Coflex?or X-Stop Spacer anybody?

[CharlesinCharge]

Arabella,

Yes, a fusion will last for a lifetime. Once the bone grows over and fuses, it is just as strong as a regular bone in your body. You say you are scared of ADR because it is major surgery, but fusion is just as major and takes longer to heal from (and has more post-op pain as well). I know because I have had both done on my spine, and the ADR was easier to heal from and no more of a major surgery. There have been some unsuccessful outcomes on this website from ADR, but the same can be said for fusion. Did you know that studies show the long-term success rate for fusion (this is going back over 50 years) is only 60% or so??

You need to make an informed decision and I am not telling you what to do or not do, but I would not rule out ADR because it is major surgery or you are afraid. ANY spine surgery is major surgery, there is no way around it. I don't think you have any worse chance of success with ADR than you do with fusion, and your young age should not be a factor---there are people on this board as young as 22 that have had ADR surgery.

[trkdoc714]

Just to add to Charles' post, fusion is becoming thought of more and more as causing adjacent level disc degeneration at the levels each side of the fusion. To mirror his comment, at your young age that could mean more problems down the road.

If you can, avoid or put off any surgery as long as you're comfortable that it won't worsen your condition or pain levels (and if you can live with the pain levels). In this time, try to get as many medical (surgeons, not medical tour guides) opinions as possible.

Good luck to you,

Bob

[bellyrm]

Hello guys... I was away from the computer ... Thank so much for your thoughts ... I am going to see a new doctor this wendsday to get a new opinion on my condition ... Does anybody knows if a anterior fusion at level L5 S1 is more successful than in other levels talking about not harming the other levels and being less propense to have another fusion in time? I have heard that a fusion at level L5 S1 is a bit better than at other levels? Correct me and or pls inform me if you know about this ...
Thank you for replying and reading
Arabella.

[annapurna]

There has been a lot of speculation that the decreased motion at L5S1 means that the fusion works better. In my personal opinion, motion isn't the sole determiner as the force across L5S1 is higher, more body weight on it than other higher levels. There's also stress to the SI joints to think of.

That said, this is only my opinion as I haven't seen a paper answering it either way. Anyone else?

[kimmers]

There is a paper I came across that compares fusion and ADR with respect to the force on the SI Joint.
Since I was potentially looking into having ADR or fusion at L5/S1, I was interested if there was adjacent problems after fusion on the SI joint and found this paper recently.
The paper is called "Biomechanics of Sacroiliac Joint Following Mult-Level Lumbar Disc Replacement Using a Computational Approach".
It is written by A. Kiapour, A. Ivanov, N. Ebraheim, VK. Goel, D. Mhatre, S. Biyani, T. Terai.
It is by the engineering center for orthopaedic research excellence (ECORE), Departments of Bioengineering and Orhopaedic Surgery, Colleges of Engineering and Medicine, University of Toledo, Toledo, OH,
senior author: Vijay.Goel@utoledo.edu.

It is poster No. 2416 at the 55th Annual Meeting of the Orthopaedic Research Society.

It compares Charite ADR with fusion.
The conclusion in part says: Lumbar fusion procedures have a considerable impact on SIJ overload after surgery in all loading modes, therefore clinicians should be aware of the higher risk of Sacroiliac Joint Syndrome in this patient group, as compared to TDR group.

Hope this helps,

Kimmers

[CharlesinCharge]

There is considerable debate about it, but from what I have read the ONLY real advantage of having fusion at L-5/S-1 is that there is only one level that could be affected by Adjacent Segment Disease. At any other level, you have the level above AND the level below that can be affected when you get fused (especially if you are young, as the longer you go the higher the rate of ASD per clinical reports). If you get a fusion at L-5/S-1 you only have the level above. The surgeons I spoke to told me there is still enough motion at that level to make ADR advantageous, and as Kimmers said fusion adds stress to the SI joint. The reports I read said that at 3 years after a fusion the rate of Adjacent Segment Disease was only 15%, but at 10 years out the rate was almost 40%. That is why ADR surgery came along, fusion works great for fixing Degenerative Disc Disease BUT the problem for decades has been ASD. If not for that, ADR surgery might not have been developed.