[Spinal Fusion / Lumbar] XLIF at L4/L5

[BackToTheGarden]

Hi, I'm Kathy and new to forums, etc. After avoiding surgery for the past five years, trying unsuccessful pain management, massage, water aerobics, epidurals, and meds, I'm scheduled to have an XLIF and an X-Stop done on April 12 in a city about three hours away. Long journey here after two insurance denials for an ALIF and a TLIF. My mom actually saw a tv piece on the XLIF, and I contacted Dr. Frank Holladay in Kansas City. My understanding is that the recovery is shorter, etc. than the other two surgeries. Fear about recovery and success are the two reasons it's taken me so long to give into surgery. There is an article on the Providence Medical Center website about a woman who had an XLIF and got her life back.

Has anyone had this surgery? If so, PLEASE share your recovery/outcome experience. What about hospital stay, pain on the trip home, walker need? I know it's fairly new, but Dr. H. says I'm a "great candidate" for this method of L4/5 fusion. I have constant low back, hip, and leg ache, but it's become my "normal" to the point that I can easily talk myself out of surgery. My hope is that the surgery and three months in the back brace will take me from feeling 80 (my retired doctor who told me five years ago to "quit screwing around and get your back fixed" said I have the spine of an 80 yo).

[Katie]

Hi Kathy,

I've just returned from surgery in Brazil, where I had three levels done by Dr. Luiz Pimenta. He has been involved with the development of the XLIF approach and I highly recommend it. Because of the way my surgery went, I can compare the XLIF to the more conventional method of fusion, plus I had the Nuvasive NeoDisc cervical ADR inserted in my neck as well.

I had the L4/5 done with the minimally invasive method and the difference between that and the L5/S1 is like night and day. I barely feel the incision, unless I touch it by accident, and unless I lay on it by accident. The incision is only about two inches long.

Unfortunately he could not use that method for the L5/S1 as he had to go above and behind the hip bone, which did not allow for the same procedure. The incision ismuch larger and more painful, and the internal organs are unhappy about being disturbed. They were not touched at all with the level above.

Please do not put it off any longer than necessary. You can also get a second opinion from the surgeon I used as to the use of the X-STOP vs another appliance. I thought that one was make by Medtronic, but I may be wrong. A different surgeon had wanted to put in three levels of the X-STOP but I was uncomfortable with that idea. Dr. Pimenta used the PEEK cage with me for both lumbar levels.

My recovery, except for constipation, (no small matter) was great, and I swear if I only had L4/5 done, I would have danced out of the hospital within 24 hours. That would be my only suggestion...to try and clean yourself out before surgery, and be VERY agressive with laxatives, etc as soon as the surgery is over. The doctors neglect to tell you this, and I'm not sure why, as it kept me in the hospital for at least three days longer than necessary.

If you have any more questions, feel free to email me, and we can chat on the phone also. I have a great long distance plan.

Try not to worry so much...it really is a peach of a surgery, much easier than the hysterectomy I had several years ago. Sounds weird, but true.

[BackToTheGarden]

Dear Katie,
Thank you SO much for your encouragement, suggestions, and most of all taking time while recovering to give me info. I was beginning to get very anxious, thinking I was having a very uncommon, new surgery without long-term results. You are such a trooper!!!! Here I am stressing about having one surgery when you had three. I am disappointed to hear about the burning in your legs. That is one of the things that I'm trying to fix--that burning ache down my legs when I sit too long. Is it less severe, I hope, than any leg pain you had pre-surgery?

When the doctor's nurse didn't return my Thursday call about setting up a pre-op visit (bloodwork, etc.), I called my primary physician here and set up one for Monday even though that could have been an excuse for me to back out of surgery (as my husband reminds me I tend to want to do).

I did call Friday afternoon and talk with a contact at Providence. She was great, saying that several people at the hospital have had the XLIF. When I mentioned using the "minimally invasive" website post-op instructions, this woman did scare me by saying, "This is a bigger surgery than that." My husband thinks hospital staff just always try to be conservative in their predictions. The employee thought it a good idea to stay in the hotel room my husband's booked for a week, as I wouldn't have to make the three hour drive for the one week post-op visit. Are the things done at the one week visit things my doctor here could do? Suture removal, check for infection, healing?

