ADR: Maintain motion or restore motion?

**Penguin** · 06-12-2011, 04:38 AM

Hi, I have DDD on two levels: L4-L5, L5-S1. L4-L5 degeneration is quite advanced, very narrow, not much movement. It has been like this for a couple of years now. My surgeons initial response was that degeneration was too advanced for ADR - he states that part of the purpose of ADR is to maintain motion rather than restore motion. However, upon further tests he has now assessed me as suitable for ADR as part of a hybrid. My question: when is a disc too degenerated and can ADR restore motion to some extent? Thanks in advance. Ben

**Justin** · 06-12-2011, 05:54 AM

Originally Posted by Penguin

Hi, I have DDD on two levels: L4-L5, L5-S1. L4-L5 degeneration is quite advanced, very narrow, not much movement. It has been like this for a couple of years now. My surgeons initial response was that degeneration was too advanced for ADR - he states that part of the purpose of ADR is to maintain motion rather than restore motion. However, upon further tests he has now assessed me as suitable for ADR as part of a hybrid. My question: when is a disc too degenerated and can ADR restore motion to some extent? Thanks in advance. Ben

Hey Ben, artificial disc replacement surgery can restore motion to intervertebral segments. I've personally spoken with many Spine Patients that have actually had spinal fusions revised to an artificial disc replacement. As you can imagine, there was significantly decreased motion with the spinal fusion and motion was thus greatly increased post-ADR. ADRs both restore and maintain motion.

Something to consider: if you have a spine that has become "accustomed" to its current state as "L4-L5 degeneration is quite advanced, very narrow, not much movement ... for a couple of years now," is it a good idea to create motion again. Some surgeons will argue "no" and some with argue that restoring motion again is beneficial.

However, the ones that argue "no" have an interesting point: the spine is now used to no/significantly decreased movement, so if you restore movement other parts of the spine (particularly posterior elements of the spine such as facet joints) may suffer accelerated degeneration that might ultimately cause more pain (that might be intractable) down the line. This is not to say this is going to happen in your situation, but in my opinion, warrants some thought.

**Penguin** · 06-13-2011, 03:27 AM

Hi Justin, thanks for the information. It's difficult to know which way to go with this. I put off surgery 18 months ago after years of pain because things seemed to be settling with my back - I think this may be because of the further degeneration and subsequent increased stability in this area. There is a trade off however, as I have less flexibility which prevents me from doing some of the activities I love. I wasn't aware of the increased risk of premature facet wear which may come with ADR. However, if I have no surgery I suppose my back will most likely fuse at that level, which will also prematurely wear the next level up. Time for a consultation for another opinion on this I suppose. Do you have any more information on this Justin (research etc.)?

Kind regards,
Ben

**runagain** · 06-13-2011, 04:40 AM

Hey Penguin,

Another put-offer here. I have put off surgery for almost two years. My case is a bit different than yours, but I have a disc at L4/5 and need something at L5/S1. Contrary to what your discs are doing, mine look relatively good, but I have loads of pain. Looks like I might be having surgery soon---which may be a fusion or an ADR. My area at L5/S1 has been bothering me since 2009 and I had positive discogram, with an annular tear showing up in last disco.
Hybrids do work out in several cases but as you will learn everyone is different and healing times are different. I do know that my surgeon would not put an ADR in if it would take too much distraction to do so. In other words, if my disc is too degenerated, no ADR.

R

**Penguin** · 06-13-2011, 06:04 AM

Hello R

Thanks for replying. I'm quite disappointed that I may have missed the boat re ADR. I've been asking about referrals for ADR for years but a combination of very conservative doctors and the wrong neurosurgeons has meant that it may be too late for this option. It wasn't until I saw my doctor running along the road and I thought to myself, "I want to run too", bugger him I'm really going to push this. I get sick of people in the medical profession telling me to live with it when they have no idea how restricting chronic back pain can be. Mind you, the thought of surgery scares the life out of me too. My surgeon is of the opinion that I have an 80% chance of being better than I am now, 3% chance of being worse. 97% chance I'd be no worse than at present. They're not bad odds I suppose. I could live with being no better - I've been like this for 13 years and it's not all bad. But it would be great to improve my quality of life. To be able to work full time and not come home exhausted after a few hours work, to be able to socialize more, surfing again maybe......?
Cheers.

**Penguin** · 06-13-2011, 06:12 AM

Originally Posted by runagain

I do know that my surgeon would not put an ADR in if it would take too much distraction to do so. In other words, if my disc is too degenerated, no ADR.

R

Is distraction not good?