hello everyone.. i've posted here a while ago.. Lately, I am having a difficult time deciding on what to do..

[mark kim]

I have been on numerous consultations with surgeons all over the world and recently got an discogram test done. The results came out positive and corroborated that I have a degenerated disc at the l5-s1 level with annular tears. The location of the tear is right on the nerve which the leakage from the disc causes the sciatic pain for me. I've been told numerous times that ADR would not be good due to my degenerated facets and I was offered several fusion options. I just wanted to ask the community what there thoughts are on a ALIF vs. minimally invasive TLIF. I have been to different doctors that offered either fusion type. I have read the -/+ of both. I am leaning towards the mi tlif because of a shorter recuperation, don't have to worry about the retrograde ejaculation side effect and anything operated through the abdomen freaks me out. With regards to the ALIF, the doctors who want to perform this method state that it doesn't cut any muscles in the back and allows better placement of the cages. I really like what I have been reading about the STALIF.

[Katie]

mark, can you explain what the STAFIL is for me? I'm not familiar with it. I was very happy with my ALIF as you know, but the surgeon had to deal with spondy at that level. I think it was the hardest part of my three level operation.

[Cindylou]

Mark, welcome back. I have been quite happy with my ALIF as well, however, if your surgeon has a lot of experience with the less invasive approach, I would consider it, if I were in your shoes. That said, I will also add I am not that familiar with the other approach, so research is essential, as I am sure you are doing. Best of luck in the decision making process and glad you found your pain generator as well. That's crucial. Blessed Holidays to you and yours, Cindylou

[mark kim]

mark, can you explain what the STAFIL is for me? I'm not familiar with it. I was very happy with my ALIF as you know, but the surgeon had to deal with spondy at that level. I think it was the hardest part of my three level operation.

The STALIF is stand alone alif. Here is some information I found out about it:
"STALIF TT™ is a true ‘stand alone’ anterior lumbar interbody fusion device that delivers exceptional fixation with superior clinical advantages. Unlike contemporary cage fixation devices that require supplemental pedicular screw fixation or anterior plate fixation, STALIF TT™’s unique patented design delivers solid fixation that resists flexion-extension forces, torsional rotation, and prevents graft and implant extrusion while restoring normal sagittal alignment.
This is achieved through either a single midline (trans-peritoneal) or oblique (retro-peritoneal) approach providing surgeons with the most options available for primary fusion, implant salvage, STALIF TT™/TDR hybrid and bail-out strategies. STALIF TT™ is a less invasive procedure that reduces patient morbidity, blood loss, surgery time, anaesthesia, recovery time and overall expense."

[Hooch]

The stalif is a good anterioir option. With the tlif, I dunno much about it but my biggest concern would be completely clearing the disc space, quality of cage put in, and muscle disruption. If it does require cutting of the back muslces as in a plif apparently they never heal the same. I don't buy that it is 'minimally invasive', just different. Unless we're talking about cosmetics, which is pretty far down the list of considerations imo.

[Katie]

Hmmm, I haven't had the time to look further into that, but my ALIF has no screws, rods, etc. to hold the plastic 'cage' in place. In reality it is just a flat almost hollow rectangular disc that was set between my L5/S1 (same with the XLIF at L4/5). Nothing is holding it in place, except for the bone growing there, plus I guess the ligaments, etc.

Honestly, it worried me in the beginning that there is no other support, but all is well nine months out, despite several falls I've had. I'll take time later to compare it with what you are describing and see if it is the same or similar.

[Hooch]

Hi Katie, I imagine the only reason Pimenta didn't use instrumentation is because of your metal allergies. Afaik all the screws used are metals.

There is info about the stalif below, a lot of surgeons also use screw and plate setups, or flip you over and ding some screws in your back.

The Spine Clinic :: Minimally invasive anterior fusion

[Katie]

Hooch, that is exactly the reason. But I always wondered if there were any other 'naked' ALIFs out there, and if so, why. I do have screws in the cervical ADR though, made of carbon fiber screws, so there was that option at the other levels I think.