Does anyone have any experience with treatment for an annular fissure?

[mark kim]

I recently took a MRI that showed I have a annular fissure in my l5-s1. I previously had a microlumbar disectomy to remove a herniation but it did not heal properly. I was told the tear is causing the nerve pain still. I wanted to see if anyone has done a microlumbar disectomy again for this condition to correct it with putting in some special sutures? I was given a 70% success rate for going this route or doing a ALIF which i am terrified of doing. I just wanted to get some input from other people on here.

[Keano16]

What type of surgery they want to perform now?

Surf about SED (Selective Endosocopic Discectomy). Wonderful technique for treating intradiscal problems.

[Greg]

I just had a 2 level ALIF done L4/L5 & L5/S1 and I wish we would have done it years ago. L5/S1 doesnt really have much movement in that disc anyway so fusing it isnt like you are changing much if your worried about limiting your motion and adjacent level degeneration. Just thought I'd throw that out there about the fusion. I'm only 6 days post-op and I cant believe how quick I'm recovering!

Whatever choice you make should be one that you have researched the hell out of and gotten at least 3 opinions on. You want to go into it with 100% confidence and no regrets. Fusion is kind of as big of a surgery for the spine as it gets. So I would try the most minimally invasive treatments first working your way up the ladder if you have to.

Did the surgeon say why he wanted to do the options he gave you? Knowing what exactly is wrong and needs to be fixed will help you a lot in finding the right treatment for you.

[KBear]

I couldn't agree more with Greg's advice.

[mark kim]

The surgeon recommended either the fusion or re-exploration microdisectomy. He said that the re-exploration had a 70% success rate and it could possibly seal the fissure up. I have already seen two surgeons and they both pretty much wanted to fuse. They said that when a fissure occurs from a microdisectomy the fusion was made for this purpose to seal things up. The other surgeon said I should definitely not do another microdisectomy. I didn't ask why but it seems the ALIF is good. Greg I like the advice of the fusion, I forgot the bottom segment can't be effected at the l5-s1. I'm still scared about the above levels being effected. Also, I was told that I am not a candidate of ADR. I don't know how accurate this is but I was told that there have not been many success stories for ADR at the l5-s1 level. Well I have 4 more consults and will keep you posted. I have made appointments to see some other surgeons just to get there take. I will keep you guys posted and I also have been researching the SED method.

[KBear]

There are definitely l5/S1 success stories with ADR, where I have heard of a problem is when it is 3 or more levels of ADR and it can cause too much movement. I would find out why you are not a good candidate for ADR. If there is a good reason you are not a candidate (not just that surgeon doesn't do ADR), then I would definitely not have one. I have heard of too many people pushing for ADR, getting it and then needing a revision b/c they weren't good candidates.

[Greg]

I am so glad you are getting so many opinions. That is one of the best things you can do. Given the fact that L5/S1 doesnt really move at all if you had to do 3 levels you would only feel the affects of doing 2. I dont think you have too much to be worried about and if you are (and are a candidate for ADR at L3/L4) then maybe you can fuse the bottom 2 (not a big deal there, I'm living proof) and then get ADR at L3/L4. I used to be scared about fusing multiple levels but the more I talked to people who have had them (not read about the risks or negative effects) the more I learned that the loss of mobility is minimal (I cant tell a difference) and as long as you take care of your back and dont do a bunch of bending (you are probably good at squatting instead of bending now) then it should be an easy deal.

If you want to call me (send me a message for my number....not that I dont trust SPS, I DO, its the crazies who can google, find a post and then have my number) and talk about fusion I'd be more than happy to pass on what I know and try to put your mind at ease (well somewhat) and tell you what I learned from all the conversations I had with people who had 2,3,4 level fusions. Those phone calls made me do a 180 on my fear of fusion and whether you fuse or not I think it's my duty to pass on the information.

[sportsnut3007]

If you go fusion for l5/s1 I would look into the trans one approach and see if u are a candidate for this type of fusion. It has some risk with bowel puncture, but every fusion has some risks, but I would believe this one to be the most minimally invasive, which is not necessarily best. But again ask your doctors if u are a candidate and ask qusetions why or why not.

[sportsnut3007]

If they want to repair the anulus, they have somethign called the inclose or xclose from anulex technologies. They have the inclose and x close. I would go with the inclose if its a small hole. Also, there is the barricaid i think that is available over the pond. I would only use this one if its a major space in my humble non dr opinion lol.

[mark kim]

If they want to repair the anulus, they have somethign called the inclose or xclose from anulex technologies. They have the inclose and x close. I would go with the inclose if its a small hole. Also, there is the barricaid i think that is available over the pond. I would only use this one if its a major space in my humble non dr opinion lol.

The inclose or xclose was what my doctor suggested to me when he wanted to do another microdisectomy. However, this is what he quoted as patients having a 70% success rate. That number didn't make me feel too good. I have questions also about the annulex products. I feel like if i go this route it is a gamble but it still is another option to the fusion which was what he also suggested. The choice was left up to me. Do you have any experience with the anulex products?