Artificial Disc Replacement (ADR) vs. Spinal FusionMacey | October 6, 2017 - 7:56 PM Back Surgery
Hey, Backers. Here's a loaded question.
Artificial Disc Replacement (ADR) or Spinal Fusion?
This topic is actually pretty controversial among the medical community and patients alike. Although, recent evidence is showing ADR is the safer, more effective surgical alternative with fewer risks and a shorter recovery time, the once gold standard was always spinal fusion. But is that still true?
Innovation vs. invasive —what would you pick and why? Ready. Go.2 Likes
October 6, 2017 - 8:45 PM
Hi, Macey. I'm actually laughing out loud right now because I just watched a few Youtube videos on that exact topic! A friend of mine was asking the same question.
My answer to him and to you: ADR all the way. It seems that the risks with fusions are more than the benefits. And, TBH, times are changing so it makes sense that the medical community would change too. Innovation over invasive —all the way!
October 6, 2017 - 9:22 PM
I think this answer truly lies in the specific situation as there are certain conditions that prevent you from having an ADR like your bone density is low and would cause a high risk of prolapse (I think that's what it's called).. where the disc sinks into the bone. But that being said.. in a true apples to apples with none of those curve balls. ADR in a heartbeat. Speaking from personal experience. I had 4 herniations at the same disc. After my 4th one, I went to an ortho and of course he wanted to fuse. Looked at my MRI, saw him for like 3 minutes. "Ya, we can fuse. And in 2 months you will be pain free and doing whatever you want." Ummm.. ok (with much skepticism). Well.. I booked the surgery because I was in so much pain and treated that as one option while I continued to investigate further. Went to an neurosurgeon after that and he said microdisectomy and pointed to some studies that said it was the best plan of action based on 3rd herniation and statistics, etc. So I did that. Surgery was a success, however a month later I reherniated. My disc was just total crap and needed out. Fast tracked the ADR process and was the best decision. Was on vacation after a month with family, enjoying life more. And doing more movements and activities I haven't done in years. Currently 3 months post op and continuing to get even better. WIth a fusion, I would be no where near where I am at now and I would def. be setting myself up for another surgery in about 5 years because my disc above will most likely degenerate faster and cause problems cuz it's taking more of the load. With ADR your are 3 times less likely to need surgery on adjacent disc. Like my chances there.
October 6, 2017 - 9:42 PM
That's a crazy journey, to say the least. I think you're right though. It all depends. I did read a few articles that spoke about low bone density, which you just confirmed for me.
I've also heard that the primary advantage of ADR, as compared to spinal fusion is motion preservation as seen in the picture below. I suppose it's true that motion preservation should diminish any long-term degeneration of nearby fused discs unlike in a spinal fusion —where you are at an increased risk for "adjacent level disc generation" (picture below).
And then recovery of a spinal fusion is a whole other story. Though, if you need it, you need it.
I'm so sorry that your journey had so many curve balls but the fact that you were on a family vacation one month after is REMARKABLE! How is that even possible?
This is enlightening. Thank you, Chief Backer!
October 8, 2017 - 8:26 PM
It really depends on your situation. I had a successful PLIF with instrumentation 12 years ago, L4-S1. I had severe disk dessication, and foraminal stenosis that was crushing my S1 nerve root.
Unfortunately, because of my titanium rods, above and below my fusion site are degenerating. My SI joints are a mess and I'm getting ready to have the left one fused. I also have a severely dessicated and bulging disk at L3-4 with a grade 1 retrolisthesis and L2-3 is also failing, though not as badly as 3-4.
When I originally had my fusion, ADR was only available for a single level so I was not a candidate. And I may not be a candidate for ADR when my other disks finally fail.
So, would I have done anything differently had the option been available? I honestly don't know. ADR isn't indicated for everyone. Do you research and find a surgeon you trust to help find which is the best option for your particular case.
October 8, 2017 - 8:37 PM
That is really insightful and great to hear that you had a successful PLIF. I completely agree. There are some instances where ADR wouldn’t work and isn’t permitted, which is where other options come into play —just like in your case. At least there are options though! Plus, it’s hard to use a one size fits all approach when each of our bodies/ cases are so different.
I’m also really sorry to hear that you’re still in pain and your discs near the fusion site are degenerating. It’s like one thing on top of another.
What treatments/ remedies work for your day-to-day discomfort? I’m curious how you relieve your daily pain and if you have any tips for our community.
I really appreciate your engagement and all of the info you provided.
October 9, 2017 - 12:40 PM
I'm not certain I'm the best person to ask about how I control my pain levels. In essence, I don't control my pain. I compartmentalize my pain.
I used to take high doses of OTC pain relievers: Ibuprofen and aspirin in conjunction with use of a heating pad, hot showers, mild PT exercises and analgesic sprays like IcyHot and Biofreeze. I also am prescribed Baclofen for the chronic muscle spasms. About a year ago, my doctor noticed that my kidneys were showing reduced function. My Ibuprofen use had damaged my kidneys. I had to stop taking NSAIDS.
My pain levels and rediculopathy really control my life. My activity level is quite low and I spend a lot of time reclining on my side in bed. I ended up filing for disability a few years ago and won my case.
I've been dealing with my back since I took a fall while rock climbing in 1990. I can tell you that there are no quick and easy answers for back problems. But one thing I have learned to do is to distract myself from the pain. I have all kinds of things I do as a distraction. Music. A good sitcom. Silly animal videos on YouTube. I'm a singer so something as simple as vocal warm ups help raise my endorphin levels.
The single most important thing I've learned through all these years is acceptance. Accepting that I am always going to have some amount of pain and that I have to restrict my activities. Once you stop fighting the pain and trying to find a cure for it there is definitely a sense of peace.
Changing the way we think of pain is vital. Instead of seeing it as this mortal enemy that needs to be destroyed we need to just accept it for what it is. It isn't evil or good. It just is.
I know this isn't the magic cure that everyone looks for but I hope this makes some kind of sense.
October 9, 2017 - 2:31 PM
First, I want to start by saying you are a chronic pain warrior. Secondly, I think it’s genius to compartmentalize your pain. You are not letting it define you and you’re doing your best to control your bad pain days. So for that, you deserve some recognition!
I always find it interesting to hear someone’s specific remedies so you really are the perfect person to answer this.
Ugh. I’m also sorry to hear your kidneys are having issues from the meds. That’s a pretty large negative regarding pills. We have to adapt to our new normal and overcome anyway possible.
You’re getting by the best you can and you’re listening to your body, which is so important. There’s a season for everything and this may be your season of rest. Rock climbing sounds awesome! Back in the day, I used to do that on a ropes course at my sleep away camp. Good times! To hear you had a bad injury makes me sad though. In this life, it’s best to have no regrets.
Although that action put you here, everything happens for a reason and there’s always another way or a new treatment being devised.
You nailed it. Accepting our pain is crucial in really living. At BN, we’re trying to empower other Pain warriors with the knowledge, tools and support needed to really live despite chronic pain.
Have you heard or tried of the oska pulse for pain relief?
Also, thank you for your detailed account and your honesty. You’re an inspiration