Donald Corenman, MD, DC
Post count: 8459

You have found out through experience that if you ask five spine surgeons (or neurosurgeons) their opinion, you will get ten different answers.

As I have noted before, I think the 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.

PILFs will work but in my opinion, there is no need to retract both roots which is what is involved with a PLIF. An ALIF is not necessary as the abdominal wall does not need to be incised (with a TLIF) and no great vessels or ureters need to be retracted. “Minimally invasive” techniques are really not minimally invasive and fail more often than minimal incision standard techniques (MIMS technique-minimal incision microsurgery).

All that being said, ALIFs can work, PLIFs can work and 360s can work to repair this disorder. It really depends upon the experience and technique of the surgeon you choose.

Your quote is probably the best and simplest description of the surgery I have heard (“Pars comes out, screws go in, fuse vertebrae and gutters and I’m good to go”).

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.

Dr. Corenman