically removed in May 2006.
Regarding my neck my surgeon has now begun cervical disc replacements and it is planned that I have disc replacements at C5/6 and C6/7 early in 2008 and I am hoping the cervical prosthic discs give as much relief as my lumbar ProDiscs.

It is my understanding that less than 3% go on to require surgery for adjacent segment disease following TDR and the theory is that TDR could prevent adjacent segment disease. In my case it hasn't but I am still much much better than I was before I had my lumbar surgery, my quality of life has improved tremendously and I am forever grateful to the surgeon for the difference he has made to my life.

I've read (somewhere but can't remember where) that there is a 25%-30% chance of adjacent disc disease requiring operation within 10 years following a fusion which is less than the figures Annapurna heard but I guess it depends on which research one reads.

Regards

Lynda