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  #1  
Old 01-18-2017, 08:15 PM
jgvesely jgvesely is offline
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Join Date: Nov 2016
Posts: 32
Default ADR verses fusion at L5/S1

Hi all,

I have been addictively reading this website for the last couple months but this is my first time posting.

First of all, I want to say how grateful I am for this site. I have learned so much and I'm so happy that Harrison created the site and continues to keep it running. After all I've read, I'm excited about the possibility of getting ADR!!

I have been dealing with orthopedic problems since 1992 and below is the history of my back and neck problems that I have sent to some surgeons. I realize it's a bit long, so I understand if you don't make it all the way to the end but perhaps some of you will relate to my experiences and symptoms.

From adolescence to my early 20s, I trained to be a dancer. In 1992, I was in a car accident. I was at the end of a highway off ramp and I was at a stop trying to yield with traffic. I was hit hard from behind. When I was hit, my neck was turned all the way to the left. I also was in a hatchback car so there was no trunk to absorb the impact. The next morning, I was in tremendous pain in my neck and upper back on both sides but it was stronger on the left. The pain persisted for many years although over the years it lessened. (I still have neck, upper back, and arm pain. This happens especially when I use the computer mouse). I got a lot of conservative treatment for this injury.

After about 1 ½ years after the accident, I felt well enough to start dancing again. I got a job teaching and choreographing dance and for the next 5 years, I taught 10 o 15 classes a week, choreographed a lot, and performed dance. Then one day, in dance class, I demonstrated a leap. When I landed, I felt pain in my lower back for the first time. I had a couple more classes to teach that day and by the end of the day, my lower back was in major pain.

Since then, my lower back has been a bigger problem than my neck and upper back. I have gotten a lot of physical therapy, chiropractic treatments, acupuncture, and more for my back. I got an IDET procedure (a heated catheter in my L4 L5 and L5 S1 discs). I also got multiple arthroscopic surgeries in 2001. None of these helped much, so in 2002, I completely quit dancing and became a realtor full-time.

When I stop dancing, it definitely diminished my chronic pain but I was still very limited. In 2010 (during the recession), I started teaching movement to seniors. In 2011, I seriously injured my lower back as a result of doing this. It hurt a lot to put weight on my left leg so for about a year, I couldn’t walk without a lot of Hydrocodone. I got lots of PRP and stem cell injections into the ligaments and soft tissue in my back. This helped, but I’m still very limited in terms of functioning and I have a lot of intermittent pain in my lower back and groin area. The pain is typically on one side but over the years, different sides have predominated at different times. I also sometimes get achiness in my neck, shoulder blades, shoulders, and down my arms. I noticed this happens especially when I use the computer mouse.

Activities and movements that increase my lower back and groin pain: Lifting is the worst! For the last 19 years, even lifting a glass of water can cause me immediate lower back and groin pain. Also, leaning to one side, twisting, arching my back, wearing shoes with any heels, using a car steering wheel unless it has zero resistance, and many exercise activities have been hard for the last 19 years. Since 2011 (when I reinjured my back), pulling (doors, drawers, etc.) has been a big problem. Also, standing on one leg really bothers the side of the lower back that corresponds with the leg I’m standing on. Using stairs, standing on the balls of my feet, and bending forward (it hurts to put on my own boots), have all been problematic since around 2011. For the past few months, I have been having trouble using the accelerator on my car because it bothers my lower back on the right side.

If you've made it this far, thank you! I'm very excited about ADR and have already heard from the Texas Back Institute that I am a candidate.

I look forward to corresponding with all of you on this website and I wish you all a beautiful day.
__________________
Juliette
1992 Neck injured in bad car accident
For many years taught & choreographed dance & injured lower back in 1997
Loads of conservative treatment
2000, IDET procedure L4/L5 & L5/S1,
2001, orthoscopic laminectomies L4/L5 & L5/S1 & orthoscopic discectomy L4/L5.
Surgeries didn't help
Recent years- stem cell & PRP injections- helped a little.
Recent MRI & x-rays show DDD & facet arthrosis in lower back & DDD & bone spurs in cervical spine.
3/22/17 L4-S1 ADR with Dr. Clavel

Last edited by Harrison; 01-19-2017 at 11:23 PM. Reason: Removed weird html formatting
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  #2  
Old 01-18-2017, 09:04 PM
jgvesely jgvesely is offline
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Join Date: Nov 2016
Posts: 32
Default ADR verses fusion at L5/S1

Hi all,

I have been sending out my MRI and other information to a few different surgeons. So far, 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.

