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Optimistic 04-10-2014 03:09 PM

Planning Surgery
I am a new member and have read many posts over several weeks. The discourse has been both interesting & helpful. I am typically an analytic person who researches items thoroughly, and with the stakes so high on my back, even more so. I am also a very active individual who engages in skiing, mountain biking, scuba diving, kayaking, etc.

I have experienced lower back issues, extending down to buttocks, hips and legs beginning >20 years ago with L5/S1. Several years later, L4/L5 was affected and then L3/L4. I have tried conservative treatments ranging from NSAIDS, physical therapy, chiropractic treatment, acupuncture & hydrocodone, all with limited relief. While various neuro and orthopedic surgeons recommended surgery over the years, I found that time (~1 - 3 months after the acute episode) was the best help to alleviate the acute symptoms. I subscribe to the approach of "putting off the surgery if you can live with your symptoms". I have not had any surgery or injections to date.

In the last 6 months, I experienced an increasing amount of pain as well as functional limitations. A new hip pain was examined by a hip specialist who attributed it to my back. While I have not been able to run for some time, now I am unable to jog. Walking sometimes can aggravate my symptoms. I have intermittent pain that restricts me from various activities and social engagements.

I started sharing info with European surgeons (all US docs are recommending fusion at 3 levels from L3 to S1). The opinions are coming back ranging from 1 level fusion to 3 level ADR to hybrid with dynamic stabilization.

My questions for which I am obtaining very different answers from Europe include:
1) Am I a candidate for ADR? Why or why not?
2) Do I have some spontaneous autofusion taking place between vertebrae that can affect the decision for ADR?
3) Do I have any motion (ROM) at the two lower discs? If not, will ADR be able to restore it (assuming that I also exercise the muscles, obtain PT & Chiro, etc.)?
4) If I obtain ADR and my facet joints are contributing to my symptoms, will this be addressed as part of the decompression?
5) Can the segment that is contributing to the pain & weakness be identified and can we isolate it to the neuroforamenial narrowing, disc herniation, stenosis or ligamentous-facetal hypertrophy or a combination?

Like others who have posted, the docs do not agree on the diagnosis or recommendations. I also understand that some members have consistent recommendations from the docs I am now in the final process of selecting a surgeon, approach & technology. I will keep you posted on my selection, the overall experience, my insurance hell and my outcome. If you have any suggestions, please advise. Thanks for your support & wish me luck.

drewrad 04-10-2014 04:15 PM

What's your age?

Your bio has all the familiar phrases we're all used to reading about here. The loss of lordosis seems to be the point at which decisions need to be made in terms of losing mobility. There does seem to be a point at which surgery needs to be seriously contemplated, and not just pain management, but in terms of bone-on-bone anatomy becoming more problematic than discogenic issues alone. How are the facets?

Also, since you have divergent opinions yourself, I wouldn't mind knowing about which doctors said what and who was more conservative versus aggressive. We're all probably talking to the same ones, but I'm open to hearing new names.

And finally, if you can, seeing an MRI. I'm not a doctor, but I'm getting better at seeing images. There is a difference between someone with literally no space between vertebrae and someone who has a little. I'm referring to disc vacuum syndrome where it then becomes imminent to make a decision sooner rather than later, if ADR is still preferable.

Optimistic 04-12-2014 09:23 AM

I consulted with 2 ADR specialists in UK, 3 in Germany, 2 in Spain &1 out of Cyprus. They are all the same names that are posted so often on this site. I saw another US doc yesterday, Dr. Thomas Roush, named one of the top 100 in the country. He also indicated that I am not a good candidate for ADR, even though he has performed many cervical & lumbar ADRs.

One German doctor Dr. B recommended 3 level ADR (from anterior) plus 2 level posterior stabilization (for the facet joints). While he indicated that mine is a very complex case, I wonder if this might be too extreme in terms of risks, potential failure, recovery time, etc. Has anyone had any experience with multi-level, anterior & posterior procedures in one surgery?

jss 04-12-2014 10:17 AM


Condolences on your quandary. Seeing so many post here who, like yourself, have widely divergent opinions from respected spine surgeons make me realize my good fortune in that there was little variation in the prescriptions I received for the malady that culminated in my double ADR.

While I understand the objections to ESI's, know that that is a quick and easy procedure that has a very low complication rate and can provide significant relief for weeks and months to many spine sufferers. I had at least four of them myself and experienced substantial, albeit temporary, relief each time.

What reasons did the US ADR surgeons give for you not being an ADR candidate? Though I tend to side with the Europeans, multiple contraindications from US ADR surgeons should be seriously considered.

There have been a few posters on this site that had lumbar interventions from the anterior and posterior during the same surgical session. The only handle that's coming to mind at the moment is Maddie. She doesn't post here any longer but may respond to PM's.

