Surgery Opinions - STALIF L5/S1 option...

[longroadahead]

The physical therapist tell me my pelvis is tilted and tight muscles are creating a twisting effect on my spine and the reason for my pain. My muscles still are super tight in my legs and hip etc. and am working on stretching and other exercises.

The doctor dismissed this entirely and said my pain is coming from the disc and is recommending fusion or ADR at the L5/S1. Since the level doesn’t move all that much he is indifferent between the two to some degree and recommends I enroll in a research study pending and potentially get the new freedom disc pending on which way I want to go (and insurance).

Although the L4/L5 was not a confirmed positive (rated 3/10) pain scale on the discogram it may need to be replaced at a future date and the surgeon would want ADR at this level but right now don’t think I could afford a hybrid because the insurance would not probably cover it.

My thought is stacking one disc on another may be asking for future problems especially if they are not perfectly centered (surgeons aren’t perfect) or they end up shifting to forces unknown.

My follow up appointment is in June and the doctor said I could continue PT and maybe get an epidural but the doctor thinks it is time to maybe consider surgery.

Basically, I like what I read about the STALIF at the L5/S1 and this would leave the door open if I needed a ADR at the L4/L5 at a later date (hopefully not). Any thoughts?

[tigerpaw75]

My wife had a STALIF device at L5/S1 about 3 weeks ago, with a Prodisc ADR at L4/L5, done at Texas Back Institute. The design of the STALIF appears to be pretty solid, 3 or 4 titanium screws + bone graft material...once the fusion occurs it should be super solid...

Encourage you to at least consider Texas Back for a consultation - those guys are among the best in the country.

[Fuzzy]

I had Stalif at L5/S1 with a Active L ADR at L4/L5 in November 07 and the surgery as a whole was very sucessful. In my case it was the right thing to do. It fused within a month and I have more range of motion then before. No pain. This hybrid fusion/adr procedure seems to be a very sensible approach and removes the risk of 2 ADRs from the equation.

Only problem for you is that if you have an anterior surgery you should really try to do both levels at 1 time rather then have 2 surgerys as the risk goes way up the second time.

[Juli]

I would much rather go ahead and have the hybrid now than have a second surgery later. I had a hybrid surgery. My L4/5 was not a pain generator during the discogram, but it would have been sandwiched between a fusion and an artificial disc, so we went ahead and did it. I have read on this site a few stories about patients who had to go back and have another level. Once is enough for me, that recovery was not a bowl of cherries!

My insurance would not pay for ADR at all, so I had to pay for that part out of pocket anyway, but they covered the fusion and the hospital stay and all that, so I was just stuck with the cost of the discs and the surgeons fee. It wasn't cheap, but i would rather drive a hoopty for a few years, pay for the discs and have it done!

Good luck.

[longroadahead]

A Dr. told me today the the Stalif would leave the posterior annulus intact and would have to be turned over to get rid of the disc that is compressing the nerve.

I was under the impression the Stalif would mostly remove the disc but now am not so sure...

[Jstuckey]

I'm scheduled for a STALIF TT (different from a STALIF without the TT?) at L5-S1, together with 2 M6s directly above, but not until September 28th in England. If I get any details from the surgeon on the procedure, outside of the company info available on the internet, I'll post it. The one I'm getting looks like everything in the disc space is removed, to make room for the implant (packed with bone and screws). But again, maybe this is a different version your surgeon uses.

[Jstuckey]

From the STALIF TT link: http://www.centinelspine.com/STALIF_TT_Product_Brochure.pdf

The annulus is incised as close to the endplates as possible and a wide disc
clearance is performed to allow the STALIF TT™ to be positioned on the ring
apophysis of the vertebral body.
While some surgeons perform a complete discectomy, others chose to leave a thin
rim of annulus around the posterior and lateral edges of the disc space. In complete
discectomies, particular care must be taken to fully remove the disc material in the

posterolateral corners.

Hope that helps

[longroadahead]

Thanks!

It is the disc material removal of the posterlateral corners and the back of the disc I am worried about.

2 surgeons have commented that a anterior approach wouldn't work for me or if it did I would have to be flipped around during surgery to remove the disc herniation. One did admit the complete disc could be removed from an anterior approach but it would be difficult.

Still researching and 1 more surgeon to see and then will try to make a decision...

[cls]

Hi Longroad,

Just read the first post of this thread and the description from your PT jumped out at me. I have recently discovered that my SI joints are the cause of my twisted pelvis (right rotates anteriorly and the left posteriorly) and ongoing dysfunction post L5/S1 fusion. Perhaps it would make sense to get an SI joint injection to rule out this as the cause of your leg pain? Given what I have been through I wish I had known more about SI joint dysfunction. Sorry I can't comment on the Stalif. I hope the best for you whatever direction you take.

[longroadahead]

I will discuss the SI joint again with the doctors but I ruled it out in 2009 because I had a bi-lateral SI joint injection and it didn't do anything for me.

Had a discogram in 2010 because I wanted to get the fibrin sealent injections and the L5/S1 was positive. Now the L5/S1 is pressing on the nerve root creating right leg symptoms.

Thanks for all the comments!