ALIF Procedure

[ocotillo623]

Geetings, I am brand new to the list.

My neurosurgeon here in Los Angeles has recommended ALIF* for my L4/L5 joint. I am in my 50's. I'm getting more interested as I've tried over a 4 year period MANY other interventions , traditional and alternative, and these have not helped. I would like to read about others' expereince, good or bad, with *anterior lumbar internal fusion. What else do I need to know? The surgeon states that 80% of his patients are 'much, much better.' Anybody know of pusblised studies of success rates/outcomes?

I'd also be interested in reading about successful alternative treatment experiences by those who a severe L4/5 degeneration.

Thanks all!

[Pbchoclovr]

Hi Ocotillo and

I can't really speak to the ALIF procedure, as I had a TLIF from the posterior. I can, however, speak to the degeneration at the L4/L5 level. I was diagnosed about a year and a half ago with DDD of the L4/L5 level. I went through all the conservative treatments over an 8 month period and was finally referred to a surgeon. Prior to surgery, I had low back pain, in addition to pain going down my right leg and occasionally my left leg, making it extremely difficult and painful to walk. The fusion surgery resolved all pre-surgery pain. I'm now 7 months post op and while I still have some pain, it's all related to the healing process and continues to improve. I'd have surgery again without hesitation given the exact same circumstances.

You can find many of those here on SPS's experiences with surgery and their journey as they heal in the Surgical Outcomes forum. If you look in the Spine Surgery Support forum, you'll find answers to many of the questions we've all asked. Of course, everyone is different so no two experiences are exactly alike. In general, you need to know that should you go forward with surgery, it's a long slow process healing with an initial extended time of no lifting, bending, or twisting. You'll need people with you the first few weeks to help you do a lot of things that the rules and pain will limit you in doing. Walking post surgery will be crucial to rebuilding your muscles and following your doctors orders to the letter.

Good luck as you make your decision.

Linda

[ocotillo623]

Thank you very much for the informative reply, Linda!

Hi Ocotillo and

I can't really speak to the ALIF procedure, as I had a TLIF from the posterior. I can, however, speak to the degeneration at the L4/L5 level. I was diagnosed about a year and a half ago with DDD of the L4/L5 level. I went through all the conservative treatments over an 8 month period and was finally referred to a surgeon. Prior to surgery, I had low back pain, in addition to pain going down my right leg and occasionally my left leg, making it extremely difficult and painful to walk. The fusion surgery resolved all pre-surgery pain. I'm now 7 months post op and while I still have some pain, it's all related to the healing process and continues to improve. I'd have surgery again without hesitation given the exact same circumstances.

You can find many of those here on SPS's experiences with surgery and their journey as they heal in the Surgical Outcomes forum. If you look in the Spine Surgery Support forum, you'll find answers to many of the questions we've all asked. Of course, everyone is different so no two experiences are exactly alike. In general, you need to know that should you go forward with surgery, it's a long slow process healing with an initial extended time of no lifting, bending, or twisting. You'll need people with you the first few weeks to help you do a lot of things that the rules and pain will limit you in doing. Walking post surgery will be crucial to rebuilding your muscles and following your doctors orders to the letter.

Good luck as you make your decision.

Linda

[Justin]

Hi Ocotillo623,

Welcome to the Spine Patient Society!

In your situation, it sounds like you have truly exhausted all conservative treatment. Linda's post above is spot on (thanks Linda--you rock! ).

This abstract might help put some of the spinal fusion approaches into perspective for you:
_________________________________________________

Clin Orthop Surg. 2011 Mar;3(1):39-47. Epub 2011 Feb 15.

Fusion rates of instrumented lumbar spinal arthrodesis according to surgical approach: a systematic review of randomized trials.

Lee CS, Hwang CJ, Lee DH, Kim YT, Lee HS.

Source
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

BACKGROUND:

Lumbar spine fusion rates can vary according to the surgical technique. Although many studies on spinal fusion have been conducted and reported, the heterogeneity of the study designs and data handling make it difficult to identify which approach yields the highest fusion rate. This paper reviews studies that compared the lumbosacral fusion rates achieved with different surgical techniques.

METHODS:

Relevant randomized trials comparing the fusion rates of different surgical approaches for instrumented lumbosacral spinal fusion surgery were identified through highly sensitive and targeted keyword search strategies. A methodological quality assessment was performed according to the checklist suggested by the Cochrane Collaboration Back Review Group. Qualitative analysis was performed.

