[Renee123]

#23216

I believe I understand now. Inferior and superior = one facet joint on TLIF side correct ?

[Donald Corenman, MD, DC]

#23217

Correct. One facet joint consists of an upper and a lower segment. It is like a clam shell. You have to remove both the upper and the lower facet to gain access to the foramen (TLIF=transforaminal interbody 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]

#23264

Hi Dr. Corenman:

My surgeon describes the MIS TLIF very similar to your TLIF approach. He will be using same boomerang cage and there will be posterolateral fusion. The facets are taken out however the pars fracture is left in. I don’t quite understand how. The bone from the facetectomy is used in cage. He does not use BMP however; he uses some kind of puddy allograft to augment bone.

There appears to be some trade offs with this approach, however one night in the hospital and fast recovery sounds very appealing.

1.) How can facets be removed and pars fractures left in tact ? Aren’t the two connected ?

2.) From a fusion standpoint, I am assuming I would have same chance to fuse as open TLIF with concomitant fusion. Would you say that is accurate ?

Thank you

[Donald Corenman, MD, DC]

#23305

The use of the bilateral facets in the graft should be enough graft mass to create a fusion. Lack of BMP use might reduce fusion rate about 10%. It might be more helpful to use the entire lamina instead of just the facets as this yields more material to allow fusion to occur but this is conjecture.

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]

#23400

Regarding your last post, In the MIS TLIF with bi lateral pars fracture, my surgeon says he will be doing facectomy on both sides, but only removing the one pars defect on the right side where he is doing the TLIF.

1.) I assume then the other pars fracture stay in, however a facectomy is done on the left side? Is this even possible ?

2.) In your opinion is this enough bone removal to decompress all pain generators ?

In short, I am aware of the draw backs of MIS TLIF, however I believe with use of boomerang cage, posterolateral fusion, facectomy and decompression that I should be pain free.

[Donald Corenman, MD, DC]

#23407

The inferior facets are connected to the lamina (and therefore each other) by the bilateral pars defects. A surgeon can remove the inferior facet without removing the lamina (which is what this surgeon is implying). In my opinion, the surgeon needs to view the inferior pedicle of L5 to look for the typical spur that can grow out of this area (where the pars fracture occurred) to make sure that the L5 root is decompressed. You can do that without removing the entire lamina but just removing the facet. This should be enough to decompress the L5 roots but there is much bone that can be used for graft that will be left behind in this technique.

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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