To fuse or not to fuse, and a question on docs that can be backchannel?

[JRS11]

Hello. I have posted a few times, maybe not in this section. My history is interesting but to cut to the chase I have scoliosis (which I am unsure whether this makes a Laminotomy or Laminectomy more difficult). Reason for surgery is stenosis with radiating pain down my leg from the butt to the calve for about a year now (history of this goes back 12 years but a flare a year ago made this a DO NOT IGNORE situation). Maybe someone here knows. I have seen a few surgeons, my first surgeon first wanted to do a procedure that was not approved by my insurance, moved next to a laminotomy or Laminectomy and said either way he would fuse (this I did not understand and still do not). Now he just wants to do a Foraminotomy. He comes with very good credentials. Next doc says a Laminotomy without fusion and a Foraminotomy. Next doc confirmed that but did not rule out a Laminectomy. My thoughts are why would you need to fuse for a Laminotomy? Why not do it without fusion as you can always do that but you cannot reverse the fusing? Now a bit of family history, my blood paternal cousin just had a big surgery and he did not fuse, the hardware is holding all together but the fusing was not successful and he was curious if this may be an issue as we are blood cousins. Also, I am in Souther New England, the MA, CT area and do not want to post names of docs but would be happy to hear about good ones back channel if possible.

I should mention in reading one docs notes he writes about both XLIF and ALIF. I would think the XLIF if I did do a fusion would be an easier surgery, but if I can avoid a fusion isn't that the best to start with?


Thanks for your patience in reading this post

JRS

[JRS11]

wonder why I never get replies to my posts....very curious. Maybe I am not being clear, if so please tell me.

[Justin]

wonder why I never get replies to my posts....very curious. Maybe I am not being clear, if so please tell me.

Hi Joel, I replied to your PMs. Many Spine Patients that frequent our Forums do not reply to a thread right away. Your original post was only up ~6hrs. By the way, what is a backchannel / back channel?

[runagain]

Just to reply:

Justin I think a back channel means back across the ocean to England. Something like that. I am sure one of the Brits on here could enlighten us.
JRS, is this correct?
Sorry, about the varying opinions from the docs. I had a hard time with that too, it can be quite maddening.
Hope you find your answers soon.
I would just guess with what you might do if I tried it, but there are people on here who probably can give you some ideas. Sometimes, you have to get in touch with the doctor and ask him/her the questions until you understand.

R

[runagain]

One of your questions I might be able to answer, but remember your doc can explain it best because everyone's situation, body is different and the docs go to school a long time and gain working experience to answer these questions (i.e. they know a lot more than us non-Docs?, right Justin??)

As I understand it, a Laminotomy, which removes part of the lamina of the vertebral arch, may cause instability in the spinal segment. This instability is not wanted so a doctor would do a fusion, which fuses the vertebra in place and hence prevents instability within that spinal segment?? A laminotomy can take pressure off of nerves, giving them more space to be in.

Sorry, but it is too late for me to do any in depth research and this is just taking a stab at one of your questions. Hope I did not lead to more confusion.
The back is complex and intricate.

[Katie]

Hi Joel,

I ended up having both an ALIF and XLIF at the two lowest levels, and the latter was much easier. Unfortunately we had no choice when it came to doing them...I had complications at the L5/S1 and the surgeon just couldn't work around the hip bone like with the XLIF. It all worked in the end, just a bit longer recovery. So far I'm very happy with my fusions even though I had fought long and hard for an ADR at the L4/5 level at least.

I hope all works out for you. Trust your gut with the doctors before you, and what they are offering. When you talk to enough of them, it starts to become clear which will work best.

[JRS11]

Hi Joel,

I ended up having both an ALIF and XLIF at the two lowest levels, and the latter was much easier. Unfortunately we had no choice when it came to doing them...I had complications at the L5/S1 and the surgeon just couldn't work around the hip bone like with the XLIF. It all worked in the end, just a bit longer recovery. So far I'm very happy with my fusions even though I had fought long and hard for an ADR at the L4/5 level at least.

I hope all works out for you. Trust your gut with the doctors before you, and what they are offering. When you talk to enough of them, it starts to become clear which will work best.

Thanks for your replies. I have to decide soon as I need to take care of this, I appreciate the input from all...

JRS

[RetroVirus]

There are alternatives to fusion. I am very happy with the results of my arthroscopic surgery.

[JRS11]

There are alternatives to fusion. I am very happy with the results of my arthroscopic surgery.

What alternatives are you referring to? Thanks.

[Gilbert P]

HI JRS 11

I was indicated to have a four level fusion and S-I joint fused, or a two level fusion.

I found a surgeon that said " friends dont let friends have a fusion" With that I am scheduled to have Coflex and Staxx at two levels.

I will post my results as it happens.

All The Best

Gil