Yes, you are right once again. The surgeon that wants to do the PLIF is a neuroseurgeon. Is TLIF more on an ortherpedic specialty ?
After doing so much research your argument for TLIF is the most plausible for me. It would appear that some of the other “minimally invasive” surgeries like ALIF would lead to a revision surgery down the road to remove parts fracture. Also you mentioned previusly that ALIF was more for grad 3-4 spondy. MY spondy has not change at all in 4 years. As a matter of fact the grade one slip has always been there, but I guess no moblie.
1.) Why do you insist that the Pars defect be removed when there are so many surgeons that say leave it alone if you do not have leg pain. I understand that bone spurs need to removed, but if it is not causing leg pain then why do you believe it is mandatory to take pars out ? for bone graft purposes ?
2.) Also another concern is the size of the cage being put in to the disc space, you have said previously that the TLIF is a large enough cage to support the spinal column but many “neurosurgeons” emphatically disagree with this. They say the smaller TLIF cage will not give enough support up front, which will lead to weakness and instabilty. (doesn’t cover enough area)
3.) When you put in cage for TLIF how much of the disc space do you remove and do your add BNP or other graft to the surrounding cage to help bone grow together ?
4.) You said above “TLIF is the best procedure for an isthmic spondylolisthesis as the surgery addresses the spurs that originate off of the fractured pars, fuses the disc and transverse processes (ala of the sacrum) and addresses both nerve roots (decompression) with retraction of only one root on one side.”
What do you mean it decompresses both nerve roots ? You mean when you remove the pars defect it will decompress whatever nerve roots they are pressing on ?
5.) The surgeon who does the PLIF is probably a neurosurgeon as this speciality tends to like the PLIF. If he or she is good and comfortable with this procedure, this is probably the best acceptable alternative.
Do you feel this way because the other neuro wanted to do 360 first even though he does TLIF as well. I believe he can perform surgery. He did posterolateral fusion 5 years ago (never removed disc? for a friend with spondylolithesis from pars fracture and he is doing great. He also did surgery 10 years ago on another friend with DDD spondy, again never put in cage, just screws and rods (posterolateral fusion) and he is also golfing, traveling with little to no pain.
It doesnt sound like any one was using cages 5-10 years ago ?
So I am assuming he can do a TLIF for me with a similar result.
You seem to be have the the best intuition when it comes to this. I really want to stay away from PLIF.
Will PLIF clead out entire disc space and provides as much bone graft as TLIF. Does PLIF also cram some bonegraft in the disc space next to the cages ?
Sorry, I know I a rambling, but I am getting close to scheduling this. I have some decent surgeons around, no one like yourself. but I think that can give a good result. I really only have on shot at this. I would to like ski and skate again. Do you think this is possible ?
Do you know of anyone at the Cleveland clinic or Pittsburg/Buffalo area that specilaized in TLIF ?