I met with my Neurosurgeon again this past week to discuss TLIF instead of 360.
He does feel very adamant that 360 is better to stabilize the spinal column because, as mentioned previously, cage is bigger and he can get better access to disc space. He did however mention, as did you, that pars fracture should be removed and he will use pars bone for posterolateral fusion. He seems to have everything covered; I can’t thank you enough for your guidance.
He believes retracting one nerve root with TLIF and not being able to access disc space well enough will not give me “as good” of a result, but would probably be good enough. I do respect this surgeon. He has the best reputation in my area and has consistently had very good results for over 30 years. I personally have two friends that he did posterior fusions for that are doing very well 10 years later. He has agreed to do either TLIF or 360 when I am ready.
Having said that, 360 fusion will put 8 screws in my L5,S1 and two rods (4 screws through stand alone alif cage and 4 more more posterior with two rods). I know of many surgeons that are using the same technique but it would seem like the two incisions and hardware alone could become a pain generator after all the other pain generators have been removed.
1.) Could screws from stand alone alif device create pain from the front once the bone grows around them ?
2.) Does 8 screws and two rods sound excessive to you for 360 or does it not matter once fusion takes place ?
3.) I have another surgeon that wants to do 360 without built in screws. He will not remove pars fracture and wants to put perc screws in to back me up without gutter fusion ? Any idea why anyone would do this ? Is it suppose to be less invasive ?
4.) I have a grade one spondy with no change after onset of symptoms 4 years ago. How important is O arm for TLIF ?
I believe you have good results because you are precise with your screw placement. I do not believe other surgeons have the same technology. Would you agree ?
In short, my thought pattern is the same as yours. Why would I want to have two incisions with 4 additional screws, and assume the risk of cutting through abdomen in order to put a larger cage in through the front.
I assume that 360 could be favored by a surgeon because there is no nerve root retraction.