Here for advice on ADR after fusion

[Mr. Pixel]

Hi, everyone -

I had a very successful C5/6-C6/7 fusion early in the year. Relief was immediately noticeable on awaking in recovery. Once the post-op pain subsided I was back to 100% and feeling great, with no pain or neuropathy that had been issues the preceding five years. HOWEVER...

Woke up two weeks ago to shoulder and neck pain consistent with C4/5 stenosis. Reading posts here, I now have the understanding that I am probably dealing with adjacent segment disease. Perfectly understandable since the original problem was due to deterioration, and I would suspect adjacent segments to have similar issues and in the end unable to take the added load.

I have not yet consulted my neurologist or neurosurgeon so as to not trigger issues with insurance (insert usual story). Fortunately, the current pain is mild (1-2) and controllable with over-the-counter NSAIDs.

My neurosurgeon came highly recommended by many, and I could not fault the results up to this point. OTOH, when we talked surgery he immediately pooh-poohed ADR because I was "too old (57) for it to be worth it given the additional complication" and that I also would not notice any loss of flexibility given the segments being fused. He was correct on the latter point. However, he did not discuss risk to adjacent segments. Also, because I "drove a desk" in my regular job, he refused to listen to my protests that I do home remodeling as a side business - heavy lifting, vibrating tools... the stuff that puts heavy loads on the spine.

So... the question is: given that treatment of C4/5 is likely in my future, what is the experience with ADR in a segment (or segments) adjacent to a previous fusion? Does it mitigate the risk of "cascading failure" and significant loss of flexibility that seems to me to be likely if we also fuse C4/5?

Thanks much for your guidance!

[jss]

Pixel,

Sorry about your new problems, but welcome.

Congratulations on the successful fusion. I had a successful ACDF at C4/5 in 2000, which led to a successful ACDF at C5/6 in 2002, which led to the need for three more ACDF at C3/4, C6/7 and C7/T1 in 2009. While the spread of my DDD was a worst case scenario, most people don't acquire adjacent segment disease after a fusion; only about 1 in 4 (which is a LOT).

Though I don't doubt they're out there, I'm unaware of any studies that followed ADR recipients after a prior fusion. However, the hybrid procedure (performing an ADR and a fusion next to one another in the same surgical session), which is essentially what you're looking at, has become a popular procedure for multilevel spine patients.

Rather than undergo more fusions, I had ADR at two of the DDD levels in 2009; will be three years on the 25th. To date I remain symptom free and can do anything I want to.

Good luck, Jeff

[Mr. Pixel]

Thanks, Jeff. That is encouraging. Obviously I'm not looking forward to more surgery and the subsequent downtime, but we have to do what we have to do.

My objective here is to get the facts up-front before, again, triggering the insurance bureaucracy, something you evidently know well. I am in the fortunate position of being able to retire early, and the main issue holding me back is access to health insurance proximate to needing another procedure like this. I don't need to anger the coverage gods right now.