Could Fusion be better for me than ADR???

Hi everyone! You guys are going to think that I'm totaly clueless about what to do about my back surgery the longer I wait. Actualy, it's not me that was delaying the ADR surgery. My last two surgerys for replacment of my L5/S1 disc by using the Charite ADR were both cancled at the last minute by my surgeon's nurse. Anyway, the more people I talk to including the new surgeon I've been reluctantly referred to are all telling me that I should go with fusion instead of the Charite replacment disc. My Insurance Co. has given 100% approval for the disc replacment after 8 months of appeals. I'm being told that at my age ( 50 ) that a fusion will work just as well with a lot less invasive surgery. I've waited almost two years for the opportunity to get the ADR & now that I'm no longer going to the Spine Clinic where the surgeon has performed over 100 proceedures of disc replacment I'm getting less supportive information. Just wondering if anyone else thinks that with total degeneration at L5/S1 that a fusion would be better for me than disc replacment. If I wanted fusion I could have the operation two years ago & gone on about my business. I'm still asking them to schedule me for ADR & told them at the Medical University Hospital in Charleston, SC that I would have a letter of insurance coverage to them by this Wednesday. Could I be wrong in thinking that I must get the disc replacment as opposed to the fusion?

[annapurna]

Sounds like you're seeing the effects of different surgeons' viewpoints about spine correction. I was thirty-five when I got my L5/S1 ADR and was, at the time, told that a fusion would serve me just as well provided that I did not engage in any serious sports or other physical activities. These restrictions did not match well with my lifestyle, so I opted for the ADR. By this time, you probably know all the arguments pro-con about motion preservation in the spine. All the motion preservation techniques are newer (therefore riskier), more difficult for the surgeon, etc. Fusion is more well understood and somewhat easier to perform, but eliminates the motion your spine was designed to have. I don't think that these facts have changed at all from when you first decided you wanted an ADR instead of a fusion. Unless you expect to die at age seventy or so, fifty is really not that old. Additionally, most middle-aged and elderly people are much more active than they were even ten years ago. If you expect to be doing lots of vigorous physical activity, then the argument for motion-preservation is valid in your case regardless of your age.

What I would NOT do is go to an inexperienced ADR surgeon just so that you can get the ADR. Go to someone who really knows what they are doing even if you need to travel away from your local area. I traveled to Germany for three knee surgeries and two spine surgeries, so I know that medical travel isn't that difficult and can even be somewhat rewarding.

Is your insurance restricting you to using only surgeons in your local area? If not, you might want to consult with Dr. Yue or Dr. Bitan - both of whom are on the east coast.

Best of luck in your decision.

Laura

[Mariaa]

My WC insurance was willing to pay for 2 level ADR these last 2-3 years but I wasn't secure enough with my feelings about surgery yet, so I hesitated and had decided to do it this spring.

Now with new WC people in charge, I'm being told it's back to a 3 level global fusion. Which I think is a ridiculous waste of my time/life..

However, my OSS of the last 8 years had recommended a fusion at L5S1 and ADR above it. I was hesitant with that decision also as it's not the space that I worry about regarding placing the cage in, it's the hardward that's utilized such as screws.. I already have scar tissue on S1 nerve root which has been a problem I believe for over the last 10 years or so I've been told. Maybe one day I'll find out it isn't problematic however, I tend to think scar tissue can be a pain generator in itself when it encasing a nerve root.

I've also just read so much about screws moving that I'm just too uncomfortable having any in there.. it would have to be fusion w/o hardware for me basically..

Perhaps a one level L5S1 fusion isn't going to be much less dramatic in terms of how you recover, but I'd also be concerned about adjacent disc problems. I've read too many various spinal forum members complaining about either continued pain or new onset pain, disc problems after fusion so I'm just not convinced it's the way to go. But this is just my opinion which not even really an educated opinion, just one of observation from reading about failed fusions over the last 8 years...

Now, about my history of hesitancy..I've lived with the effects of a failed discectomy which turned my life upside down.. so am very reluctant to incur more pain/failure... hence the hesitancy.

Might be right for you.. keep on researching~
and hang in there. If you don't feel right about something, don't do it, that's my last piece of advice~ Maria

Hi Maria,

My story matches yours. I am scheduled L5/S1 fusion and ADR L4/L5 after a discectomy 8 yrs ago.
That's the best assessment given by Dr. Bitan, Dr Bertagnoli etc...
But I am waiting to go with a Doc in Canada who performs only Maverick and the other only Pro-disc.
That's where my dilemna is. What's happening with you? Could you e-mail directly?
R

[NCFUSED]

ProudDad,

I had my L5-S1 (PLIF) fused back in May becasue I couldnt get approval for ADR. I am 39 YO, and was/am very activeI am very happy with the results. I am now @ 95% movement, can bend all the way over and my quality of life has increased 100%. Although I would have like the ADR over fusion, I am happy with my results.

Doctor says I can start playing Golf in the spring!!!

I will probably need something done @ L3-4 sometime down the line. Hopefully ADR will be more accepted by Insurance by that point....

If you have any Fusion questions, I'd be happy to help if I can...

I also have been waiting for insurance to pay for the ADR. I saw another doctor last week and he sent me for a lumbar CT scan. It showed that the L-5 disk is gone and collapsed. The bones fused together in a bad way. He said that I now am fused.

The scan also showed that I am osteoporotic and recommended against the ADR because in ten years the bones could collapse around the disk. He is proposing that he break the untimely fusion that just "happened" and he would fuse it in the proper position with a spacer for the disk, and a plate in the back of the spine instead of screws.

Any one heard of this or have any thoughts? He said the disk above looks fine.

Someone had posted that their doctor in Germany said if osteoporotic then cement could be used. Anyone know about that?

Thanks!