[Donald Corenman, MD, DC]

#10405

An ALIF will work reasonably well for an isthmic spondylolisthesis. In my opinion however, the TLIF will do what an ALIF will do and more.

The nerves can be decompressed directly posteriorly where in the anterior approach, the nerves are not directly addressed. Also, fixation of the two vertebra (L5 and the sacrum) is much better with pedicle screws which can only be placed posteriorly.

Anterior approaches can also affect the bowel and in males, there is a 4% chance of retrograde ejaculation. This is why I prefer the posterior approach.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[KHolohan]

#10415

In speaking with a surgeon he stated that he has a “98% for a full fusion using BMP”. Any long term issues with BMP? I have heard of cases that do not fuse. In your opinion how long does it take for the back(bone) to fully fuse? He mentioned that he would like to avoid using screws in area which is fractured (the facet)and compressing on nerves due to inflammation/arthritis and setting a screw through the facet which is the area causing a problem may not be best. (He was using this as his argument to do the ALIF procedure).

With the TLIF are you seeing earlier indications of arthritis or associated issues due to the amount of hardware place anterior and posterior?

My only intention here is to get as much info from various doctors as possible to make a solid decision on which direction to go in.

Thank for your help and discussion.

[KHolohan]

#10416

also…where does an disk replacement/implant (I keep getting a notice about Titan Spine Implants). Does this type of implant serve as the disk or does bone from around it and fuse?

[Donald Corenman, MD, DC]

#10419

I recommend BMP for a fusion in the lumbar spine as this substance does promote fusion very well. Your surgeon might have a 98% fusion rate but there is no way to confirm this unless he has written a paper in a peer reviewed journal.

Normal fusion of the lumbar spine in my hands takes about five months.

I do not understand why he or she does not like pedicle screws. The posterior approach allows decompression of the nerve roots and much better fixation of the two levels. If he or she is comfortable with an ALIF, again there is nothing wrong with this technique but for the aforementioned issues.

There is no change in the “level of arthritis” from an anterior or posterior fusion of the lumbar spine.

The Titan spine implant is an interbody spacer device designed to have bone grow into it. I generally do not like metal devices as X-rays cannot determine if there is a solid fusion.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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