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Old 07-17-2012, 04:59 PM
Slackwater Slackwater is offline
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Join Date: Aug 2007
Posts: 782

Originally Posted by drillnpick View Post
We also discussed the possibility of ADR for my L2-3 ruptured disc. He said even "if" it were an option for me in the U.S., which it is not, that he wouldn't recommend ADR for my lumbar. Part being that I have a 3 level fusion below it and partly because he feels that cervical ADR is a wonderful option for patients but doesn't have the same enthusiasm for lumbar ADR. He feels that there are too many other "obstacles" to consider when it comes to ADR being a success in the lumbar region, and he has read of too many failures of ADR in lumbar region and says that is partly why insurance won't cover it.
Side Notes,
I do not recall seeing a journal article or case report with ADR at L2/L3.

Your surgeon said something about lumbar obstacles / failures. In the event somebody reads this and wants a little context, see the below.

Lumbar ADR and Fusion at multiple levels have "obstacles"(?), let's say points and counter-points measured over time periods. The points measured are outcome (ODI/VAS, quality of life), complications, durability and re-operation.

Insurance companies have a lot of Fusion and some ADR/TDR data points. Insurance companies ~understand lumbar fusion points and what costs money. The data around lumbar ADR / TDR is not complete. Patients, surgeons, medical community, etc, want a new surgical (or other) technique, a grand slam, out of the park, significant statistical improvement, etc. for patients. ADR/TDR has OK+ metrics, needing OK+++.

The surgeon noted too many failures with Lumbar ADR. I suggest the complication and reoperation rate between Fusions and ADR need has been measured for single-level operations and the outcomes are published for the limited data set of xx years. This goes back to a more significant statistical difference, or "need a grand slam".

The multi-level (2 or 3 level) operations with Fusion and ADR have slightly lesser outcomes than single-level. Two (2) Level ProDisc results measured OK+ compared to Fusion (note.Level.J.Bone.Joint.Surgery.2-Level)

The biomechanics of a three-level Lumbar ADR / TDR has risk factors. Please note the below to make the fusion choice correct (note. E.Spine.J.2012)
Effect of multilevel lumbar disc arthroplasty on [lumbar] spine kinematics and facet joint loads in flexion and extension: a finite element analysis.
Schmidt H, Galbusera F, Rohlmann A, Zander T, Wilke HJ
Eur Spine J. 2012 Jun;21 Suppl 5:663-74.
(1) the more artificial discs are implanted, the stronger the increases in spinal mobility and facet joint forces in flexion and extension;
(2) deviations from the optimal implant position lead to strong instabilities.

The European Spine Journal article notes device "lift-off" is possible with three levels and the use of Charite'. The "position" of the ADR increases in importance with more levels. The journal reports from the above, other surgeons and ortho-biomechanial researchers note lumbar ADR surgical placement will affect the surgical success rate.

Cervical ADR is getting to be more accepted (note.J.Neursurgery.Spine)
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