Dr. Luiz Pimenta -- Advanced Applications and Techniques for the XLIF Procedure (discusses Artificial Disc Replacement Revision)

[NancyC]

Posterior lumbar interbody fusion of L5-S1 is what I had. XLIF is more from the side Interbody Fusion - ALIF, PLIF and XLIF Check out the link in my post above for one technique that was minimally invasive. I now have 0 lumbar pain unless I twist or lift a lot. Normally, I don't pick up over 35 lbs and from knee height or above.

Why is he doing it in two different surgeries?

My understanding is that he is fusing the discs, putting on the cage first, then after the swelling goes down and he can establish that there has been no nerve damage, he will put the screws in via fluroscope. Each procedure means 2-3 days in hospital. I thought it would be a great deal longer!

Jack, it is encouraging to hear you now have 0 lumbar pain.

[Katie]

Nancy, I have searched the forum to see if you have posted more after your surgery dates, and was wondering how things went.

I had an XLIF at L4/5 and ALIF at L5/S1 with Dr. Pimenta, all in one surgery. (I had an ADR inserted at C5/6 at the same time.) The XLIF was a much easier surgery, site wise, than the ALIF. The incision was half the size and felt much less invasive, which of course is the plan.

If not for constipation problems, I would have been out in three days. I hope yours went very well also.

[NancyC]

Hi Katie,

I'm SO glad that everything went well for you. Sounds like the perfect surgery.

One thing you wrote puzzles me - I thought XLIF and ALIF were the same thing, just different materials.

Constipation can be a problem, but at least it is easy to fix. I'm sure you've have plenty of advice on that!

My surgery? I don't quite know what to say. It's been a month now and I am still in extreme pain. I was in pain in the hospital - was accused of drug seeking, which is horribly frustrating. I don't even drink alcohol, why would I look for drugs?

I didn't go through with the second surgery (where the rod and screws are inserted) because I was far too exhausted and in pain to go through with it. Maybe at a later date, but right now I am angry, resentful and have problems with mobility. I wish I could just have ONE day without pain, but nooooo, I'm a drug-seeker.

Sorry to vent like that. I've stayed away from this forum mainly because I am so disappointed in the health care system treating me like a dog and I can't sit for long.

Dr. Ganesh Swamy at the Foothills Hospital in Calgary did my surgery. I barely have a scar, thanks to him. He doesn't want to treat my pain, though. Nor do the Acute Pain Team at the hospital. No one does, and I feel I'm being punished for something.

Anyway... Did you have abdominal swelling after surgery? I did and still do. I used to wear a size 32 jeans, now when I go out (which is not often) I wear a borrowed pair of men's size 38 army pants due to the swelling.

And when you get up from a sitting position, do you hear noises like cogs in a machine? I do and it's weird.

Thanks for asking, and sorry for venting, but I guess this is the place to do it.

Nancy

[azennaro]

Hi Justine

i have just had facet joint resurfacing by Dr
Pimenta on
l4/5 leaving charite dsk in.
At L5S1 he could not as the facets had started to self fuse and they cannot pry them open, due to my instability at this level he had to fuse PLIF leaving the charite disk in.
The clinical trils are 1 year into a two year period with 16 people being done so far,
A 50/50 sucess rate.
This was the best option for me to try and preserve L4/5 level and not fuse, I guess only time will tell.
The company is Zeeger I will have some more information in the next couple of weeks to post and hopefullyy a video
Cheers

[Katie]

Hi Anna, I'm a bit confused about this

The clinical trils are 1 year into a two year period with 16 people being done so far, a 50/50 sucess rate.

Do you mean that Dr. P's surgery was a trial? And the Zeeger's mention...do you mean Dr. Zeeger? Sorry that I'm not getting it....it's 3 am here...just got up because the cat was hungry I hope you are doing well, better every day.

Nancy, I'll answer your questions after the quotes so I don't miss anything..if that's possible for me

One thing you wrote puzzles me - I thought XLIF and ALIF were the same thing, just different materials.

XLIF is a minimally invasive technique that goes in from the side with less than a two inch incision on the left behind the hip bone (in me at least) I can't even see the incision now. It is a special way of accessing the needed vertebrae level by weaving a probe through the psoas muscle that prevents any nerves from being damaged...the probe shows where they are and they go around them, first with a probe, then with the tools to clean out the disc and osteophytes and insert the cage.

