How to choose your fusion type: ALIF vs. PLIF vs. TLIF vs. MIS

[Scott]

Hi Everyone. I am so happy to find this site. I have been dealing with back pain for 3.5 years now. I am an Engineering Project Manager, so I can still work. But my quality of life has gone way down. I can no longer cut my lawn, shovel snow, garden, coach soccer, etc. You all know the drill. I have gained 45 pounds in 3 years due to my sedentary lifestyle. I have to have my wife and kids pick stuff up off of the floor for me all of the time. See below for my history.

I saw a highly recommended neurosurgeon in Lancaster PA who recommended an ALIF. Sounds good since I do not need to have my back muscles cut. Moving all of my internal organs, including the main veins and arteries does scare me. The neurosurgeon sent me to Annapolis MD to have my discogram, since the doc there does it under versed. Test was easy and confirmed that L4/L5 has tears in it and is the cause of my pain. Also confirmed that my other discs were good. Neuroradiologist called my condition IDDS (Internal Disc Disruption Syndrome) a form of DDD. He felt that I should consider Minimally Invasive Surgery and recommended that I get a second opinion in Annapolis. I have that appointment scheduled for Jan 17.

I am relatively healthy and only need a one level fusion. I was told that I was not a candidate for ADR because I have Facet Arthritis. Also, my insurance will not cover it. How do I decide what is best for me? How did everyone else make their decision? My condition seems relatively simple compared to many of yours, but I want to make the right decision.

Does Minimally Invasive Fusion have the same success as traditional open fusion? If so, why would anyone want a traditional open fusion?

Also, any surgeon recommendations within 5 hours of Lancaster PA would be great.

Any help will be greatly appreciated.


Signature:

Lower Back Pain, Right Leg Pain and Numbness.
P T, NSAIDs - No Improvement
2009 - MRI - Loss of height in L4/L5, darkening, and slight bulge into spinal canal.
2009 - June 2010: Branch Blocks, Steroids, and RF Neuroabaltions. Some Pain Relief.
2010 - Pain gets worse. Second MRI. L4/L5 is worse than before.
2010 - Second Surgical Consult. Recommends ALIF and wants a discogram to confirm.
2010 - Discogram (Versed!) Confirmed L4/L5 is bad. Doc called it IDDS (Internal Disc Disruption Syndrome)

[Gilbert P]

Hi Scott
Refuse to fuse! with all the advancement in spine surgery you need to educate yourself in all the possible options for your spine.

Get many opinions do lots of research and find the best surgeon in the world to help you.

You only have one spine get it done right the first time

We are here to help ask lots of questions

All The Best

Gil

[Justin]

Hi Scott,

Welcome to the Spine Patient Society.

Hi Everyone. I am so happy to find this site. I have been dealing with back pain for 3.5 years now. I am an Engineering Project Manager, so I can still work. But my quality of life has gone way down. I can no longer cut my lawn, shovel snow, garden, coach soccer, etc. You all know the drill. I have gained 45 pounds in 3 years due to my sedentary lifestyle. I have to have my wife and kids pick stuff up off of the floor for me all of the time. See below for my history.

My heart hurts reading the quoted text above. I can empathize with a poor quality of life--I was bed ridden before my 2nd surgery and my wife had to help me with my activities of daily living.

I am relatively healthy and only need a one level fusion. I was told that I was not a candidate for ADR because I have Facet Arthritis. Also, my insurance will not cover it. How do I decide what is best for me? How did everyone else make their decision? My condition seems relatively simple compared to many of yours, but I want to make the right decision.

The best way to decide what is best for you is to get multiple surgical opinions (if possible), weigh the "pros and cons" of each approach and ultimately decided on a surgery & surgeon that you feel most comfortable with.

Does Minimally Invasive Fusion have the same success as traditional open fusion? If so, why would anyone want a traditional open fusion?

