Thank you again. I follow your logic but I guess not everyone has the same logic. Again, many surgeons seem very enthused with the ALIF recovery time and the fact that there is no nerve retraction. However, it sounds like the cons of ALIF could far out weigh the pros especially for a male patient…
“The pars fractures that caused the isthmic spondylolisthesis separates the facets from the entire vertebra. Preserving the facets will not make a difference in stability, but there are detriments to not removing them.”
“These facets are great bone graft sources and should be used for graft. Not using them again makes absolutely no sense. This graft can make the difference between a solid fusion and no fusion at all. In addition, there is typically a large spur that grows off the bottom of the pedicle of L5 where the fracture originates. This spur compresses the L5 root and can cause compression if the disc is distracted by a intradiscal cage.”
1.) In a PLIF the pars defect is removed, leaving the facets in tact. The pars defect is used for bone fusion in the two cages and also posterolaterally?
2.) In a TLIF the entire pars defect is removed along with spinal process and the one facet joint off to the side where my disc herniation is ? OR is the pars defect removed along with both facet joints and tranverse proceses ? This would sound like the entire portion of lower back at L5,S1 is being removed and replaced by interbody and posterolateral fusion ? Are there any bones left behind?
3.) When you place TLIF cage in, do you leave some of the wall of the disc to hold the cage in ?
4.) Do you also fill the disc space with BNP to supplement the cage ?
5.) How long is the recovery in terms of pain meds and returning to normal activity with TLIF ?
6.) Will patients require the use of oral steriods or IV steriods after surgery to reduce inflammation ?
Thank you again for sharing your knowledge and expertise!!!