RESULTS:

A literature search identified six randomized controlled trials (RCTs) comparing the fusion rates of different surgical approaches. One trial compared anterior lumbar interbody fusion (ALIF) plus adjunctive posterior transpedicular instrumentation with circumferential fusion and posterolateral fusion (PLF) with posterior lumbar interbody fusion (PLIF). Three studies compared PLF with circumferential fusion. One study compared three fusion approaches: PLF, PLIF and circumferential fusion.

CONCLUSIONS:

One low quality RCT reported no difference in fusion rate between ALIF with posterior transpedicular instrumentation and circumferential fusion, and PLIF and circumferential fusion. There is moderate evidence suggesting no difference in fusion rate between PLF and PLIF. The evidence on the fusion rate of circumferential fusion compared to PLF from qualitative analysis was conflicting. However, no general conclusion could be made due to the scarcity of data, heterogeneity of the trials included, and some methodological defects of the six studies reviewed.

PMID: 21369477 [PubMed - indexed for MEDLINE] PMCID: PMC3042168

[Kimberly]

Hi there and welcome to the forum!You've gotten some great advice above but I can chime in on the ALIF procedure as that is what I had on JUne 29, 2012 (about 7 months ago.)

I started an entry entitled "alif DONE" in the "Surgical Outcomes" section and it's here:
alif...DONE!

Although everyone's spine situation is unique and everyone heals at different rates, there are a few things I would say are pretty universal after a spinal fusion. Linda is right in that you will definitely need a little help for the first few weeks. You will be advised to not bend, lift or twist (BLT) for some time after surgery (although when a surgeon removes this restriction will vary from patient to patient.) Walking is always recommended. Short frequent walks are usually more beneficial (and easier to do!) than one long walk a day. Usually your spine surgeon will work with a second vascular surgeon to access the spine from the front (anterior) where the cages are placed. Then they will install the stabilization hardware (rods/screws) from the back (posterior.) So, I have three separate incisions (one in front and two in the back.) Typical hospital stay (although everyone is different) is about 3 days. I had a few post-operative issues and was there for 6.

All in all, I am MUCH better than before I had the surgery and would do it again in a heartbeat. But it is a long and slow recovery process. I still have a ways to go in my recovery (I know....even at 7 months I am still recovering! They're not kidding when they say slow!) I tried to have very realistic expectations and for me, this has been extremely helpful. I am not completely pain free yet (but did not expect to be at this point). I am confident I will continue to heal and get better. I did not expect a 20 year old back out of the deal nor did I expect that my fused spine would function the same as the spine I was born with.

It's a little like taking care of an older car - if I treat it a little more gently, give it a lot more maintenance, and not take it out for long drives every day, she should last me a good long time (with maybe a few minor issues that need looking into from time to time.) But I am living again! and life is GOOD!.

Feel free to send me a private message (PM) by just logging in and then clicking on my name, or just ask anything you like! Everyone here is happy and eager to help.

Best of luck as you make your decision and move forward to a more pain-free life.

Take care,
Kimberly

[Katiem3987]

I had PLIF of L4/L5 through L5/S1 on January 23rd. Only 3 weeks out so can't really comment much.As of right now all my left leg nerve pain is gone. My neuro said he was confident he could greatly improve if not get rid of it. I was thinking second discectomy originally (had one in 2005 at L5/S1) but he thought it would leave me unstable. And thought he could do a better jib if cleaning up around nerves with a fusion.My only concerns longterm as of now are what will happen to L3 on the future. But trying to concentrate on recovery right now. Not as scary as I thought but trying and slow

[ocotillo623]

Thanks very much to all who have given such thorough responses! I am learning more about the procedure and have a few more questions! If you have input on one or more of these I would be happy to hear. At least now I understand the difference between: ALIF, PLIF, TLIF and XLIF!
I'm working on what resources I will need upon release from hospital.

Recovery:

1. How long shall I expect to stay in hospital?
2. When I leave the hospital, can I expect to make it to the bathroom on my own?
3. How long before I can walk?
4. ... return to work?
5. ... resume exercise (swimming)?
6. When will physical therapy start?
7. How much assistance will I need and for how long?
8. Did you go to a rehab center, have in-home assistance, stay by yourself (I live alone (with my cat)).
9. One person mentioned the he/she slept in a reclined because a bed didn't work at first.