With the ALIF, they went in through my front right abdominal cavity (but not into the sac where the organs are) and go over the top of the hip bone. The XLIF allowed them to go around the bone...smaller incision, no disruption to internal tissue/organs. Unfortunately they couldn't reach the lower vertebrae except with the ALIF, and do the extensive work needed there. I had spondy, the vertebrae were out of alignment like a set of steps and he had to fix that plus put in the cage.

But both levels used the same cage, just a flat hollow disc with a bar across the center really, not a 'cage' as I pictured it when they first mentioned it.

I had no screws, rods etc. Just the cages sitting there with the pressure of the vertebrae holding things together till the bone filled in. I am allergic to all the metal they would have usually used. But they were able to use carbon fiber screws in the C5/6 ADR.

Constipation can be a problem, but at least it is easy to fix. I'm sure you've have plenty of advice on that!

Mene wasn't that easy, of course . I had been badly constipated before surgery because of the very large amounts of morphine I had to take. Despite all the suggestions from our wonderful board members, it took Tamarin paste, a specialty fruit of Brazil that finally got things going after 7 or 8 days. Enemas only worked once, but my system didn't keep working on its own until the 'magic paste'

My surgery? I don't quite know what to say. It's been a month now and I am still in extreme pain. I was in pain in the hospital - was accused of drug seeking, which is horribly frustrating. I don't even drink alcohol, why would I look for drugs?

I wouldn't expect that you should still be in that much pain. Is it from the incision or deeper, in the spine/original area? I'd pay the good doctor another visit.

Unfortunately what you experienced is a common problem...they accuse most people of being 'druggies'. They are so pure, of course, and have never touched alcohol, etc ever. They certainly have never been in pain like we are/have been, and not likely had more than a hangnail.

When I had a discogram in Quebec City, the cocktail of drugs had no effect on me, none at all. I'd never been in such pain in my life...I was sobbing uncontrollably. They were afraid to give me more because of the load I already had on board...at that point I would have been happy to stop breathing if it meant stop hurting. I had no such problem in Brazil, but I'm pretty assertive .

I didn't go through with the second surgery (where the rod and screws are inserted) because I was far too exhausted and in pain to go through with it.

They didn't want to do it in one shot while you were under anesthetic? I was out for about seven hours, with three levels. Putting you through a second one would be pretty stressful and yes, very painful if you are already not having that pain managed.

I truly think that my experience with so little post-op pain had a lot if not all to do with asking for an epidural during and for the 24 hrs post-op. The German surgeons told me that they do this routinely, as even though you are unconscious with a general anesthetic, the body still feels the pain and goes into great stress/shock and post-op pain is much worse, in their experience. I've posted this in the past, but maybe have to have Justin put a sticky on it to keep it current.

I'm so very sorry that you are in so much pain. I was able to walk the hospital corridors the day following surgery and every day after that. I wasn't pain free by any stretch, but was quite mobile. I was mainly just uncoordinated, and the IV bag kept smacking me in the head as I walked...welcome to my world...daily...I'm a real klutz After I got out of the hospital, but before we could go home (needed a checkup and OK to travel, so had to stay for awhile) We took advantage and traveled to a couple of beach resorts and rested up better than staying in the city.

This isn't to make you or anyone else to feel worse, but to let you know if you do go in for more surgery, to try for the epidural. I had my morphine reduced significantly almost immediately after surgery because they were convinced (probably correctly) that it was causing most of my constipation. I got additional pain/other meds (not sure what kind other than anti-nausea because of withdrawal) through my IV. But the full withdrawal hit after we got home...I was so dense I didn't realize that is what it was at the time. I slept for 18 hrs a day/no energy/etc. It took weeks to pass, but the pain was not too bad. I'm still on some, but 1/10 of pre-op levels.

Maybe at a later date, but right now I am angry, resentful and have problems with mobility. I wish I could just have ONE day without pain, but nooooo, I'm a drug-seeker.

These are completely legitimate feelings, and I'd feel the same way. It follows the Canadian/North American philosophy on pain control though...the main reason I couldn't get surgery in the first place..."we don't operate JUST for pain" Can you find an independent pain management doctor? We have pain clinics but the wait time is not good. I'm so sorry you are going through this.

Sorry to vent like that. I've stayed away from this forum mainly because I am so disappointed in the health care system treating me like a dog and I can't sit for long.

I hope you come back more often...the support here is what got me through my darkest days, but I understand the difficulty in sitting.

Dr. Ganesh Swamy at the Foothills Hospital in Calgary did my surgery. I barely have a scar, thanks to him. He doesn't want to treat my pain, though. Nor do the Acute Pain Team at the hospital. No one does, and I feel I'm being punished for something.