All the best, Juliette
__________________
Juliette
1992 Neck injured in bad car accident
For many years taught & choreographed dance & injured lower back in 1997
Loads of conservative treatment
2000, IDET procedure L4/L5 & L5/S1,
2001, orthoscopic laminectomies L4/L5 & L5/S1 & orthoscopic discectomy L4/L5.
Surgeries didn't help
Recent years- stem cell & PRP injections- helped a little.
Recent MRI & x-rays show DDD & facet arthrosis in lower back & DDD & bone spurs in cervical spine.
3/22/17 L4-S1 ADR with Dr. Clavel
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  #3  
Old 01-19-2017, 04:19 PM
FutureRobot FutureRobot is offline
Senior Member
 
Join Date: Jan 2016
Posts: 107
Default

Hi there, my issues are mainly at l5/s1, and imo this question is kind of a toss-up. From what I've gathered, if there is one level to have a fusion it's l5 s1. I know a couple people who've had it done at this level and they are fine. I think with this level, the question comes down to activity. If you are going to be doing light exercise and be moderately active, I think fusion is probably a good bet. If you want to get back to doing whatever you want, I'd probably lean toward ADR.

IMO, this level is kind of risky for ADR, since it doesn't have as much movement and has increased load. The facets are key here, and the more facet issues I run across, the more hesitant I am about ADR. This is a controversial topic for sure. If I was going ADR at this level, I would probably choose a very robust implant, and I'd definitely ask many surgeons for their opinion. TBI is a great place though, with great results.

In your case, you wouldn't have to worry about adjacent levels because your ADR will be on top, but you definitely need to be concerned about the shape of your facets.
__________________
HIZ tear at l5 s1 with mild disc height reduction and mild dehydration.
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  #4  
Old 01-19-2017, 08:54 PM
jgvesely jgvesely is offline
Member
 
Join Date: Nov 2016
Posts: 32
Default Thank you!

Future Robot,

Thank you so much for responding to my post! I really, really appreciate it! It's great to hear your input with regard to this issue. I do have mild to moderate facet arthrosis in my lower back. Is it the general consensus that ADR is harder on the facets then fusion is? If that is the case, maybe fusion is a safer bet for that level.

Thanks again!
Juliette
__________________
Juliette
1992 Neck injured in bad car accident
For many years taught & choreographed dance & injured lower back in 1997
Loads of conservative treatment
2000, IDET procedure L4/L5 & L5/S1,
2001, orthoscopic laminectomies L4/L5 & L5/S1 & orthoscopic discectomy L4/L5.
Surgeries didn't help
Recent years- stem cell & PRP injections- helped a little.
Recent MRI & x-rays show DDD & facet arthrosis in lower back & DDD & bone spurs in cervical spine.
3/22/17 L4-S1 ADR with Dr. Clavel
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  #5  
Old 01-19-2017, 11:19 PM
Harrison's Avatar
Harrison Harrison is offline
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Join Date: Oct 2004
Posts: 7,010
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Hi Juliette, welcome.

FutureRobot offers some good insights. Here's the problem, which I was just discussing today: facet arthrosis (which includes diseases processes) is a tricky thing. Mild arthrosis seems to be OK for ADR, both here and abroad. Moderate arthrosis is a contraindication -- sometimes -- in the US. But not in Europe. They will take anyone, it seems...

Whatever the case, you need to find the pain generator. But it does not end there.

There are many, many different diagnostic techniques that can numb the affected pain area to TRY to triangulate on the diseased tissue that is causing your pain. In general, RF ablation, cold laser ablation and steroid injections (medial branch block) are mainly performed. But even among these, there are many variances in the technology, technique and observed effect. So be mindful of these and ask many questions.

There's much more to this, but I am pooped. Want to watch the weird news and go to bed. Ga night.
__________________
"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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  #6  
Old 01-19-2017, 11:25 PM
Harrison's Avatar
Harrison Harrison is offline
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Join Date: Oct 2004
Posts: 7,010
Default

J, will merge this with your other topic that you started in another forum (now merged).

Wow, what a story you so eloquently shared. I hope we can hold you hand as you face your next steps. We are here for you.
__________________
"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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  #7  
Old 01-20-2017, 05:31 AM
WakesurfMike WakesurfMike is offline
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Join Date: Nov 2016
Posts: 37
Default I don't know of any disc that are FDA approved for 2 level lumbar

I think the reason is they legally can't do two levels ADR in the Lumbar area in the US.