"Traditional" fusion has been the gold standard of spine surgery for many decades. Over time, the procedure has integrated minimally invasive approaches, a wide array of devices and improved long-term outcomes.

Also, any surgeon recommendations within 5 hours of Lancaster PA would be great.

There are many great spine surgeons right out your backdoor. In Philly, the Rothman Institute is highly regarding as is Dr. Balderston at 3B Orthopedics. Also, I'm sure the University of Pittsburg has many outstanding spine surgeons. Dr. Bitan in New York is a great surgeon. Dr. Yue at Yale University is also highly regarded. Of course, there are countless others, but this should be a good start.

Make yourself at home and let us know if you need anything.

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[Justin]

Hi Scott
Refuse to fuse! with all the advancement in spine surgery you need to educate yourself in all the possible options for your spine.

Gil, Scott stated that he has facet arthritis, which is a contraindication to artificial disc replacement surgery.

[Cindylou]

Scott, you already got a lot of good feedback, I just wanted to welcome you to SPS. Glad you found us. Believe me when I say we get what you're going through. Chronic pain just sucks. I hope you find the right solution soon for your spine and we are here to support you. Cindylou

[KBear]

Welcome Scott,
I'm not familiar with all the different fusions, though it does sound like you need fusion and not ADR (facet joints being a contradiction). I would definitely get a few opinions and if your lucky it will be easy and they will all say the same thing, otherwise you will have to do more research and decide what is best for you. Feel free to ask any questions you may have, there is not a such thing as a dumb question when it comes to your spine.
Good Luck,
Kathy

[Hooch]

Gday mate,

Minimally invasive is just a buzz word, don't worry about it. ALIF is minimially invasive, as is XLIF. PLIF gotta hack out a lot of bone. TLIF going through the foraminal hole and hacking out a facet.

You're right, no need to go in the back and scar up your posterior muscles and manipulate the nerves. So you go in the front or the side. The side (XLIF) is newer than ALIF. XLIF goes through the psoas so they've gotta dodge the nerves in there, ALIF through the front so gotta dodge the nerves and arteries\veins there. You've also gotta consider the sort of cage they put into the space. There's plenty of info on the web.

In a case of IDD the surgical standard is ALIF. I can't really think of any major advantages XLIF offers, but I'm no surgeon. At least it rules out the chance of retrograde ejaculation! Personally the doc would have to persuade me why he'd take one option or the other.

Welcome.

[Justin]

I forgot to mention that I would personally go with XLIF. If you can avoid an anterior surgery, I would. Going through the abdomen carries inherent risks. Also, the adhesions (scar tissue) that form after an ALIF can make you more prone to a small bowel obstruction later in life (this possible complication down the road--postsurgical adhesions are the leading cause of small bowel obstruction).

With XLIF, you have to worry about the lumbar plexus running through the psoas muscle as well as chronic pain related to the approach through the psoas.

Just my two cents.

[ajj1001]

welcome to the forum, just my feedback on plif, the actual op wasn't that bad, I had good pain relief, the restrictive rehab sucks but i think that's the same for every fusion. getting the right option for a good long term outcome us the most important. thing.

[NancyC]

Hi Justin,

I don't know what the above acronyms in the title mean - I am having spinal fusion (either T12 to L5 or L2 to L5, we haven't decided) and when you wrote:

"My heart hurts reading the quoted text above. I can empathize with a poor quality of life--I was bed ridden before my 2nd surgery and my wife had to help me with my activities of daily living."

I don't understand. Why does your heart hurt? What caused you to be bedridden?

I apologise in advance as I don't know very much about what is happening to me (I have an appointment tomorrow, January 12th to ask questions) and I don't know what many people are listing below their names.

Sorry to be so ignorant, but I guess if I stick around a while I will learn.

My surgeon told me that he is cutting me open on the side, gluing the discs together and putting a cage around them. The next day he will continue the surgery by putting screws in to hold it all together. Is this what traditional spinal fusion is???

Thanks,

Nancy