Good luck, Jeff

Optimistic 04-12-2014 04:13 PM

I appreciate your input Jeff. I recognize that ESIs can sometimes provide immediate relief, I have nerve issues at all three levels (and potential facet joint problems) and am looking for a "permanent" solution. While this may be a bit overly optimistic, I lean towards a positive outcome rather than being a doubter.

The US doctors, as well as some Europeans, state one or moe of the following:
1. My DDD is too advanced - they could have done someting in ADR 8 years ago
2. ADR surgery will not fix my facet joint arthritis
3. If they put in an ADR, my facet joints will become a new pain generator
4. My vertebrael bodies have already started to autofuse
5. I need posterior decompression to release my facets - leading to combined posterior dynamic stabilization & anterior ADR, a procedure that is relatively new and subject to excessive risk.

I'd be interested in your & other's opinion(s) and thanks for the intro to Maddie.

jss 04-12-2014 04:46 PM


From my current understanding of the contraindications in that list, my first inclination would be to pursue ADR at only the levels that the majority of consulted doctors thought could be successful. That's probably not going to be every level; maybe even none. I, along with everyone on this board, will be pulling for a positive outcome for you. As much as I dislike fusion, it's important to realize that in some cases that a positive outcome might have to contain a fusion (or two).

Will the posterior decompression be the "minimally invasive posterior lumbar foraminotomy" that I've read about? My understanding is that the recovery from the minimally invasive version, which is done orthrosopically, is a FAR easier recovery than the non-orthroscopic version.

Good luck, Jeff

Harrison 04-16-2014 12:24 PM

Please see this multi-page topic:

Optimistic 04-16-2014 01:34 PM

Risks & Complications
Thanks for pointing out the issues with ADR. I have also reviewed the risks and complications with fusion. One of the links below (3rd) shows that the patient is the one that isn't necessarily benefiting while the medical device manufacturers, hospitals & surgeons all do well by the surgery.
Spinal Fusion Risks and Complication

Multilevel Spinal Fusion for Low Back Pain

Highest-Paid U.S. Doctors Get Rich With Fusion Surgery Debunked by Studies - Bloomberg

I understand that failed back surgery syndrome (FBSS) affects up to 40 percent of patients. With a 3-level fusion which is only one of the options I am considering, risks only increase. This is why I am seriously looking at ADR & hybrid procedures rather than simply choosing what many of the surgeons I have consulted with are recommending (i.e. fusion). Below is more info about FBBS, which I believe can come from fusion, ADR and even microsurgery, which still represents surgery.
Primary causes

Many factors can contribute to FBSS, including:
  • Failure to adequately diagnose the condition(s)
  • Failure to adequately treat the condition(s)
  • Spinal fusion failure
  • Surgery performed at the wrong level of the spine
  • Creation of new spine conditions at another level after open-spine surgery (very common)
  • Scar tissue formation
  • Hardware insertion
  • Missed fragment of disc or bone still pinching nerve
  • Inadequate decompression of nerve root
  • Nerve damage

Patients with FBSS may experience or develop:
  • Continued/chronic pain
  • New spine conditions
  • Pain above or below the treated level of the spine
  • Limited mobility
  • Inability to recuperate
  • Dull/aching pain in neck, back or legs
  • Sharp/stabbing pain in extremities
  • Joint immobility
  • Spasms
  • Anxiety
  • Depression
  • Dependence on prescription drugs
I am hoping that everyone on this site is looking for the info you shared on your CD, which includes: 1) Accurate Diagnosis (as good as one can obtain), 2) Review of Treatment Options, 3) Selection of Surgeon & Procedure, and 4) Road to Recovery.

I am still on steps 1 & 2 but making fast progress. I have recently obtained my flexion/extension X-rays (which some surgeons requested) and plan on an EMG test tomorrow (even though these may not be of significant value).

I have also obtained multiple inputs from many European doctors and planning the phone consult with at least two of them. It is not an easy decision between ADR hybrid & fusion & between more complex surgery (anterior & posterior at multiple levels) and minimal surgery in which I may have to have another surgery before long.

Some members on this site have had an easier time with surgeons agreeing on the problem (diagnosis) and on the treatment. Unfortunately, I am not one of those. Maybe the consults will make the decision easier.

tnt136913 04-16-2014 03:20 PM

I ha a l4 thru s 1 360 fusion in 2000 with hardware with dr guy Danielson with tx spine and joint and was pain free until my l3 l4 blew , if you find the right neuro surgeon that dosent cut muscle fibrers and goes in between them you will have a pain free out come as long as you do not have nerve damage from stennois

tnt136913 04-16-2014 03:47 PM

another thing is these docs at tx spine and joint used both the pro disc and the charrite but due to to much facet problems they stopped there use,,, also check out dr charley Gordon , he is in the fda process of working on a 1 level tli type adr that moves

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