Do you know how many of these surgeries Dr. Swamy has done? I have lots of people asking about Canadian doctors and it's good to have this information. Again, try a separate pain clinic if possible...but I know how hard it is... They all think you are selling the stuff

Anyway... Did you have abdominal swelling after surgery? I did and still do. I used to wear a size 32 jeans, now when I go out (which is not often) I wear a borrowed pair of men's size 38 army pants due to the swelling.

LOL, I remember looking like a pregnant moose! Between the slow gut movement even after I got out of the hospital and the long surgery and numerous repositions during it that ticked off every muscle and tissue possible, I was very 'puffy' to say the least. It has gone down...but not as much as I'd like! The scars are almost completely invisible, but there's no bikini in my future

And when you get up from a sitting position, do you hear noises like cogs in a machine? I do and it's weird.

In a word, no. I had a very weird feeling of everything in my lower back being 'squeezed' for a month or two...it was very tight and like in a vise. But like almost everything, it passed. I'd get that checked if it doesn't get better fast. You are being good about no twisting, bending, lifting....right? I had to laugh the other day. My 76 yr old friend had a hysterectomy in her late 40s and was told at the time not to vacuum. She held her husband to that and hasn't vacuumed herself since...either he or a house cleaner does it! She knows how to do things right

Thanks for asking, and sorry for venting, but

I guess this is the place to do it.

You got that right!

Please keep us posted and vent away. If we can offer advice/encouragement or hope to anyone, please stay in touch. This forum is a touchstone and it kept me going when it was so very tough.

Hugs to all.

[NancyC]

Hi Anna, I'm a bit confused about this Do you mean that Dr. P's surgery was a trial? And the Zeeger's mention...do you mean Dr. Zeeger? Sorry that I'm not getting it....it's 3 am here...just got up because the cat was hungry I hope you are doing well, better every day.

Nancy, I'll answer your questions after the quotes so I don't miss anything..if that's possible for me

Hi Katie - thank you SO much for your kindness; you had me bawling like a baby because someone understands!!!

XLIF is a minimally invasive technique that goes in from the side with less than a two inch incision on the left behind the hip bone (in me at least) I can't even see the incision now. It is a special way of accessing the needed vertebrae level by weaving a probe through the psoas muscle that prevents any nerves from being damaged...the probe shows where they are and they go around them, first with a probe, then with the tools to clean out the disc and osteophytes and insert the cage.

Well I guess I had XLIF; I feel so stupid sometimes as I don't know as much as all of you do.

With the ALIF, they went in through my front right abdominal cavity (but not into the sac where the organs are) and go over the top of the hip bone. The XLIF allowed them to go around the bone...smaller incision, no disruption to internal tissue/organs. Unfortunately they couldn't reach the lower vertebrae except with the ALIF, and do the extensive work needed there. I had spondy, the vertebrae were out of alignment like a set of steps and he had to fix that plus put in the cage.

But both levels used the same cage, just a flat hollow disc with a bar across the center really, not a 'cage' as I pictured it when they first mentioned it.

I had no screws, rods etc. Just the cages sitting there with the pressure of the vertebrae holding things together till the bone filled in. I am allergic to all the metal they would have usually used. But they were able to use carbon fiber screws in the C5/6 ADR.

Mene wasn't that easy, of course . I had been badly constipated before surgery because of the very large amounts of morphine I had to take. Despite all the suggestions from our wonderful board members, it took Tamarin paste, a specialty fruit of Brazil that finally got things going after 7 or 8 days. Enemas only worked once, but my system didn't keep working on its own until the 'magic paste'

I wouldn't expect that you should still be in that much pain. Is it from the incision or deeper, in the spine/original area? I'd pay the good doctor another visit.

It's in the lumbar area. I am back on methadone, but it doesn't seem to do much anymore. 10mg 3 times daily and I can't control my pain???

Unfortunately what you experienced is a common problem...they accuse most people of being 'druggies'. They are so pure, of course, and have never touched alcohol, etc ever. They certainly have never been in pain like we are/have been, and not likely had more than a hangnail.

Oh yes, of course we want to be stoned all the time because it's so much fun to be stupid

When I had a discogram in Quebec City, the cocktail of drugs had no effect on me, none at all. I'd never been in such pain in my life...I was sobbing uncontrollably. They were afraid to give me more because of the load I already had on board...at that point I would have been happy to stop breathing if it meant stop hurting. I had no such problem in Brazil, but I'm pretty assertive .

