Considering fusion v. multi-disc replacement

[Montana]

Hello - Just joined, and looking forward to gaining information. I'm considering fusion v. multi-disc replacement, the former covered by insurance here, the latter on my own nickel elsewhere. I'm 54, had a two-level discectomy (L4/5, L5/S1) @ 20 years ago, and am now 5 months into new problems - pain down back of both legs, lower back pain, numbness in both feet. 3 shots to spine didn't help, nor did PT regimen. Discogram and CT revealed the same two discs are completely flattened.

Montana

[Katie]

Welcome Montana. Just a quick note to say I was in the same situation, asking the same questions for several years. Because of newly discovered metal allergies, I had to go with two fusions, an XLIF at L4/5 and ALIF at L5/S1. I also had an ADR, the NeoDisc put in at C5/6 in the same surgery.

While I wanted at least one level of ADR at the L4/5, there wasn't a non-metal one available. There are a few members on the forum who are of the opinion that an ADR at L5/S1 is a bit of overkill, as there is usually very little movement there anyway. I would have been happy with that arrangement, with just one level fused.

Good luck with your research. It sometimes feels overwhelming, but comes together in due time.

[Cindylou]

Welcome Montana, Fusion gets such a bad rap with ADR on the horizon, but it is always good to keep in mind that fusion has been the gold standard for 50 years for a reason. I think you are wise to be considering both. I have 3 artificial lumbar discs, but I also have an ALIF at my L6-S1 (transitional level). And it is doing just fine. Frankly, I wish, looking back, that I had had only 2 adr's with a hybrid squeezed in between.....but that's hindsight, and who knows? Do your do diligence and I hope you find a solution that works for you, for many years to come. Best, Cindylou

[theboy247]

Hi Montana,

I hope this finds you on a good day with your pain well under control. In January this year I had a total disc replacement of L5/S1 (anterior approach). At the moment I cannot remember the name of the implant, I will look it up and let you know. I was delighted with the results of the surgery as it gave a serious reduction of my back pain. 7 weeks post surgery I was out for a gentle walk when I felt something "pop" in my back, I thought it was perhaps a muscle spasm, despite it being painful I didn't worry to much as I was confident that what ever had happened it would quickly pass. 7 days later whilst out for another walk I felt a much bigger pop, I instantly felt sick, my back pain shot through the roof and nerve pain shot through me. It turned out that the chiseled slot in L5 had propagated into a crack which allowed the superior section of the implant to move.
The implant was removed via the same opening in my abdomen (6") and a STALIF fusion performed.
The STALIF has been fine and the vertebrae are fusing well, unfortunately I didn't get to enjoy much benefit as L4/L5 had further deteriorated leaving me with increased back pain and sciatica.
3 weeks ago I underwent a PLIF fusion (with cages) at L4/L5, it's still early days to make any kind of sensible full conclusion.
I was extremely unlucky to have the problem with the disc replacement as I believed it to be the preferred option over fusion.
Whatever course of treatment you decide to follow I wish you every success and I pray that your pain is relieved allowing you to live a full and happy life. If I was going to give any advice, I would say that if you opt for a disc replacement and there are problems with it you still have the option of a fusion, whereas if you opt for the fusion first I believe the disc replacement option will no longer be available.

Wishing you all the very best!!!

[Pbchoclovr]

Hello Montana,

Welcome. Unlike some of the other posters, I only have a fusion of the L4/5. I have some minor issues with the L5/S1, but not enough to have to have surgery on it. I am 10 weeks post surgery, so it is still very early. Like you, I wanted to have an ADR. But after several consultations and much research, I sadly came to the conclusion that I wasn't a candidate for the ADR due to too much arthritis in my lumbar region of my spine. So I had a TLIF fusion of my L4/5. Even now, I was mentioning to my PT yesterday, that I would have liked to have the ADR instead of fusion. She reminded me that when looking at studies between the two approaches, satisfaction after surgery with the results is almost the same statistically. You'll read on here many who had success with ADR, but you'll also read like a previous poster of people who had issues with their ADR and ended up with fusion anyway. You'll also read of success with people who only had fusion and also some failures. Bottom line, if you're a candidate for ADR, it really is a personal choice and also involves complete comfort and trust with the surgeon you choose to perform the surgery. For myself, the pain I had prior to my fusion is now gone. My pain now is generated from the surgical site and all the surgeon did messing around in my lower spine. For how long I'll see the change, who knows? For now, I'm a happy camper.

Hope all the replies help you in making a decision and you find relief from your pain.

Linda

[Badgolfer]

I'm considering fusion v. multi-disc replacement, the former covered by insurance here, the latter on my own nickel elsewhere.

Montana,

I am 56 and had a 2 level laminectomy 10 years ago....very similar to you. I chased the ADR option pretty hard but ultimately have decided on a 2 level TLIF in 10 days with DSS at L3/L4. Ultimately my back had degenerated to a point where ADR wasn't an option. Questions you should consider; How are you facet joints? Are they already showing signs of arthritis and wear and tear? ADR's tend to put a lot more pressure on them. Do you have any other problems like spondylisthesis which needs the stability of the fusion and rods? In my case I have spondy and pars fractures which eliminated ADR for me. I also had ostephyitic growth and arthritis on the facet joints and clear that they need protection...not more wear and tear. In my opinion (!) ADR are great for a young person that has had an accident, damaged a disk, and that is their only problem.

A good study is available; "Incidence of contraindications to total disc arthroplasty: a retrospective review of 100 consecutive fusion patients with a specific analysis of facet arthrosis" by David A. Wong, MD, MSc, FRCS(C)a,*, Betsy Annesser, DPtb, Tim Birney, MDc, Roderick Lamond, MD, FRCS(C)d, Anant Kumar, MDe, Stephen Johnson, MDd, Sanjay Jatana, MDe, Gary Ghiselli, MDe. Although a little tech in the Dr world this shows the key things that indicate Fusion vs ADR. I can send you a pdf copy if you desire.

Share your radiologist report and you might get some other thoughts from people on this forum.

Dan

[Phil_b]

ADR was never an option for me as things in my spine were too far gone. Have to say the results for a three level fusion (L5 - S1) with rods have for me been outstanding. I had been trying to get someone to do this operation for years and it was finally done a month ago tomorrow. Whilst I still have pain I am not on any painkillers at all not even Paracetamol! I walk four times a day and have got up to about 400 mtrs each time, not brillant but its a start. Everyone is different I guess but for me fusion was the only way forward and upto now it has been outstanding.

Regards

Phil

[Badgolfer]

it was finally done a month ago tomorrow. Whilst I still have pain I am not on any painkillers at all not even Paracetamol!

Phil,

You can't imagine how happy reading your words made me today. Facing 2 level TLIF in a week I have been overwhelmed/scared by the stories of pain and discomfort for months after surgery. I am hopeful of an outcome like yours...and now I have an example that it is possible :-)

Doesn't mean I think I may escape so easily..but it is possible.

Thanks
Dan

[Phil_b]

Got to be honest Dan whilst I was dreading the op mainly because of some of the horror stories out there it was something that needed to be done. No-one is more surprised then me with the way things have gone - it hasnt been easy but nowhere near as bad as I thought things would be. All I would say to anyone going under the knife is stay positive.

If I can be of help pm me and I will get back to you Dan.

Regards

Phil