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in reply to: Stand alone ALIF on a male #11249
Yes, I have been consulting with a lot of neurosurgeons. Most ortho recommend PLIF of ALIF.
“The posterolateral fusion is performed only from the back of the spine. Generally this fusion should always be included when the incision is from the back of the spine although I have seen some cases where for some unknown reasons, it was not done. ”
1.) So if a ALIF is done and they “roll me over” to put in percutaneos screws and rods without making a midline incision, would you think their would also be a posterolateral fusion or just the hardware going in ? This is where I get confused. What is the point of having ALIF without poterolateral fusion ? I assume that would be the same as doing a TLIF without posterolateral fusion. To be clear, there is no real benefit to having posterior support without posterolateral fusion ?
2.) Is it better to decompress a disc herniation from the back or can it be done just as well through the front ?
“The TLIF prepares the disc space just as well as the ALIF and fusion is improved by both instrumentation which stabilizes the spine and by the posterolateral fusion which allows for more surface area for fusion.”
Are you saying the size of the cage(s) in TLIF or PLIF doesn’t matter ?
Would the PLIF be just as strong as the TLIF and ALIF with the two small cages ?
Last,I see that a PLIF does not remove the facets and just the pars fracture – preserving the facets – is there any benefit in preserving the facets ?
Thank you so much for the clarification. It is impossible to get all of these concerns address in a surgical consult. I believe the details make all the difference!
in reply to: Stand alone ALIF on a male #11245Thank 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 !
Thank you kindly.
“You can have anesthesia “run you dry” during surgery which might help as some patients with heart failure need to be run”
1.) Can you please elaborate on the above? It sounds as though pots could effect my rehab/walking, any specific instruction ?
2.) what is difference between TLIF and PLIF ?
3.) I have one surgeon that wants to make incision through right side of my back where disc herniation is to clean out disc space, then do laminectomy (remove pars defect) and use bone from laminectomy to put in cage for fusion. Does this sound accurate or would you suggest a different method?
sorry for all the questions !
Thank you
in reply to: Whiplash/Post Concussion Syndrome #6701Also, if I were to undergo a 4 hr ALIF with the symptoms I am having, weather they are Post concussion or not, do you believe the anesthesia would exacerbate symptoms or be safe ?
in reply to: Whiplash/Post Concussion Syndrome #6700thank you.
It is not my intention to sound argumentative; I have certainly not ruled post concussion out. The symptoms I have do not come and go as post concussion. For example, I do not have chronic headaches or memory difficulty. Cognition is pretty good. no real nausea.
May I ask, how a facet in the lower lumbar would create a headache?
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