Thank you Dr. Corenman for the fast response!! I also agree that I should have posterior fixation, and therefore is the reason that I am second guessing a stand alone ALIF.
” If he suspects that there is a chance of continued pain and that he will need to go posteriorly in a second surgery to stabilize the surgery, why not do this entire process posteriorly at one sitting? “
Most surgeons I have spoken to emphatically believe that obtaining the largest fusion bed from ALIF will provide the most support and will not require second surgery. I am told the intervertebral fusion will not be nearly as strong with the smaller TLIF or PLIF cage(s).
The surgeon also says I do not need a decompression of the Pars fracture if I am not getting leg pain. However, I do have a large disc herniation at the same level and it would seem to make sense to decompress the disc from the back vs. the front ? Correct ?
” I assume that if the surgeon noted that he might need to “roll someone over during the same surgery and putting in the back up screws and rods during the same surgery” is that if he performs the anterior approach for an ALIF and finds greater instability than he assumes is present, he will need to perform a poster instrumentation and fusion at the same setting.”
In response, the surgeon believes that the posterior fixation is not really necessary but is the best way to guarantee the fusion of the intervertbral body by locking it down.
However, most importantly, it sounds to me that even with the posterior fixation that I would still need a lateral fusion on either side with BNP to add further stability. I don’t believe rolling me over and putting in perc screw and rods also provides a lateral fusion with BNP or from the bone that is taken from the pars fracture.
Would this be accurate ?
Do you also believe it is absolutely necessary to also have lateral fusion with Grade one spondy or is this too much ? Also, would lateral fusion need to be done on both sides or just on the one side where you remove the facet to access to disc space ?
Sorry for all the questions.
THANK YOU !