[Renee123]

#23418

With the MIS TLIF the surgeon would be able to decompress nerve root if a bone spur was present the same as with open TLIF ? I want to make sure nothing is left behind.

In your opinion, if MIS TLIF surgeon is using same boomerang cage and performs posterolateral fusion, would that give me the same chance of fusing as a regular open TLIF without using BMP?

[Donald Corenman, MD, DC]

#23420

“With the MIS TLIF the surgeon would be able to decompress nerve root if a bone spur was present the same as with open TLIF”? If he or she has good hands, the answer is yes. I would hope the surgeon would use a microscope.

“In your opinion, if MIS TLIF surgeon is using same boomerang cage and performs posterolateral fusion, would that give me the same chance of fusing as a regular open TLIF without using BMP”? The answer is a qualified yes. This surgeon would not have as much amount of bone graft as a minimally open procedure but still should have a good success rate.

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]

#23422

Thank you very much for all the detailed information ! Funny you should comment on the microscope because that was my next question.

I did read that my surgeon uses a high powered microscope that cost the hospital $250,000; I did not know there were different kinds of microscopes or they were that expensive !

Is there a specific name/type of the microscope you use ? I am curious if it is the same kind.

I just assumed that every spine surgeon would use a microscope to view the nerves, seems like common sense.

[Donald Corenman, MD, DC]

#23425

There are essentially two different companies that make scopes, Leica and Zeiss. They are equivalent. I would say that only 40-50% of surgeons use microscopes.

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]

#24039

Hi Dr. Corenman,

Thank you again for all of your advice. Regarding the MIS TLIF discussion we have been having on this thread I wanted to clarify couple things before I make my final decision on which surgeon to go to. Perhaps you can provide more insight.

One surgeon uses a boomerang cage and does posterolateral fusion (I think on both sides) with allograft.

The second surgeon uses an expandable titanium boomerang cage that is adjustable for lordosis. He will use BMP in front of cage with no posteralateral fusion (says not enough bone).

Im in a quandary.

Questions:

1.) Will BMP (second surgeon) provide for faster fusion and faster recovery time vs Boomerang cage with allograft and no BMP ?

2.) If facetectomy is done on both sides does that allow for pars fractures to be removed bilaterally ?

3.) When a surgeon says they need to decompress both sides with MIS TLIF does that mean decompress as in removing bone on both sides or decompress both sides by restoring disc space ?

Sorry for all the questions! Thank you again!

[Donald Corenman, MD, DC]

#24042

BMP generally will allow more success to the fusion rate. However, the endplate preparation and whether autograft is mixed in with the BMP will also help to make the determination. The posterolateral fusion also has to be included in the fusion equation. Posterolateral fusion can help fusion rates by improving fusion by between 15-20%. One provision is that allograft is much less effective in the posterolateral position for fusion than autograft is. Since allograft is less effective, probable less fusion rate for the second than the first technique noted.

The titanium expandable cage has much less surface area for fusion than the boomerang cage has but with BMP used probably gives an advantage overall. It would be great if these two surgeons could merge their techniques to create the best advantages.

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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