help with decision
 

Hello all, new member, Phil in the SW. As most of you are doing I am at a fork in the road. I have severe DDD with osteophytes at C567 and a central herniation/annular tear at L5S1 near the theca sac. Moderate to severe symptoms consistent with these areas. All of life affected, etc. Both Clavel and Bierstedt have reviewed my case and recommend ADR at all with the M6. I am OK with the neck but am hung up about the M6 at L5S1. Both Docs will fuse there if I can't come around. I am concerned about shear forces and migration over the next 20-30 years and how the polymer nucleus will hold up. Had Skype call with Clavel and was thoroughly impressed and helped. Have had conversations with Bierstedt patients and they have done well. My talks have all been thru Malte then he calls or emails me back but not always so have not talked with Bierstedt. I hope some of you more experienced folks can shed a little light about what to do. I know I must make this decision but any dust clearing you can provide will be appreciated. All MDs in US say wait, wait, wait. Obviuosly they've never had fire down the back of their legs for 3.5 months. Sincerely, Phil

Phil, have you considered getting a consult at the Texas Back Institute? Or other American docs who have been doing spinal disc replacement for the last 14 years?

Phil,

+ 1 on TBI

Having done both C and L I can say in both cases I would and did wait. My Lumbar was an issue for a really long time. I had no choices left in the end since I had Cauda Equina. The Cervical was not a choice either since I was losing the ability to swallow and massive muscle loss down both arms.

My opinion none of this should be taken lightly. Pain in my opinion shouldn't be the only indicator to do anything but obviously if it destroying you then yes.

Your question regarding L5S1. Well mine was gone and almost naturally fused. If I needed 5S1 done I would not have done ADR there. Thats just me. THe mechanics of that location anecdotally just doesn't make sense. It seems that most that have issues with ADR are at that level. I very much feel that the perfect candidate must be chosen for ADR at 5S1. Any contraindications IMHO should steer you away from that. IMHO and IME avoid that area at all costs. My experience was 17-18 years from the first injury there. I really dont think thats what caused the higher levels for me especially now that there are 2 ADR's above and no issues (for now) at all.

Choose wisely.

Frank

Make sure your facets are not shot before considering at Lumbar level:shedance:

facets
 

All docs say facets are OK, 1 in US says they are mild to mod deteriorated, none say severe or "shot" . Filum

My facets at L4-L5 are moderate and Biersdat told me they were fine.
Went for facet joint shots and then rhizotomy.
Sharp pain gone.
Dont let a doctor tell you they "LOOK" fine.
Make sure you do your due dilligence and rule out facets.
My 2 cents

I have not had any facet pain yet, If my disc gets thinner I probably will though. On my MRI the facets have a gap still and look like the others at higher levels. I am still leaning in the direction of an ALIF down there.

This may not be helpful, but I had a 3-level hybrid w/ADR L3-L5 and fusion at L5-S1. The only continued pain I struggle with is, IMO, the fusion. Dr. Blumenthal said it wasn't necessary to have ADR there, because of the location, so that's why we fused. I just wonder, in my case, if an ADR would have been a better choice.

Then again, the weather in Texas has been so crazy this year that it could just be I'm a 55 yr old chick and it's COLD outside, lol!

All that to say, in the end..it's your choice. these folks here are the best researchers!

Yo, Filum,

Just a friendly reminder that there are grading scales to classify the degree of facet arthrosis, e.g. the Fujiwara's Facet grading scale. There are others – here’s one:

Facet Arthrosis Description:

Grade 0: Normal facets
Grade 1: Moderately compressed facets with small osteophytes
Grade 2: Muscle interspersed with some fat
Grade 3: Facets lacking articular joint space and with large osteophytes

Ask (or insist) that your spine doc grades your facet disease (arthosis) at the affected and adjacent levels. This will help you as a patient and other medical providers down the road.

Also, within this community, you can do advanced, simple searches on this topic. Try these terms, using this link: http://www.adrsupport.org/forums/search.php

1. Facet arthrosis
2. Facet disease
3. Facet grading
4. Facet disease grading
5. Et al

Related link: http://folsomphysicaltherapy.com/ddd...mbar-spine.pdf

On Google, try this link to find Karin Büttner-Janz’ book on artificial disc replacement:

Karin Büttner-Janz artificial disc facet disease

See the Google Books result. She did a great job assessing the criticality of assessing facet health as a possible contraindication.

I am glad my surgeon and I decided to do the fusion at the L5/S1 instead of ADR. Even though I do have a little pain while sitting, I would still stick with my decision if I had to do it all over again. I feel the ADR was just to risky.

Like others have mentioned, why don't you try and get the ADR in the neck and fusion at lumbar in the states? If you need just one ADR in the neck you shouldn't have a problem getting insurance to pay. If you need a multi-level, you will have to appeal with insurance. I was able to do so and won on my 3rd appeal.