Thoracic ADR?

[JK2234]

Do they exist?

[Gilbert P]

Hey JK

Yes they do, I do know some one that has one and is not doing very well.

The procedure is going through the front and some levels are imposable too many organs in the way, Heart, Lungs, Rib Cage etc

Why do you ask?

Gil

[KBear]

This may be total crap, but I think it is true, just from reading about people on these boards. My doctor told me early on when I was having T-spine pain, that it is very, very unusual to have an injury in the t-spine. It is possible, but from what I have seen, most people have C or L spine troubles.

[dalhousie]

I had a problem @ L1/2 which is only just out of the thoracic & into the lumbar. In 2005 I had 2 opinions who both advised fusion. I had had a lot of facet problems at that level also but I think the main reason was that it was not advisable to do anything other than fusion at that level. I was told that:

• as there is little movement @ L1/2 compared to the L4-S1 area my chances of adjacent segment degeneration were much less;

• the ideal level for ADR is L4/5.

Recently I asked my current specialist who did my 2009 ADR surgery @ L4/5 what he would do currently with DDD @ L1/2 (as I'd heard recently of overseas surgery using ADR at that level) & he also agreed that he would fuse it.

I think there are rare cases of ADR in the thoracic - L1/2 area but I wonder what their long term success is.

[Cindylou]

When I had my bike accident, the two levels that sustained compression fractures were T 11 and T 12. I ended up having vertibroplasty at those levels to stop further compression. Don't know if that accelerated the DDD in my lumbar levels or not. ?? Know one ever mentioned adr at those levels.

[Carson]

From my reading, if a disc can be accessed it can be replaced, regardless of region. But there's still very little out there about the subject of ADR in the thoracic and how ADR fares in that more rigid region of our spine. I know Mark Mintzer has a thoracic level replaced with ADR (T1/T2).

[Gilbert P]

Yes Carson
Mark is the one I was think of spoke with him recently and he is still fighting the battle and gaining slowly.

Gil

[JK2234]

I will be back to this thread when i get my MRI report of my thoracic next tues...

Thanks for the info everyone.

[Greg]

I dont know for sure what kind of ROM (range of motion) the thoracic region of the spine has but if you have an issue there that requires the disc to be removed it would only seem logical to do an ADR if motion preservation was a necessity. Thats what worries me with too many people pushing for ADR because fusion is a great procedure that has been a standard for a long time (good reasons for that, "If it aint broke, dont fix it") and now that ADR is the new buzz word in the spiney world people think that since its new it must be better. If you have a level that needs a major surgery like fusion/ADR than one should only get an ADR if motion preservation is needed. If not than fusion works just fine.

I just dont understand sometimes why people choose to get ADR at the L5/S1 (S1...or L6 for some) when that level has almost no flexion/extension. Motion preservation isn't needed there so get a fusion. Of course there always could be underlying circumstances that may prevent a fusion but it concerns me hearing or reading about people getting ADR for L4-S1 or L3-S1 when the ADR technology isn't far enough along to work best with that many levels.....throw in a fusion in the mix! Spinal fusion seems to get a bad rap because of the worries of ASD or limitation of movement that I fear keeps people from getting the right procedure. As long as you take care of your back afterwards (squat to pick something up, dont bend over) then you wouldn't be putting that extra stress on the adjacent levels causing a more rapid degeneration.

Sorry if I got a little but I just wanted to throw that out there because I have been reading a lot (especially tonight) and seeing a bunch of people talking about getting or have gotten a bunch of ADR's where they may have been better off with hybrid or fusion all together. I just can't wait for a hybrid surgery to become a standard care procedure that is accepted by the insurance companies. Of course the insurance company needs to get past the part of accepting ADR as a practical and effective procedure (especially when they cost about half of what a fusion would.....you'd think they'd want to spend less money Oh well, sorry to get off topic. I think I need to start a thread on fusion vs ADR in the right or wrong spot(s) cause I want to talk about it and not have to JK's threads anymore

[trkdoc714]

From my understanding the thoractic levels have limited range of motion +/- 3 to 4 degrees. My stepdaughter has scoliosis and had 4 of her thoractic discs removed and the vertabrae fused. She really doesn't exhibit any limitations from the loss of motion.

Access to and the limited range of motion of these levels make it prohibitive for a surgeon to safely choose an ADR over fusion. The increased range of motion of the current ADR designs could actually create more spinal issues due to up to 12 degrees of motion at a level normally with a 3 to 4 degree range.

As far as ADR for the L5/S1 disc space, there is a school of thought that this will prevent adjacent level complications of the SI joints and L4/5 disc. The normal range of motion of the L5/S1 is +/- 8 degrees. I guess it is a matter of specific pathology of the patient.

Recovery (as forcast for me) was longer for fusion than the ADR (6 to 12 months v.s. 8 to 12 weeks). This also was a consideration for my decision.

Bob