Alastair
03-06-2006, 07:24 AM
Pros of (endoscopic) ALIF fusion:
Endoscopic is less invasive, promotes faster recovery (for the incision) but not necessarily lifestyle.
BMP compounds enable very effective, very high rates of fusion (seem to be 95% or even better for most clinics. But don�t confuse fusion effectiveness with operative success; many patients see 100% fusion but still have problems.)
Lumbar fusions are proven with good outcomes supported by hard data. Fusion procedures have been performed for more than 50 years; BMP compounds are new but quite effective.
Cons of (endoscopic) ALIF fusion:
Loss of mobility in fused area after complete fusion takes place (the intended goal!). Short or long term, this can contribute to premature degeneration in adjacent discs and connective tissues, called Transition Syndrome. Stats vary on the number of patients that require subsequent fusion, ranging from 30 to 60% of all patients.
Procedure with scopes is complex, with a comparatively longer operation time (app. 4 hours). Longer operation time may mean higher risk for some people.
Higher probability of nerve or vessel damage than with open or mini-open techniques. Supporting data for this quite varied.
Wearing a brace for 3 months (2-4 depending on patient and doctor).
Limited routine and mobility because of fusion setting period.Fusion takes on average 15 months to complete; 3-24 months is the range.
Medical community�s opinion is decidedly mixed on long-term efficacy. Many doctors seem to be skeptical of endoscopic ALIFs and long-term effects of fusions.
Some surgical teams do not have a vascular surgeon involved in the procedure, possibly posing a risk in the case of vascular problems.
Pros of Charite� ADR: (specifically compared to endoscopic ALIF):
Shorter operation time, app. 1.5 hours.
Anterior approach makes healing comparatively more �comfortable� than a posterior approach; no muscles are torn either.
No �walking on eggshells,� and one can resume most normal activities almost immediately.
Natural range of motion is retained in all critical axis (possible exception of downward motion, as the core is high-grade plastic).
Unconstrained design is more �forgiving� than semi-constrained� design (as found in ProDisc and others) in terms of providing more device placement margin or error.
Lots of patient outcome data is available: clinical trials in the U.S.; long-term data from Europe indicate very positive outcomes. Over 7000 procedures have been performed to date.
Disc core is accessible for replacement or revision (unconstrained design makes it easier to access).
Cons of Charite ADR: (specifically compared to endoscopic ALIF):
Approved by the FDA, but not by many insurance companies.
Possible complications post-op; although 48/50 patients from New England Baptist are doing extremely well and had no complications. European results mirror these outcomes.
An open anterior procedure and is more invasive than an endoscopic procedure. A longer recovery time for the incision than ALIF.
ADR is still relatively new in the U.S., and there is still a �learning curve� for doctors, physical therapists, etc. to provide the best possible treatment to patients.
Clinical data is still being dissected, analyzed and criticized.
Many different sources were used to compile this information. The two most helpful and reputable sites available today are:
http://www.spine-health.com/index.html and
http://www.spineuniverse.com/
Endoscopic is less invasive, promotes faster recovery (for the incision) but not necessarily lifestyle.
BMP compounds enable very effective, very high rates of fusion (seem to be 95% or even better for most clinics. But don�t confuse fusion effectiveness with operative success; many patients see 100% fusion but still have problems.)
Lumbar fusions are proven with good outcomes supported by hard data. Fusion procedures have been performed for more than 50 years; BMP compounds are new but quite effective.
Cons of (endoscopic) ALIF fusion:
Loss of mobility in fused area after complete fusion takes place (the intended goal!). Short or long term, this can contribute to premature degeneration in adjacent discs and connective tissues, called Transition Syndrome. Stats vary on the number of patients that require subsequent fusion, ranging from 30 to 60% of all patients.
Procedure with scopes is complex, with a comparatively longer operation time (app. 4 hours). Longer operation time may mean higher risk for some people.
Higher probability of nerve or vessel damage than with open or mini-open techniques. Supporting data for this quite varied.
Wearing a brace for 3 months (2-4 depending on patient and doctor).
Limited routine and mobility because of fusion setting period.Fusion takes on average 15 months to complete; 3-24 months is the range.
Medical community�s opinion is decidedly mixed on long-term efficacy. Many doctors seem to be skeptical of endoscopic ALIFs and long-term effects of fusions.
Some surgical teams do not have a vascular surgeon involved in the procedure, possibly posing a risk in the case of vascular problems.
Pros of Charite� ADR: (specifically compared to endoscopic ALIF):
Shorter operation time, app. 1.5 hours.
Anterior approach makes healing comparatively more �comfortable� than a posterior approach; no muscles are torn either.
No �walking on eggshells,� and one can resume most normal activities almost immediately.
Natural range of motion is retained in all critical axis (possible exception of downward motion, as the core is high-grade plastic).
Unconstrained design is more �forgiving� than semi-constrained� design (as found in ProDisc and others) in terms of providing more device placement margin or error.
Lots of patient outcome data is available: clinical trials in the U.S.; long-term data from Europe indicate very positive outcomes. Over 7000 procedures have been performed to date.
Disc core is accessible for replacement or revision (unconstrained design makes it easier to access).
Cons of Charite ADR: (specifically compared to endoscopic ALIF):
Approved by the FDA, but not by many insurance companies.
Possible complications post-op; although 48/50 patients from New England Baptist are doing extremely well and had no complications. European results mirror these outcomes.
An open anterior procedure and is more invasive than an endoscopic procedure. A longer recovery time for the incision than ALIF.
ADR is still relatively new in the U.S., and there is still a �learning curve� for doctors, physical therapists, etc. to provide the best possible treatment to patients.
Clinical data is still being dissected, analyzed and criticized.
Many different sources were used to compile this information. The two most helpful and reputable sites available today are:
http://www.spine-health.com/index.html and
http://www.spineuniverse.com/