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  • LBM
    Participant
    Post count: 6

    Dr,

    I am having to have an additional PLF to secure my (non union) ALIF at L5/S1. The procedure as discussed (in my own words) is:

    1. Low profile Globus Creo screws and rods
    2. Decortication of L5 TP and Sacral ala to lay bone graft
    3. Use of low dose Infuse along with DBM and auto from the decortication

    My question is: how safe is low dose Infuse and if I can avoid using it and just go for the auto/allo – would that be a better/ safer option?

    I’m concerned about the long term health issues with BMP but I’m having the surgery to stabilise the ALIF so I do require a solid fusion construct.

    Do you have any opinion regarding which option would be better? I know that’s a big question, but just wanting to get some more insight into long term issues with BMP and the risk to reward ratio in my case

    Many thanks

    Donald Corenman, MD, DC
    Moderator
    Post count: 8018

    So it seems you have a pseudoarthrosis (lack of fusion) at L5-S1 after an attempted fusion via ALIF (anterior lumbar interbody fusion). The correct procedure is a posterolateral fusion as your surgeon recommended. I think BMP is imperative to use to give you the best chance to fuse. Since there are no exposed nerve roots (I assume that there is no nerve pain or need to decompress the nerve root), then there is no significant chance of nerve inflammation (which can occur with exposure to BMP).

    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.
    LBM
    Participant
    Post count: 6

    Hi Dr,

    Thanks for your reply. The main goal here is to stabilise the spine (my spongy slip has reoccured unfortunately) – I am starting to get some residual L5 dermatomal pain but it feels more neuroinflammatory vs nerve root compression – I dont have any motor dysfunction – the L5 exiting roots were fully decompressed at the original surgery

    My obvious concern is the risk from BMP – but my surgeon is using an extremely low dose along with the DBM and Cancellous bone chips.

    Do you use BMP in your PLF fusions?

    LBM
    Participant
    Post count: 6

    Just to confirm – I had a left hemi laminectomy at the original surgery to decompress the left L5 nerve root

    Donald Corenman, MD, DC
    Moderator
    Post count: 8018

    The old laminotomy is now scarred over so no worries there. I would consider a “medium” or even a “large” (12mg) BMP kit to deal with a pseudoarthrosis.

    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.
    LBM
    Participant
    Post count: 6

    Hi Doc,

    I had the surgery last week and all went very well. I managed to get a full reduction with no traction neuropraxia and my surgeon managed to use the BMP with the cancellous bone chips and DBM.

    What I wanted to know, as I can’t find any research about it – is can I start taking my vitamin D and K2 supplements now, as I am concerned if that will interfere with the BMP. My main concern is ectopic bone growth – and want to avoid that at all costs.

    I also take magnesium and vitamin c

    Thank you

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