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Agreed! Thank you!
which in this case do you believe is more important – BMP without posterlateral fusion or posteralateral fusion without the BMP in the disc space ?
Would it be advisable to ask the one surgeon that uses the boomerang to use BMP in the front of the cage; he seems to be opposed to BMP ?
Also, posterolateral fusion with MIS TLIF is not the same as with open TLIF from what I understand there is not as much bone and MIS surgeons to not get wide enough to lay bone in the gutters so its not really a true posterolateral fusion. Is this correct ?
Hi Dr. Corenman,
Thank you again for all of your advice. Regarding the MIS TLIF discussion we have been having on this thread I wanted to clarify couple things before I make my final decision on which surgeon to go to. Perhaps you can provide more insight.
One surgeon uses a boomerang cage and does posterolateral fusion (I think on both sides) with allograft.
The second surgeon uses an expandable titanium boomerang cage that is adjustable for lordosis. He will use BMP in front of cage with no posteralateral fusion (says not enough bone).
Im in a quandary.
Questions:
1.) Will BMP (second surgeon) provide for faster fusion and faster recovery time vs Boomerang cage with allograft and no BMP ?
2.) If facetectomy is done on both sides does that allow for pars fractures to be removed bilaterally ?
3.) When a surgeon says they need to decompress both sides with MIS TLIF does that mean decompress as in removing bone on both sides or decompress both sides by restoring disc space ?
Sorry for all the questions! Thank you again!
Thank you very much for all the detailed information ! Funny you should comment on the microscope because that was my next question.
I did read that my surgeon uses a high powered microscope that cost the hospital $250,000; I did not know there were different kinds of microscopes or they were that expensive !
Is there a specific name/type of the microscope you use ? I am curious if it is the same kind.
I just assumed that every spine surgeon would use a microscope to view the nerves, seems like common sense.
With the MIS TLIF the surgeon would be able to decompress nerve root if a bone spur was present the same as with open TLIF ? I want to make sure nothing is left behind.
In your opinion, if MIS TLIF surgeon is using same boomerang cage and performs posterolateral fusion, would that give me the same chance of fusing as a regular open TLIF without using BMP?
Regarding your last post, In the MIS TLIF with bi lateral pars fracture, my surgeon says he will be doing facectomy on both sides, but only removing the one pars defect on the right side where he is doing the TLIF.
1.) I assume then the other pars fracture stay in, however a facectomy is done on the left side? Is this even possible ?
2.) In your opinion is this enough bone removal to decompress all pain generators ?
In short, I am aware of the draw backs of MIS TLIF, however I believe with use of boomerang cage, posterolateral fusion, facectomy and decompression that I should be pain free.
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