[Donald Corenman, MD, DC]

#21162

The length of the incision is not as important in a TLIF as you think. I like a small incision as I use a microscope and have developed a technique that does not require much dissection. Nonetheless, the larger incision is acceptable and probably will be just fine. There is a lot of bone to use in a Gill procedure (taking the fractured lamina off) and there is nothing wrong with just using that bone without BMP. I have however found that BMP accelerates the fusion and does increase the percentage of patient who will gain a 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.

[Renee123]

#21166

Thank you,

Very good to hear that length of incision is not extra painful.

Is there any residual pain associated with a laminectomy ?

[Donald Corenman, MD, DC]

#21167

For this surgery, you have to take the lamina off. It is already “disconnected” anyways as the pars fractures produce the disconnection. You also have to take the lamina off to access the pedicle spurs which compress the L5 roots and need to be removed. The bone is also valuable for 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.

[Renee123]

#21170

I met with a reputable orthopedic spine surgeon today in my area that recommended TLIF.

He said even though I have a bi lateral pars fracture that he would only remove one side to access the disc space.

He said he would leave the other side of the pars in the spine and he would have enough bone from the other half to do fusion in the spine and vertically along the screws and rods.

Does this sound right to you?

[Renee123]

#21198

Hey Dr. Corenman:

Can you answer the above please :

1.) I met with one surgeon who says he does TLIF for the pars fracture, but only does the traditional TLIF and removes half of the pars/facet to access the disc space leaving, I guess, the other side of the pars fracture in tact…does this sound right to you ?

2.) Also, I met one other surgeon regarding TLIF, who says he will remove entire pars fracture, however does not use BMP within the disc space, however he will use BMP along the screws and rods. He says sometimes BMP in the disc space can grow into the spinal cord. He was a a good surgeon and said once I fuse it doesn’t matter which method was used.

Please let me know your thoughts. I am going to schedule soon.

Thank you !

[Donald Corenman, MD, DC]

#21237

Both surgeons have a point and are not incorrect. Part of the issues are your symptoms. If you have leg pain on both sides, the surgeon who approaches both sides is probably going to have a better outcome. There is an argument against this, however. The surgeon who approaches only one side can make the argument that placing the disc spacer distracts the disc space and makes more room for the un-approached nerve root by “indirect decompression” He would not be wrong.

I am of the position that both sides need to be approached in an isthmic spondylolisthesis. This is for increased bone graft availability and the ability to decompress both roots. I have a high success rate for fusion and also a very good success rate at relief of leg pain. I would not argue (much) with the single sided approach but prefer to know that both roots are free after surgery.

BMP has a learning curve and if used properly, will not generally overgrow if used in the disc space.

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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