Yes, I have been consulting with a lot of neurosurgeons. Most ortho recommend PLIF of ALIF.
“The posterolateral fusion is performed only from the back of the spine. Generally this fusion should always be included when the incision is from the back of the spine although I have seen some cases where for some unknown reasons, it was not done. ”
1.) So if a ALIF is done and they “roll me over” to put in percutaneos screws and rods without making a midline incision, would you think their would also be a posterolateral fusion or just the hardware going in ? This is where I get confused. What is the point of having ALIF without poterolateral fusion ? I assume that would be the same as doing a TLIF without posterolateral fusion. To be clear, there is no real benefit to having posterior support without posterolateral fusion ?
2.) Is it better to decompress a disc herniation from the back or can it be done just as well through the front ?
“The TLIF prepares the disc space just as well as the ALIF and fusion is improved by both instrumentation which stabilizes the spine and by the posterolateral fusion which allows for more surface area for fusion.”
Are you saying the size of the cage(s) in TLIF or PLIF doesn’t matter ?
Would the PLIF be just as strong as the TLIF and ALIF with the two small cages ?
Last,I see that a PLIF does not remove the facets and just the pars fracture – preserving the facets – is there any benefit in preserving the facets ?
Thank you so much for the clarification. It is impossible to get all of these concerns address in a surgical consult. I believe the details make all the difference!