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  • woodlawn1
    Participant
    Post count: 6

    Hello,

    I’d previously posted the bulk of my diagnostics and history, so not going to run through that again. Since that post, EMG showed acute L5 radiculopathy bilaterally, although I am only symptomatic on the left side.

    I have three opinions, all of whom say the only option at this point is an L5-S1 fusion. The opinions break out this way-
    1.)President-elect of big spine society recommends L5-S1 ALIF with possible posterior instrumentation, the latter probably to be added in a different surgery.
    2.) Neurosurgeon at a big Brain and Spine research institute says stand-alone ALIF.
    3.) Mayo clinic surgeon indicates L5-S1 open TLIF, says standalone ALIF would result in surgery again in a month or two. He notes the combination of there still being at least 15cc of fluid still in the disc means the herniation will just worsen over time and the facet joint is so overgrown open TLIF would be it. He also has the most aggressive post operative plan in terms of hospitalization (overnight vs 3-4 days) and progressing back to normal. He also said the TLIF is harder for the surgeon, better for the patient ultimately.

    I guess the question is this- how to choose? I’m already against 2 since I don’t want to get operated again. I respect 1, but 3 has no financial incentive since they are all salaried and have no ties to device manufacturers. I know there’s some nebulous patient comfort thing involved, but is there anything else I should be looking for to make a decision? No one’s revision rates are higher than average, 1 and 3 are a hair lower.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    In my opinion, if you need L5-S1 surgery, I would advise either the TLIF or the ALIF with posterior fixation.

    The TLIF is a great surgery when performed correctly. The surgeon has to be skillful to gently address the nerve roots. Surgeon technique is the entire surgery,

    The ALIF (stand alone) does not have great fixation (no pedicle screws) and can loosen too easily which is why a posterior fixation is necessary. An ALIF needs a very good approach surgeon to get the correct exposure.

    Dr. Corenman

    woodlawn1
    Participant
    Post count: 6

    Well, it took more than an hour of lysing adhesions in order to get to the facet joint that needed to be removed, but 12 days out and a new set of ARTIC hardware later, and TLIF seems like a winner.

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