[Kimberly]

Hi Ocotillo623,

How long shall I expect to stay in hospital?

Typical stay is about 3 days. I had several "issues" that needed to be worked out (mainly regarding medication and bowel issues) which took me a little longer. I stayed for 5 nights and was released on day 6.

When I leave the hospital, can I expect to make it to the bathroom on my own?

Yes, absolutely. Occupational and physical therapists will visit you in the hospital making sure you can do simple self-care tasks like get in and out of bed safely (log-roll!), climb up and down stairs (if you have them), walk (with a walker at first), use the toilet, shower, brush your teeth. You wil be very slow of course but you should be able to do these things by yourself before you go home. Help is always nice, of course- like someone handing you the shampoo, getting your towel for you, making sure you do not slip getting in and out of the shower - but you can prepare your home before surgery for things like this. For example, I bought bathmats for the floor (which I usually don't use) and rearranged toiletry items so that they were within easy reach in the shower or on the bathroom counter (and not in a low drawer or under the sink.)

How long before I can walk?

They will have you up and walking (with a walker for support and stability) while you are still in the hospital. Day 2? Day 3? Can't really remember, but it is early. I remember thinking, "Oh my gosh....you've GOT to be kidding me." when they came to get me up for the first time. And although transitioning from down to up (and from up to down) was painful, being up on my feet felt good.

return to work?

That really depends on you, your recovery, your surgeon, what you do for a living, and how much time off you can afford. My surgeon told me to plan on carving out at least 3 months before I was going to be up for returning to work. I took a little longer than that but part of the reason for that is I am a teacher at a community college, so it made much more sense for me to take the entire semester off instead of coming back in 3/4 of the way through. Some folks return to work much sooner than that. Everyone is different.

resume exercise (swimming)?

Again, that will depend on your doctor. Some folks have pool work as part of their physical therapy exercises, but usually begin by walking in the pool. I think Linda swims and used the pool for PT could probably answer that better than me. Hopefully she will chime in.

When will physical therapy start?

Although they want you to walk walk walk from the time you get home from the hospital, my PT didn't start until the 3 month mark.

How much assistance will I need and for how long?

Again, everyone is different, but I had family come for the first several weeks. My husband took 3 weeks off and we had some family trickling in/out for about that long. I could care for myself in the bathroom ok (toilet, teeth, shower) but they helped take care of my kids, did laundry, cooked, brought me DVDs and juice, made sure I was on top of my meds and kept me company on my many slow walks :-)

Did you go to a rehab center, have in-home assistance, stay by yourself (I live alone (with my cat)).

I had the luxury of having help at home, so I went home.

One person mentioned the he/she slept in a reclined because a bed didn't work at first.

I was fine in bed and actually felt best lying flat on my back or on my side. So a regular bed was fine for me, but I did use many many pillows in all sorts of crazy places to help get comfy.


I hope that helps. Feel free to keep the questions coming. :-)

Kimberly

[Katiem3987]

I am on a phone and can't figure out how to do the fancy answers yet.I was in hospital 6 days. Was going home 5th but my drain was still putting out to much.I was up day #2 with PT. I walked 2x a day with them. And once a day with nursing students who visited room. With a walker like stated above.Only trouble other than drain was I had to be recathed 4 times as I had trouble peeing. Once home I have a toilet thing that makes it taller. Well worth it! Life saver. A grabber thing. And still use my walker although I think I may be on tail end. Makes me feel more secure.In my own bed. No issues. Sitting is hardest for me. Getting better week 3.Can't answer rest. My 1st appt is 6 weeks out. Just walking allowed till then. My mom moved in until that appt as I have 3 small kids. Fun times

[Kimberly]

I second what Katie said.

I also had a "reacher-grabber" that they gave me in the hospital. A definite must-have.

I purchased a "bedside commode" (from Walgreens) for use at home. I did not need it by my bedside (I could walk to the bathroom just fine) but I took the "bucket" out (threw it away) and placed the rest of the unit it over the toilet. It functioned like a very sturdy raised toilet seat but had arms for getting up/down, four "legs" which were sturdily (not a word, I know) on the floor and since the bucket was removed, there was nothing to clean. Just a nice, high toilet seat. I used this for a good month before i felt I didn't need it anymore.

Kimberly