Dr. Corenman,
So I am really confused now…
I saw the surgeon for a final appointment to sign the papers. The surgeon tells me he would do a Minimally Invasive TLIF and hardware. No PLF at all. So I am wondering is this really enough support for my spine? I am 34 and I saw how small the TLIF spacer is. He also told me I would be off of work for 8 weeks and I do have a moderately active job as a elementary PE teacher and tennis coach. I cannot imagine returning that quickly…
In the meantime I had my final consult with another highly respect surgeon in the area who I was waiting to see. He without a doubt told me a MIS TLIF only would not hold up and I would end up with a revision. He told me he does TLIF’s often but not in patients as active and young as me. He told me he would do a two day surgery. On Monday he would perform an ALIF with a titanium cage and ground up donor bone. HE said the cage is designed to show fusion not block it so that was not an issue. He even showed me several X-rays of others with it. He would also reduce my slip simply because of gravity. The reduction and return of disk space would decompress my nerves. It is clear how much my spondy moves…it reduces to a grade 1 when I am prone like on my CT and MRI but weighted it is a grade 2. Then on Wednesday he would perform a second surgery, a PLF with hardware. He would also be able to visualize the nerves when he is removing the fractured arch which he would use for the bone graft. This setup would give me 3 places to fuse and the larger space of the ALIF spacer would serve me better with my activity levels. It certainly makes sense that this approach would make things solid. He told me 6 months off of work. 3 months in a brace and then 3 months to ease into things. This timeline seems more realistic especially considering the magnitude of the surgery.
Have any advice?