ADR � anterior lateral approach ? Possible TLIF ? Dynesis ?

[spineally challenged]

Hi All
I Recently went to see my local ADR surgeon.
He mentioned that he was aware of research into implanting ADR�s through a lateral anterior approach. This would be relevant in my case and for others requiring repeat surgery as it would provide implant access without the need for such gross mobilisation of the great vessels. The Mobidisc has a rotating keel which should potentially allow for a lateral approach however to the best of his knowledge this has not yet been done. The Mobidisc site actually lists possible anterior lateral approach as one of its features however he thought that as of yet they have not developed the necessary jigs and additional apparatus to make this a reality.
I am also aware of another disc - Aesculap Active L implant � which apparently has design features and instrumentation suitable for an anterior lateral approach. If anyone has any information on this disc then I�d be most grateful if you could pass it on.
If any of you are aware of any research or advance in this area I would really appreciate any information..

His reccomendation for me at this time was for TLIF at the my remaining degenerate 4/5. He viewed repeat ADR between the 2 existing ADR�s at 5/1 and 3/4 as potentially too dangerous due to difficulty in mobilising the great blood vessels because of expected scar tissue. TLIF sounds a possible good option - it combines lower risk to the posterior nerves than with PLIF together with anterior compression of the fusion graft as found in ALIF. However he informed me that although he is familiar with both PLIF and ALIF this would be his first TLIF procedure. He was confident that his existing experience in the PLIF procedure would translate for a successful progression to the TLIF. I'm not so sure I'm keen on being his first.. � Any thoughts?
After so many years struggling to avoid fusion and having read so many negative stories I'm having a hard time giving up on further ADR. Of course the third option is to do nothing and wait to see if science catches up with me although I feel I already did that waiting for the ADR technology in the first place.

It has also recently been suggested to me by yet another doctor that Dynesis at the 4/5 might be a possible solution. In the past I have always been told that Dynesis was not suitable for me because it was only applicable were disc height remained fairly good. If anyone has any information regards the current thinking on Dynesis use and its suitability for patients with advanced DDD and narrowed disc space then again this would be much appreciated.

I apologise for asking soooo many questions in one post

Keep well
Tim

[mmglobal]

Tim... I wouldn't want to be a surgeon's first, fifth. or tenth ANYTHING.

As we've discussed, your good ADR's at surrounding levels should insulate the fusion from the rest of the spine, eliminating many of the fears we have from fusion. This conservative approace seems good.

I've observed Mobidisc and Activ-L procedures. Yes, the Mobi does have the rotating keel, but to my knowledge, nobody is doing the lateral approach. There are many potential issues that makes me fear the lateral approach for any ADR and especially for keeled devices. The Activ-L can be ordered both with and without keel.

I'm going to North American Spine Society meeting later this month. It is the largest spine congress in the world... I should learn much more about many of these issues.

You are going to be 'experimental'... whatever you do. Email on the way.

Mark

[mmglobal]

What do Bertagnoli and F-M say about Dynesys at 4-5?

[spineally challenged]

Hi Mark
Thanks for your input.
Dr's FM and Bertagnoli didn't regard Dynesis applicable in my case.
Email on it's way.
All the best Tim

[Alastair]

Hi Tim,
well I don't know if you've been reading these pages recently but as you know in the UK we're not having a whole lot of success with Dynesys. I think some of the problems are to do with the screw length at the moment.

One thing which crosses my mind immediately, is that in our conversations there is no evidence to say what is causing your problem. Dynesys would take the pressure off the spine joints where it is applied, and we do have UK members who have had Dynesys and then had ADR after it, with reasonable success -- -- -- but not the other way round.

Cheers,
Alastair

[ans]

Dr. Regan about five mo. ago mentioned that he was traveling abroad to learn the lateral approach. Delamarter's partner, Kropf, mentioned the lateral approach above L4-5 down the line. We'll see.

[spineally challenged]

Alastair and ans
Thanks for your input.
All the best
Tim