Is ADR indicated in pain-free DDD?

[ans]

Saw Delamarter's partner awhile ago. He suggested that after getting a two-level ADR that for DDD (or maybe future nerve root problems? he didn't say) that two more ADR's should be placed above via a lateral approach (above L4-L5).

Is ADR ever used prophylactically in cases of DDD? Or in stenosis w/o pain?

Thanks, Allan

[Danielle Shawgo]

That is a good question. I know that I am scheduled to have 2 levels done and I have 5 levels with degeneration. I kind of wish that they would go ahead and replace the other too because I know that I will probably have problems down the road but it wasn't suggested to me.

[ans]

I think it's a good question. We hear elsewhere that it's insidious but when is surgery indicated? Only when there is pain or as a preventative?I considered that the doc meant that I will have trouble in the levels above the proposed two-level ADR but how in the world would I know when the time was right. He was very certain that I'd need two more ADR's and I never followed thru w/"why" so for some idiot reason.

What is the natural history of DDD and does it always lead to pain. And if so, is this pain from the annulus or other areas and what are the treatment options? As one PA or NP told me, it means my back is "crumbling".

I'd be very wary of having a 5-level ADR! Please consider options.

Lotsa talk about DDD but what's it's natural history and implications?

http://www.spine-health.com/topics/c...w_degen01.html

I hope to find out from Dr. Bray. If the appt. wait is too long I'll call both Regan's office and get back to you.

Allan

[mmglobal]

"We do surgery on patients, not on x-rays!"

With spine surgery, less is better. You should do the minimum surgery that stands a good chance of addressing your problems. With few exceptions (cervical myelopathy, advancing substantial neuro deficit, etc..), prophylactic spine surgery is unlikely.

Just my 2 cents.

Mark

[Juli]

Hi Mark!


I am scheduled to have L5-S1 fused and ADR at L3-L4 and L4-L5. My discogram did not reflect any pain at L4-L5, or very minimal pain which did not feel like my regular back pain, however on the MRI that disc looks very bad,worse than the L3-L4. My doctor said it just made sense to go ahead and do the ADR there to prevent subsequent surgeries and I completely agree. I think it just depends on the specifics of the situation. In mine, leaving a severely degenerated disc between the fusion at L5-S1 and the ADR at L3-L4 just didn't seem like a good idea.

Just another two cents!

[spineally challenged]

Hi Juli
I think you and Dr Bitan are making a good decision.
On discogram my severely degenerate L4/5 did not produce pain and was left in place sandwiched between 2 ADR's at L3/4 & L5/S1. On MRI the 4/5 was the most degenerate of the 3. At 2 years out my life is severely restricted - more so than pre-ADR. I wish my doctor had not relied so heavily on the discogram and taken the whole picture into account. I am now considering a repeat procedure to fix the remaining 4/5. Repeat procedures are far more risky and I'm having trouble commiting myself to what will be for me a third surgery.
Good luck and let us know how it all goes..
Tim

[mmglobal]

Juli, great post! I'm glad it brought Tim out too. These situations show how unique each situation can be.

With your L4-5 looking so bad, the fusion required at L5-S1, and the difficulty in going back in for a repeat operation at L4-5, this is perfect example of a place where you'll replace a disc that is not a pain generator. Even if it didn't look as bad, the other considerations may make it a wise choice to take 4-5.

Dr. Bitan ROCKS! I look forward to hearing of your success.

Tim... I hope you find some relief soon.

Mark

[spineally challenged]

Hi Mark
Good to see you back..
Hope your trip was both enjoyable and successful and you didn't work too hard.

Things haven't been so good for me lately - the last 2 months have seen me pretty much housebound. However just this last week I've been able to walk again for more than just a few minutes so hopefully I'm due a slightly easier patch. Still waiting for facet blocks.
All the best
Tim

[Juli]

Thanks for the positive feedback! I really feel like I got the correct diagnosis for the first time in my life and figure between that and surgery selection, I have put myself in the best situation I can. (I have been losing weight also to try to help myself in the recovery period. I have lost 43 pounds since February, 27 to go! Sorry, I had to toot my horn, I am pretty excited about that) I was hoping the weight loss would help my back now but no such luck. I only gained all the weight in the last couple of years so I know that is not the source of the problem in the first place but rather a byproduct.

Tim,

You had your ADR with Dr. Zeegers right? And he opted to leave the L4-L5 in place based on the discogram? Did you get any relief and after time the problems worsened or did the ADR at the other two levels not help at all?

I saw Dr. Zeegers just to get multiple opinions and based off my MRI and xrays he thought that I would need L3-L4 and L4-L5 done but that was subject to change based on the discogram. He did not think I needed a fusion at L5-S1 because he thought it was already fully fused. I don't know if he would have changed his
mind after the discogram or not.

[spineally challenged]

Hi Juli
First off gongrats on the weight loss - I'm sure your hard work will pay off in the operating theatre and your subsequent recovery..
My recovery was never textbook but initially there was improvement particularly with sitting. At about 6 months I increased my activity levels and from then onwards things have gone down hill. My life is very resricted and I have suffered repeated prolonged episodes where sitting, standing and walking have all been limited to less than 5 minutes. In between I do have better patches during which walking in particular improves but sitting and standing in one place remain constant problems. The likelihood seems to be that my increased activity overstressed the sandwiched severely degenerate L4/5 - although this remains unproven.
I wish I'd had all 3 levels done in one go but I can't go back - what's done is done. The best I can do now is research my current options to make the best choices possible for any future intervention. The alternative is to accept life as I am. Things could be worse - for the main part I can escape the worst of the pain by lying down and I have a loving supportive family.

Again I wish you every success in your upcoming procedure - it sounds like you will be in good hands.
Keep in touch
Tim