[Blizzaga]

Originally Posted by jgvesely

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!