When I tried to be assertive, they had a psychologist come and see me! Can you believe it???
The Acute Pain Team came to see me, and when I asked for an epidural, I was ignored.

They didn't want to do it in one shot while you were under anesthetic? I was out for about seven hours, with three levels. Putting you through a second one would be pretty stressful and yes, very painful if you are already not having that pain managed.

Yeah, I was out from 7:20 a.m. and woke up about 16:30 a.m. in Recovery. This was February 22nd, and they planned on putting in the rod and screws on March 4. The night before (I was still in hospital) I cancelled the surgery, but no one told the doctor who showed up in my room bright and early on March 4th. I was the one who had to tell him that the surgery was off.

I truly think that my experience with so little post-op pain had a lot if not all to do with asking for an epidural during and for the 24 hrs post-op. The German surgeons told me that they do this routinely, as even though you are unconscious with a general anesthetic, the body still feels the pain and goes into great stress/shock and post-op pain is much worse, in their experience. I've posted this in the past, but maybe have to have Justin put a sticky on it to keep it current.

I'm so very sorry that you are in so much pain. I was able to walk the hospital corridors the day following surgery and every day after that. I wasn't pain free by any stretch, but was quite mobile. I was mainly just uncoordinated, and the IV bag kept smacking me in the head as I walked...welcome to my world...daily...I'm a real klutz After I got out of the hospital, but before we could go home (needed a checkup and OK to travel, so had to stay for awhile) We took advantage and traveled to a couple of beach resorts and rested up better than staying in the city.

This isn't to make you or anyone else to feel worse, but to let you know if you do go in for more surgery, to try for the epidural. I had my morphine reduced significantly almost immediately after surgery because they were convinced (probably correctly) that it was causing most of my constipation. I got additional pain/other meds (not sure what kind other than anti-nausea because of withdrawal) through my IV. But the full withdrawal hit after we got home...I was so dense I didn't realize that is what it was at the time. I slept for 18 hrs a day/no energy/etc. It took weeks to pass, but the pain was not too bad. I'm still on some, but 1/10 of pre-op levels.

How long does an epidural last?

These are completely legitimate feelings, and I'd feel the same way. It follows the Canadian/North American philosophy on pain control though...the main reason I couldn't get surgery in the first place..."we don't operate JUST for pain" Can you find an independent pain management doctor? We have pain clinics but the wait time is not good. I'm so sorry you are going through this.

I hope you come back more often...the support here is what got me through my darkest days, but I understand the difficulty in sitting.

Do you know how many of these surgeries Dr. Swamy has done? I have lots of people asking about Canadian doctors and it's good to have this information. Again, try a separate pain clinic if possible...but I know how hard it is... They all think you are selling the stuff

Dr. Swamy told me he had done 10 or so of these operations before me and he is supposed to be the expert. As for pain, I am a patient at The Chronic Pain Centre here in Calgary (that's where the methadone is coming from) but I had to swear to the Dr. that I would not take more than prescribed and couldn't take anything else along with it because I am a drug addict, you know

LOL, I remember looking like a pregnant moose! Between the slow gut movement even after I got out of the hospital and the long surgery and numerous repositions during it that ticked off every muscle and tissue possible, I was very 'puffy' to say the least. It has gone down...but not as much as I'd like! The scars are almost completely invisible, but there's no bikini in my future

I went to Emergency a couple of weeks after my surgery for pain meds and I had some abdominal pain. I explained about the swelling - they did an X-Ray, and although I was not constipated in the least, the doctor told me he could see at least "5 pounds of fecal matter" in my abdomen! Talk about being full of s**t!

In a word, no. I had a very weird feeling of everything in my lower back being 'squeezed' for a month or two...it was very tight and like in a vise. But like almost everything, it passed. I'd get that checked if it doesn't get better fast. You are being good about no twisting, bending, lifting....right? I had to laugh the other day. My 76 yr old friend had a hysterectomy in her late 40s and was told at the time not to vacuum. She held her husband to that and hasn't vacuumed herself since...either he or a house cleaner does it! She knows how to do things right

She sure does!

Thanks for asking, and sorry for venting, but You got that right!

Please keep us posted and vent away. If we can offer advice/encouragement or hope to anyone, please stay in touch. This forum is a touchstone and it kept me going when it was so very tough.

Hugs to all.

I don't know how to thank you sufficiently. Your answer means the world to me.

Nancy