ADRSupport Community - ADR verses fusion at L5/S1

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- - ADR verses fusion at L5/S1 (https://www.adrsupport.org/forums/showthread.php?t=13598)

I'm a three level hybrid. Clavel fused my L5/S1 and inserted two M6s above that. That was 2.5 years ago.

He said my sacral slope was too steep.

Just curious but how does the doc deal with spurring and facet arthrosis from an ante

When they put something solid in to fuse it, they restore to the height of what a normal disk would be. This takes the pressure off the nerves and the facet joints . The facet Joints will no longer be supporting the weight it should reduce inflammation and pain from the facet joints. Sometimes they also fuse the facets as well but not always.

Fusion at L5-S1 will always put you at risk of wearing out your SI joints, something to be aware of.

Quote:

Originally Posted by hanshan (Post 115296)

Fusion at L5-S1 will always put you at risk of wearing out your SI joints, something to be aware of.

SI and hip and there's little you can do with the SI joints other than fuse them when they become problematic.

Quote:

Originally Posted by jgvesely (Post 115252)

I have only heard back from the Texas Back Institute. They recommended that I get an ADR at L4/L5 and a ALIF fusion at L5/S1 (a hybrid). When I asked why fusion was recommended at L5/S1 rather than an ADR, I was told it was because I did not have much disk space left at this level. (I have only been corresponding with Christine, the doctor's representative). Do any of you know the reason why a fusion would be recommended at L5/S1 for people with a lot of disc degeneration at that level? I know there is not much movement to begin with at the L5/S1 level and it's my understanding that since there is no disc below L5/S1 and I would be having an ADR at the level above it, that there's not much risk of hurting adjacent discs. Still, fusion is a lot more expensive, and I've heard that the surgery takes longer and that the recovery is longer. I definitely trust the Texas Back Institute and I've heard many great things about them. I'm just curious to know what other people's thoughts are on the question of doing ADR vs. fusion at L5/S1.

Quote from Dr. Rischke et al. in "Preclinical and clinical experience with a viscoelastic total disc replacement" published 2011 in the International Journal of Spine Surgery:

"Some investigators advocate fusing the L5-S1 segment rather than implanting a TDR because of lower reported ROMs at this level. Although the ROM has been reported to be lower in some loading modes at L5-S1 compared with L4–5,ROM should not be the important factor in deciding between fusion and TDR. The compressibility of the L5-S1 segment is vital in the transition to the relatively stiffer segments of the pelvis below. Thus, in the degenerative state, the resistance to compressibility is lost, leading to clinical symptoms. This study shows that restoring stability and compressibility results in excellent clinical relief of symptoms. We therefore advocate the use of VTDR in this segment over fusion wherever possible."

I wanted to bring this up, since I heard some parties use the range of motion (ROM) argument for fusing L5-S1. Even if ROM may be small in flexion and extension, the L5-S1 may play a vital role in compression!

Dear Blizzaga, Annapurna, Hanshan, Drewrad, and Pittipete,

This is a very belated thank you for the information that you shared on this thread I started a while back! I am sorry that my appreciation is so belated....I have been experiencing some pain when using the mouse and typing the past few weeks. I am now switching to voice activation.

I will be getting ADR on levels L4-L5 and L5-S1 with Dr. Clavel on March 22nd. I am excited and a little nervous. At some point in the future, I will probably get my neck worked on too.

I hope you are all doing well!:wiggle:

Quote:

Originally Posted by jgvesely (Post 115558)

Hi, so you decide to do ADR on your L5S1 not fusion?

ADR instead of fusion on L5-S1

Quote:

Originally Posted by donmas2000 (Post 115583)

Hi, so you decide to do ADR on your L5S1 not fusion?

Yes. From everything I have read, it seems like the better choice. And it is what Dr. Clavel recommended. Also, I have heard from several different sources that surgeons in America are starting to recommend hybrid surgeries because it is more easily covered by insurance.

All the best to you!

Hi WakesurfMike, are you going down the surgery path? It seem like i have the same level problem with you L5S1. I am doing conservative treatment for almost 1 year and i am better with sitting and standing but not bending and lifting with more 3 kg. What do you think about surgery?

I find it incredibly interesting that Tiger Woods went to TBI for his l5-s1 issues and went with a fusion over ADR. TBI is definitely a pioneer when it comes to ADR in the US, and Tiger Woods is arguably one of the most famous athletes of our generation. I wonder why they didn't choose ADR at the l5-s1? To me it's a bit telling.