Fusion Rates: ALIF vs. XLIF

[Scott]

OK, so I need a one level fusion at L4/L5. ALIF is more invasive than XLIF. But, is the fusion rate for each procedure the same? How about the pain relief? I am all for shorter hospital stays and less damage to my body, but not necessarily if the surgery is not as successful. Please share any thoughts and links to studies that I may not know about.

Scott

[Hooch]

Gday,

Once you get to this stage you're wanting to know more than the average patient and you'll have to research. You're still in the same boat as everyone else with outcome uncertainty, but I spose at least you get some idea of what you're letting yourself in for.

You'll find even for something as seemingly simple to monitor as fusion rates there'll be a lot of conflicting literature. Patient outcome is even more of a mess. The key is to remember success is generally defined as some reduction of disability. ALIF and XLIF both leave plenty of vision for the surgeon to clear the disc space, with cages and instrumentation the fusion rates should be similar. They are generally very high these days.

The two big journals are spine and euro spine journal, so if you've got access to springer or something through work or uni you can have a read. Otherwise the abstracts aren't too bad, google scholar, pubmed etc. A lot of people have been down this path before, so you can search their posts and see them asking the same questions and finding answers on this forum and others like adrsupport etc. This can occasionaly be heartbreaking as you follow their story, other times great outcomes.

Elsevier

Good luck.

edit - just be aware that 6 or 7 years ago these geniuses thought it'd be a great idea to do fusion without instrumentation, the BAK cage. This is what the Charite was compared to in the FDA studies, and obviously the fusion rates were crap as nothing was screwed into place.

[Fried-spine]

I had XLIF surgery it certainley is not less invasive. I'm 2 plus years post op and have severe nerve damage, drop foot, wasting of muscles in my leg and severe swelling. They cut from the side opposed to the front but besides having to make their way around lot's of organ's, they weaken your femoral nerve (sometimes in my case permanently) and by going through the psoas muscle it actually causes a hot burning in your thigh. Mine is still present all this time later. If I had it to do over again I'd live with the before symptoms because my after symptoms have been actually worse. Sorry hate to be a debby downer but Ive got to be truthful. My level L4/L5. They presented it as "less invasive" I completely lost all use of my bladder and had complete incontience after the surgery. I'm not competley incontinent but still have a lot of urgency with now hesitancy because of the nerve damage. I know decisions are tough when it comes to surgery but the more I learn the more I'd never have gone through with this "less invasive" BS they tried to get me to believe!

[Pbchoclovr]

I don't know much about ALIF and XLIF other than both do require alot of movement of internal organs and are more invasive. So this doesn't really address your question of which surgery is more successful. Personally, I had a TLIF of the L4/L5 space which was done minimally invasive. My surgeon did say that he could have done either of the two approaches you mentioned in my situation, but his preference was for the TLIF. Hospital stay 4 days, incision site - 3 small (1 -1 1.5 ins.) incisions as opposed to one long incision. Swelling was minimal. I have 2 rods with 4 screws for instrumentation. Approach was from the posterior with minimal muscle movement/damage to reach my spine. My surgery completely resolved my presurgery issues. I would do this surgery again given the same circumstances, as opposed to living with the pain.

Have you asked your surgeon which method he prefers and his reasoning for that particular approach? Is he recommending either approach due to specific issues with your spine he is trying to address? Or... is it he is just more comfortable with either of these approaches? The answer to these questions might help you make a decision as to which approach to use.


Linda