I know the latest disk that was FDA approved is the Active L and it is still only for one level.

http://www.fda.gov/MedicalDevices/Pr.../ucm455656.htm

When is it used? The activL® Artificial Disc is indicated for people who have fully formed and fully grown bones (are skeletally mature), have low back pain due to a problem with one lumbar disc (as determined by a doctor), have been diagnosed as having degenerative disc disease (DDD) in only one lumbar disc at either level L4/L5 or L5/S1 (as determined by a doctor), and have gone through at least six months of non-surgical treatment without relief.
__________________
WakesurfMike
2007 Herniated L5/S1 Lifting changing X-ray tube at work. MRI PT/ Steroid shots/med
2009 switched to Remote/phone support
2010 workman’s comp lawsuit
2011 Microdiscectomy approved 80% pain relief
2011-2016 few flare ups but would always get beter after a few days.
6/2016 Pain is not going way
07/2016 MRI, tramodol, Nucynta, Celebrex
08/2016 Regenerxx PL-Disc shot- didn’t work at all
10/2016 can't even stand or sit for work for 30 minutes before pain gets worse
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  #8  
Old 01-20-2017, 06:30 AM
WakesurfMike WakesurfMike is offline
Member
 
Join Date: Nov 2016
Posts: 37
Default different ways to fuse

If you do end up going with fusion at one level there are many different ways to do it. I personally would not want to deal with a second wound to heal.

I would go for this that could be done at same time a your ADR

https://www.youtube.com/watch?v=dmO2BDDFigg

instead of this which would require going in from the back as well

https://www.youtube.com/watch?v=52LYh-DKVAQ
__________________
WakesurfMike
2007 Herniated L5/S1 Lifting changing X-ray tube at work. MRI PT/ Steroid shots/med
2009 switched to Remote/phone support
2010 workman’s comp lawsuit
2011 Microdiscectomy approved 80% pain relief
2011-2016 few flare ups but would always get beter after a few days.
6/2016 Pain is not going way
07/2016 MRI, tramodol, Nucynta, Celebrex
08/2016 Regenerxx PL-Disc shot- didn’t work at all
10/2016 can't even stand or sit for work for 30 minutes before pain gets worse
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  #9  
Old 01-20-2017, 03:41 PM
jgvesely jgvesely is offline
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Join Date: Nov 2016
Posts: 32
Default Thank you and thoughts about added height

Harrison, thanks so much for the warm welcome and the information!

WakesurfMike, thanks very much for the information and the helpful videos! I agree, I would definitely get the fusion done from the anterior approach and at the same time as the disc replacement. Fortunately, that is what Dr. Blumenthal recommended.

I was told that Dr. Blumenthal recommended the fusion over the ADR at L5/S1 because I had advanced disc generation at the L5/S1 level. I am wondering if the added height from a new disc would be too disruptive for my body. However, when I looked at the video of the anterior fusion, it looked like height was added with the fusion as well. There's lots to consider!
__________________
Juliette
1992 Neck injured in bad car accident
For many years taught & choreographed dance & injured lower back in 1997
Loads of conservative treatment
2000, IDET procedure L4/L5 & L5/S1,
2001, orthoscopic laminectomies L4/L5 & L5/S1 & orthoscopic discectomy L4/L5.
Surgeries didn't help
Recent years- stem cell & PRP injections- helped a little.
Recent MRI & x-rays show DDD & facet arthrosis in lower back & DDD & bone spurs in cervical spine.
3/22/17 L4-S1 ADR with Dr. Clavel
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  #10  
Old 01-20-2017, 04:08 PM
pittpete pittpete is offline
Senior Member
 
Join Date: Jan 2008
Posts: 307
Default

Just curious but how does the doc deal with spurring and facet arthrosis from an anterior approach?
__________________
Born 1970/1995-Hurt at work/1996-Right disc fragment L4-L5 discectomy-On/off back pain,no serious leg pain until/2007-Right herniation L5-S1,recurrent small herniation at L4-L5 with unbearable leg pain/6/08 discectomy L5-S1/leg pain relieved/occaisional mechanical pain/2012-Cymblata 60 mg,occasional aleve/2014-LB pain not debilitating but chronic,Rhizotomy relieves facet pain on right side/2015-L4-S1 facets shot/4/15 PLIF L4-S1 with facectomy
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