[john123]

#11640

so to be clear

1.) stand alone ALIF with interior fixation really should not be done with out pedicle screws for spondylosisthesis with disc hernation at same level due to pars defect ?

2.) If the ALIF 360 surgery is performed I would be better off with the TLIf as I would only have to retract one nerve root and will have the added stability of a posterolateral fusion ?

3.) I have heard and read many times that once nerve root(s) are retracted that the retraction can create a life time of painful nerve irritation. Is this common ?

4.) how do you size and fit the TLIF cage ? Isn’t it trial and error like the ALIF procedure?

The way my back feels is that there is nothing holding it up in the back, i.e. pars bone; it feel like it is caving in without the brace, therefore I do not see how a stand alone ALIF would hold me up without posterior fixation.

[Donald Corenman, MD, DC]

#11641

ALIFs can be done safely without posterior fixation in the case of an isthmic spondylolisthesis without significant nerve root pain (leg pain). The question is fusion rate as well as complication rate for an anterior approach. I believe it is acceptable but less successful than a posterior TLIF fusion where there is both anterior and posterior fixation as well as fusion on both sides.

If you are having a “360”, this would not be called an ALIF. A 360 would be an anterior and posterior fusion (an approach from the front and the back). In my opinion, this is unnecessary unless the slip is very large (grade III or larger).

I retract nerve roots all the time without damage or injury. It has to be done gently with proper technique by an assistant who is well trained. Interestingly, the decompression of the “Gill fragment” (the disconnected lamina and inferior facets) generally does not require nerve retraction. The nerves have to be uncovered as there typically are large spurs growing out of the inferior pedicles which compresses the nerves. An osteotome (like a chisel) is used to clear these roots.

The TLIF cage is sized just like the ALIF cage, with a “trial” of different sizes. The trials come in one millimeter increments for a good fit.

A stand alone ALIF will work but as I said before, a TLIF is better for stability success rate and healing.

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.

[john123]

#11816

Dr. Corenman,

Thank you so much again for the invaluable information and your meticulous advice !!

[john123]

#11956

Quick question, when reading through a consent form for fusion surgery , I saw that aside from death, paralysis, etc, being the risks of surgery that blindness could occur from spinal surgery or spinal fusion as well?

I would assume this is a low % however, is this true? Have you ever seen a patient become blind after surgery ? What is the probability that this could happen ?

Thank you again !

[Donald Corenman, MD, DC]

#11960

Blindness after any surgery is a possibility. There is only one artery that supplies the eye and with the patient face down, the eye is suspended. If there is pressure on the eye, trauma to this region or some very rare conditions where the artery is fragile and weak, loss of vision can occur.

I have seen this once in thirty years in a patient who had a major thoracic spine dislocation with paralysis. We took him to the operating room and repaired his thoracic spine. The surgery took 5 1/2 hours. Remarkably, he fully recovered from his paralysis but was left with partial visual loss.

ION (ischemic optic neuropathy) is very rare and precautions can be taken to reduce the potential, but the risk is there, especially with long cases (even open heart and other surgeries).

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.

[john123]

#12051

I assume with a TLIF surgery there would be a low risk of blindness ?

I was also just reading a post from “Novak” on the forum regarding a pars defect. Although my grade one spodylolisthesis is old, my pain seems to be controlled with my brace.

Do you believe it would be worth it to try a bone growth stimulator at this point?

I was just reading that a bone growth stimulator could promote healing of non union fracture and is part of a conservative treatment ?

If so, what kind of bone growth stimulator would you suggest ?

Thank you again !

[Author]

Posts