ADR questions - just getting started
 

Hello to everyone and thank you for continuing to support and offer insight to all involved.

I am just getting started with exploring ADR. I have dealt with a degenerating L5/S1 disc with no lithesis for 6 years. I am getting started with a local neurosurgeon that teaches at U of Michigan for an initial opinion. I want 3 surgical opinions overall. So I need as much insight as I can get in order to make the best decision for my situation.

I looked for a while for these answers and couldn’t find any, but here goes:

1. If I only have L5/S1 ADR, and the disc above needs replacement years later, am I unable due to re-entering the abdomen (kind of like the risk of ADR to fusion revision?)

2. If I decide to do an ALIF with a STALIF-M device, and years later need an L4/5 ADR, do I disqualify myself the same way as mentioned in #1?

The L4/5 is mildly degenerated but still lots of height and fluid. I am 45 and if just the L5/S1 is proposed to be operated on, what if the one above goes bad later? I know with a fusion, more likely, but I am reading ADRs don’t necessarily protect from further adjacent degen.

Thank you for any thoughts or input.

It's been a lot of years since Laura had to address this question but she also has a L5S1 Charite ADR and a partially degenerated L4-5 disk. At the time the thought was that a second surgery would be challenging due to scar tissue from the first surgery but not impossible.


In an analogous but not identical situation, her two cervical ADRs were put in in successive surgeries. The first was easily done and recovery was quick. The second took longer to heal from and partially damaged the nerves in the area, leading to limited response of one eye's iris to light and the need for a year or two's worth of training to get her vocal cords to fully operate again. Still better than living in pain with the degenerated disk but your concern is well-founded.


One thing you might wish to investigate is the various stem cell offering for your L4-5. They don't work all that well if the disk is leaking fluid but it sounds like you're not there yet. Laura had autologous chondrocyte discal therapy disk injections, an early form of stem cell treatment, on her L4-5 disk at ProSpine and was able to rehydrate the disk to the point where it's not given her difficulty in the ten years or so since she had the treatment. If you regard the stem cell work as a means to buy time and hold off the need for and ADR or fusion, that should calibrate both your expectations and the money and trouble you'd put into getting it. Maybe you'd be lucky and not need another surgery. Maybe you'd just buy a few years to address your L5S1, heal and regain strength before you need to address the L4-5.

Thank you for the reply. I have been reading the thread you participated in with the Australian dr. Yes, the 4/5 disc is bulged but good color. Thanks again.

German, not Australian. Technically, maybe Austrian but ProSpine is in Bogen, Germany.


The approach of stem cell injections to treat incipient degenerative disk disease is offered by a number of doctors, though anytime you hear someone talk about stem cell therapy you need to do a lot or research about what's offered to ensure it's not snake oil. You don't have to go to ProSpine to get the treatment; heck, it was so long ago they might no longer offer it. I would try to pick someone with a longstanding practice and experience if you do go this route, though.

Forgive me, I meant the thread with Ozphysician regarding stem cells and facets. Really good stuff.

Thank you again for the insight on stem cells. I will definitely look into this further. I meet with the first neurosurgeon on Friday to just get an idea of what my options are. Hopefully my facets are in good shape but my end plates look rough. No modic signal just wavy. Not sure if endplate degeneration disqualifies me from ADR.