[Donald Corenman, MD, DC]

#22227

Disc bulges are common with decreased disc height and are generally no matter with this type of surgery from the front. It is the compression of the nerve root that is the problem. This can occur with a disc herniation or a bone spur (more common). The distraction of the disc space from the front can reduce the compression of the nerve. This is why the surgery is generally successful from the front.

The ALIF has risks inherent in its approach and also in continued nerve compression if the disc space distraction does not decompress the nerve. The posterior approach has risks too. You have to handle the nerve root carefully and abnormal retraction can cause nerve irritability. This is why a surgeon might want to perform an anterior procedure instead of a TLIF. He or she does not have to handle the nerve root, there is less chance of a dural leak and the procedure is performed without a microscope-making it easier. The nerve might not be fully decompressed, however.

If the surgeon performs an ALIF and the nerve continues to be symptomatic, he or she can always go posterior to decompress the nerve but that obviously requires another surgery. This is my argument for the TLIF in the face of a spondylolisthesis.

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.

[biofreeze]

#22230

I think there was a typo in your fist two sentences.

So I should assume that a disc fragment could be left compressing the nerve root with an ALIF ?

[Donald Corenman, MD, DC]

#22231

Don’t think there is a typo. The disc fragment can be left with an ALIF.

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.

[biofreeze]

#22233

Go it. And I assume this disc fragment could cause back pain after after an ALIF hence TLIF ?

Do you know Why any surgeon would leave the disc bulge ??

Sorry for the repetition. Just want
to make sure I have this right.

[biofreeze]

#22234

Actually. I’m sorry. Just re read your last comment and it mskes sense now !

So after the ALIF if there is still pain I assume a laminectomy would need to be done with possible microdisectomy ? Seems like a big risk to take.

[Donald Corenman, MD, DC]

#22237

If there is continued leg pain and an MRI post surgery noted a retained fragment or a spur continuing to compress the nerve root, a laminotomy (or a full laminectomy in this case called a “Gill procedure”) should be performed to decompress the root.

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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