Hey everyone! I just wanted to stop in and introduce myself. This is a wonderful site for someone like me who's got a decision to make.

In '97 I hurt my back at work and after 3 years of hearing that it's "just muscle problems", an MRI showed a lg. herniation at L4/L5. Had a laminectomy in 2002 which worked great up until late last year. Just a gradual progression I believe. A new x-ray and MRI shows DDD, severe endplate osteitis (?), and spondylosis. In my first visit to a NS, I was given the option of do nothing, fusion, or ADR.
So here I am trying to soak up as much info as I can so that I can make a good decision!

kk, Welcome to the forum!

how severe is the spondy? grade I, II, III IV? or do they refer to the size of the slip in mm or percentage?

Mark

Honestly, there was no indication on the MRI report referring to grade. I will have to inquire about that one. It was actually fairly vague. I know that my disc space was minimal at the time and lately I've been feeling some "grinding" in that area. But that just happens on occasion.

Greetings kk,

You found the right site to gather plenty of information including supportive and caring people in situations similar to yours. I too was given 3 options: do nothing, fusion, or ADR. I selected the Charite ADR and am thrilled with my results so far. Keep us posted on your venture.

Crystal

Crystal,
Who is your insurance co and did they pay?

Mark, here is what my MRI indicates (I could use some help understanding it as well):
Discogenic disease, spondylosis, and a diffuse posterior disc bulge at L5/S1. Moderate to severe degree of endplate osteitis secondary to chronic discovertebral trauma. Postsurgical changes are indentified as L5/S1. No epidural fibrosis, no residual or recurrent HNP. Remaining disc spaces of the lumbosacral spine are otherwise unremarkable.

kk -- I responded to your message.

I don't think I can give you any help on your question above -- my deal was pretty cut and dry. There was no question but for me to have ADR. After reading your post, I would go to Dr. Bajwa for a 2nd opinion -- since he is so close to your area and has done many ADR surgeries.

He is really good at taking the difficult terminology easy to understand.

Let me know if you have further questions.

BTW -- I'm in Hector (north of Watkins Glen)!

SG - How did you become so sure about the ADR? Was it medical or that fusion was the alternative? Although I'm leaning towards ADR, I'm still not sure.

kk -- I didn't even think of fusion -- and that was before ADR was approved. Dr. Bajwa had me wait for ADR (6 months). I really put a lot of trust into Dr. B and he guided me the whole way. I also work for J&J, (the company that owns Charite), and knew it to be a safe and effective solution to my problem. I had the surgery b/c I am too young to keep with these problems for the rest of my life. Keep emailing me, and we can go from there...

For me, I have chosen ADR over fusion for several reasons:

1. Range of movement: A two level fusion would seriously restrict my range of movement, while a two level ADR would not.

2. Recovery time: Generally speaking, the recovery time of ADR is significantly less (and better) than fusion.

3. Age: Since I am 34, the last thing I want to do is fuse two levels in my lumbar spine. I used to be a fairly active person, but I haven't been active in over a year, and would prefer to return to an active lifestyle. In my opinion, I have a much better chance of returning to a fairly active lifestyle with a two level ADR versus a two level fusion.

4. Quality of life: In my opinion, the quality of life for ADR patients in the long run is better than the quality of life for fusion patients.

David

Well thought out David - -- I hope this goes well for you
Best
Alastair http://adrsupport.org/groupee_common...icon_smile.gif

Thanks.

At this point in time, it is pretty much a waiting game.

Either Dr. Y can get me into a study of some kind, or I wait for the FDA to approve prodisc and then go that route....

David

If I just had issues at L5/S1, I would probably take fusion, as it can be quite successful. I have been told that I have L5-S1 congenitally fused and have never had movement there. I have always been less flexible than most people I know, but lived a very active life, raquetball, softball, biking, jogging. I was active duty navy for 16 years with this condition. But the deteriorating discs at that level and the two above it put a stop to my activities by the time I was in my late 20s. With ADR still being relatively new in the U.S and the fight with insurance, I would jump on fusion if it was just that one level. But, I do not want fusion at three levels, I think that is too much range of motion lost.

Anywho, that was my thought process, just to share with you. I do believe there are many who disagree and would never choose fusion over ADR. But I have even had many well known doctors who do ADR indicate that fusion at L5-S1 can be a good option.

Well, here is the other mystery. My problem disc has always been refered to as L4/L5 up until an x-ray report from early this year. It is now being refered to as L5/S1. A couple reports have indicated a transitional segment (?)which I think is where the confusion began. The NS seems to be sure it's L5/S1.
But it is causing major problems as my comp carrier fighting that it's a new injury. Needless to say, they are becoming difficult to deal with. They don't want to take responsibility.

I personally would be more apt to believe a MRI, discogram, or CT scan than I would a X-ray when it comes to potentially diagnose DDD.

If you don't mind me asking:

--Which level(s) do your recent MRI indicate as DDD?
--Have you had a recent discogram?

David

The x-ray is actually where the confusion began. An MRI a few months later refer to L5/S1. So between the MRI and the NS, I'm inclined to think it is L5/S1.

I've actually never had a discogram nor was it ever suggested.

I apologize, because now I think that I am a bit confused....

Are you saying that you had a laminectomy in 2002 on the L4-L5 level, and now you have issues with L5-S1, or are you saying that your issues have pretty much always been with L5-S1?

Thanks.

David

I'm a bit confused as well.

