New Guy

[annapurna]

Originally Posted by nanfromsactown

I think they usually do the fusion at the lower level and ADR above, so that motion is maintained and wear and tear on the adjacent disc is minimized.

That's typically only if both levels are equally bad/good. If one level is significantly different from the other, they'll recommend fusion for the one that most needs it. Also, you're talking about L45 and L34; as you have disks both above and below the two affected level, you'll be risking adjacent level degeneration regardless of which order you put them in.

[laid up doc]

yeah that's a rough combo... you have to almost assume L5/S1 will go eventually... then it's TLIF time.

[annapurna]

In fact, just thinking about it, your surgeon may want the ADR low thinking that it would give you mobility if L5S1 goes at some point. If you fused L5S1 and L45, you would likely end up with hip and SI joint issues in your lifetime. This is pretty wild speculation so a discussion with the surgeon is in order but this might be one reason for his recommendation.

[nanfromsactown]

Originally Posted by annapurna

That's typically only if both levels are equally bad/good. If one level is significantly different from the other, they'll recommend fusion for the one that most needs it. Also, you're talking about L45 and L34; as you have disks both above and below the two affected level, you'll be risking adjacent level degeneration regardless of which order you put them in.

Oh gosh, i misspoke! Forgive me, I was thinking they were going to fuse l45 and ADR l5s1 and that seemed odd, but Jim/Laura are right in what they said! My brain was thinking the fusion would only be up against a moving segment.

I'll go back to my gentle exercises :/