I must say that I've learned to deal directly with the hospital. I received promised information called back just moments after my call Friday. Hooray!!!! I'm still dealing some with not having overdone it with yard and garden work enough and telling myself the pain isn't that bad. Maybe I should throw in some housework. Now there's a thought. I do have to remind myself that I'm taking Ultram ER every time I'm going to walk, sit, etc. and meds and ice. Not to mention, yes I really would like to actually clean my house.

A last BIG concern. Since I already have bad neck and shoulder(esp. left) pain that only massage/ice/ and the YMCA pool seem to help, I was sorry to hear about your shoulder pain. Oh, I bought a stool softener. Should I also take with me to the hospital a laxative? When a family friend had back surgery, she had your trouble until a nurse "snuck" her a laxative.

Sorry this is so long. I'm last in line for a computer in our home.

Thanks again. Yes, I would love to talk by phone.

Kathy

[Katie]

Hi Kathy,

A few things popped into my mind with your last post.

First, you said that you also have neck and shoulder pain. Has your doctor looked at your cervical levels? What is causing your pain there? My extreme pain in the lumbar region masked the more serious compression in my c5/6. It took three different surgeons examining me before one discovered the cervical problems.

My leg 'pain' is new. I don't really consider it to be pain per se, more of a burning sensation, and it started after the surgery. Dr. Pimenta explained that it is a result of the nerves being aggravated and that it should pass soon. The only leg issued I had were linked to the sciatic nerve, and it came from the nerve being pinched from an over tight muscle. Massage helped it a lot. The burning pain is much better this evening than it was yesterday, and I am convinced that the extended flight aggravated the situation. Fingers crossed that it gets better, soon!

I am also confused about your treatment plan. Are you having a fusion at the L4/5 or the X-STOP? You are only having one level done, right? Why that instead of fusion or artificial disc? Just curious.

Dr. Pimenta gave us two books from Nuvasive, one explained the difference between the various approaches very well, and the other gave the patients' stories before and after surgery when using the XLIF method. It is called "the better way Back", and has at least one story involving your surgeon. You might find it in the library, or contact the company for a copy.

I would highly recommend taking a stool softener before surgery, and something afterwards also. But tell the staff at the hospital that you are concerned about it and will take something if they don't provide it. The worst thing that could happen is if they double up on your laxative, not knowing that you already had one Well, for me it may not have been a bad thing, but perhaps for others.... I found that the Tamarin paste, in a jar, worked the best. Or at least it was the last thing I had (several doses) before everything started 'moving'

You can email me your phone number and I will try and call you tomorrow if you like, or on Monday at a good time for both of us. Thanks for the feedback. I'm happy to help...I remember those first few years when I felt so all alone with my pain.

[BackToTheGarden]

Hi, this is Kathy's husband posting from her hospital room.

The surgery was yesterday and went pretty well. The surgeon mentioned "very unusual spinal anatomy" that required him to improvise a little bit on his approach to the spine. As a result it took a little longer than expected.

He was able to relieve compression on 2 nerves and correct some twisting of the lumbar spine. Also it turns out we were mistaken about the X-Stop; he just did a basic XLIF along with a posterior clamp of some kind help ensure a good fusion.

Obviously it's early but so far he thinks she'll see "really significant" long-term relief.

[Dave]

Hi Kathy's husband. I'm glad the surgury went well. Please let her know that we are thinking of her.
Best wishes.

[Katie]

Wow, what a relief to have that over with, "Mr" Kathy I so appreciate the update, as I'd been thinking of her all day.

I hope she had as easy a surgery as I did for that approach...it was definitely my easiest of the three. Give her our best.

Did she get my last minute email with suggestions on how to make life a bit easier over the next few days? If you made back home and she wants to chat, please just let me know. I'm sleeping about eighteen hours a day now, but will certainly wake up enough for a chat with her

[scduggan]

Dear Kathy and Mr. Kathy,
I am so glad to hear the surgery was a success. Also, welcome to the website. Please keep us posted and I am wishing you well!
CD

[Cindylou]

Glad her surgery went well and thanks for updating us Mr. Kathy! Hope to hear from the real Kathy when she is up and only when able.