I did have the lami on L4/L5 in 2002. Which it has been. Now it's being called L5/S1. What I was told by the NS is that no matter what it's being called, the prior surgery and new problems are the same area. It's a natural progression. It just depends on who's reading the films and how they count the vertebrae. All surrounding discs are healthy. It all stems from this "transitional segment".

I agree. I am still confused.

But.... I am not a neurosurgeon nor an orthopedic surgeon.

Perhaps someone like Mark / Alastair / Juli will show up again shortly and have something else to add to the conversation...

David

Me too. So far, no matter who explains this to me, I can't quite understand it.
All I know is that this confusion is giving the comp carrier ammo to dispute it.

If you haven't already, you might want to head over here:

How to read a MRI

it might help you be able to read your MRI films, presuming that you have them.

David

I have a couple more concerns that I hope you all can help with...

I found out yesterday that my comp. carrier is going to dispute my case again (never ending battle). Therefore, I don't expect additional treatment any time soon. Which leads to my first ?:
1) What are the consequences of having to wait for ADR or fusion? Could my disc height decrease to the point that ADR would not be possible? I've also been experiencing tingling in my left foot only. That's been constant for months now. It's not painful but more of an annoyance. Should I be concerned that it could turn into irreversable nerve damage?

2) Is a discogram necessary prior to ADR? It was never suggested that I have one.

3) Is there any risk to your kidneys w/ADR surgery?

kk -- I think almost everyone gets a discogram prior to ADR -- it provides a roadmap for surgery.

The more I read and chat back and forth with you, the more I am concerned -- you shouldn't be confused about what you have. Get into Dr. Bajwa -- he is smart, easy to talk to, and compassionate. Considering he is so close, it would be a shame not to.

No kidney risk that I've ever heard of, but I'm not an expert there. SG

Each body reacts differently to nerve compression, pain, limited disc space, etc... I too had nerve damage due to compression prior to my ADR. My surgeon requested an EMG to check the extent of the nerve damage prior to sugery. I spent about 10 months with my right leg constantly numb, cramping, throbbing and more. Upon awakening in the recovery room my irritated right leg felt completely normal again. My MRIs and X-rays were so clear that I didn't need a discogram, but if there is any confussion it would be a good idea. As with any surgery there are risks, but kidney damage was not one of the major concerns shared with me. If you need assistance appealing your case, Charite has a wonderful guide to the appeals process. Check out the topic that I posted. I used this format when I appealed to the State of California Workers' Compensation Board.

Be diligent,

Crystal

My guess was that my MRI provided enough detail that a discogram has not been necessary. The rest of my disc spaces are healthy so I guess there was no question.

luvmysibe - I will definitely check out your appeal. They have put me through the ringer for so long, it's time for them to be on the receiving end.

opp's sared my computer with Marria last night she is here for the So-Cal gathering and forgot to log in myself.

Paulette

Lets try this again: http://adrsupport.org/groupee_common.../icon_razz.gif
Kk,

Welcome to the forum again and glad to see you getting so much help or at least having a chance to talk out some of your concerns.

After 9 doctors opinions, I was never asked to have a discogram. It was very obvious that my L5-S1 disc was totaled. However the disc above looked really good and healthy. All agreed on that. I had an EEG for on my nerves

I had leg pain and stenosis, nerve impingement. I was told the longer I wait the more chances of permanent nerve damage to the nerves. Also because I was so collapsed I was told that waiting too long could make it so I was not considered a good ADR candidate anymore. I waited 10 months from my accident, and feel the nerve pain in my leg is so much better from the decompression provided to my spine with ADR. It takes nerves awhile to regenerate and I am hopeful that I will have saved my nerve by not waiting so long.

I agree that you should get a second opinion and maybe a few more if you can. Good luck with your insurance give it to them!

Thanks for everyone's input. It's really getting easier chatting w/everyone.

The one thing I'm quite sure of is getting a few opinions under my belt. I want to make the best decision possible. And SenecaGirl - I'm going to ask my chiro to set up a consult w/Dr. B.
I will have plenty of time I'm sure for all this while I'm batttling the comp. carrier. In the meantime, I'm looking to get set up with some water therapy (from the good things I've read on this site).

Regarding the disc level, and which is it. Your very bottom disc should be between the vertebraes L5 and S1. Is the disc they are referring to the very last or bottom disc in your spine?

If this is the case, this would again be the best area (if there is a best, opinions vary) to have a fusion. There are no discs below it to add pressure on and the flexibility there is less than other areas, from my understanding. Most insurance companies are still denying ADR, although that doesn't mean they won't start approving it any day now. Fusion should be fully covered by any insurance.

This is the part of the decision that we all agonize over, to wait for insurance to pay or to have doctors become more experienced, to take fusion now? Is fusion ever good? I would jump on the same bandwagon a few others are on and say get multiple opinions from doctors who you know are experienced with both surgeries before you make a decision.

My doctor is Dr. Bitan, in NYC, he was involved in the charite trials over here and had some experience in Paris before coming to the states. He was the one who gave me the diagnosis that made the most sense to me. I saw three different reputable doctors back to back before I made a decision. Just another avenue for you to explore! http://adrsupport.org/groupee_common...icon_smile.gif

Good Luck!

Juli - yes, L5S1 is the very last disc I have. I have heard from a couple people that that spot would be the best place for a fusion and I completely understand that. But at this point, my plan is to just get a few opinions and go from there.