Hi All: I've been posting here for a short while regarding a bad L5-S1 herniation and my orthopedic surgeon (whom I trust) is recommending an ALIF plus PLIF approach to removing the disc. I basically understand his reasons for doing so and am going to see a thoracic surgeon next week to see if I "qualify" health-wise for the anterior fusion. I should mention that I am 37, fairly healthy otherwise, although I am overweight and smoke. I lost 40 pounds in the past 6 months (weigh 180 now; am 5 foot 5) and I just quit smoking (today!) in preparation of all this.

My question is this: has anyone gone to a thoracic surgeon and been told they can't get the ALIF surgery? If so, why? I know I'm a big girl but am or at least was very active before this back pain nightmare started a year ago. I want the best chance of fusion and am concerned that the vascular surgeon will say no. If anyone has gone to see a vascular surgeon, what do they do when you get there? How do they decide if you are in good enough shape I know I shouldn't be obsessing about this, but I am.

Any experiences you could offer with this type of surgey would be helpful. They are suggesting donor bone.

Thanks,
Schragie

Hi,
I had a fusion done this past Nov. 11 poterior, anterior was done on the 14 th.
I did not see a thoracic surgeon, since the anterior was not decided on until they were into the middle of the first surgery. I had degenerated disc's at L4-L5 and L5-S1, which led to a grade 2 spondy. I have ended up with a 360 fusion, with screws and rods and cages, except the vertibre that moved could not be put back in place it had to be instrumented at the grade 2 spondy, due to scar tissue from past surgeries.


My spine Dr. will not do fusions if you have not been off cigarettes for at least a year, and I was just under his cut off weight of 200 lbs. so a lil over weight seems to be ok.

Great job with the weight loss !!!!!!

Every Dr. has varying guidelines so if I were you I wouoldn't be too worried, if he didn't think you were gonna be able to have the surgery, I'm sure he wouldn't be wasting your time sending you there. It's always best to make sure there isn't something that they can't tell up front is there. My Dr. always puts me thru the wringer and I have had 4 surgeries in the last 3 yrs. Same battery of test each time. I woudl be worries if your Dr. didn't check everything out first.

Not so sure if I have been any help or not, Just thought I would share what I do know with ya, Good luck and May God watch over you and Bless you.

Carol

Hello Schragie-
I'm afraid I don't have much experience with ALIF - YET! I had a single level L4-5 fusion in 3/05 that did not fuse so I may get a a crack at a 360 (PLIF and ALIF) pretty soon. I was very interested to hear about your docs cut off weight since it has never been mentioned to me and I wouldn't make a 200 lb cut off today because I have gained 20 lbs since my surgery. Very interesting.
But I did want to comment on the donor bone you mention. I would be researching this and asking my docs for some very good justifications (and there are good reasons why this may be your best option) on this one. You'll easily find plenty of posts on this board and plenty of other information on sites like spineuniversity and ************ and so on to tell you that donor bone is an inferior choice compared to your own bone and to BMP. The topic is complex and there are many possible approaches but having just learned that my fusion has failed I can't help but want you to really force a discussion as to why you would accept donor bone when it is known to have such a lower success rate. And BTW - I did not have donor bone - I had my own bone (considered the gold standard) so there you go. The very best of luck to you - Suzy-Q

Hey Suzy and Carol -- thanks so much for answering.

My doc did not mention that he had a cutoff weight in particular -- he just mentioned my "weight" and my "smoking". Today is day 2 without cigarettes and it should be easier than day 1. The real test will be going to work tomorrow and not smoking. I really wanted to quit smoking months ago, but it was tough to handle the smoking and weight loss at the same time, so I picked one to start.

Suzy -- I am sorry to hear that your fusion failed. I will definitely ask the surgeon why he is suggesting donor bone when I see him again. I must admit that when I heard about the 360 there was a part of me that was relieved about the cadaver bone instead of harvesting it from me. My hips already hurt! I did have a successful fusion in my neck about 7 years ago with cadaver bone, so it didn't disturb me so much when he said it. Still, you're right and I should pursue this issue next time I see him, which is in 2 weeks. My best friend just found out that her cervical fusion did not fuse (4 years later) and she is having a redo of her surgery probably around the same time as me. Was the pain from the harvesting of your own bone the worst part of your recovery? That's what I keep hearing from people.

Carol -- how are you feeling now that it's almost 4 months post-surgery? It sounds like you've been through so much with all these surgeries and I really hope that this is successful for you. I try so hard to keep a positive attitude (like you) about things, but it gets really really difficult as I become more and more unable to do stuff. I keep telling myself that I will be closer to "normal" again after the operation and rehab but I remember how long it took me to feel human again after my cervical fusion (about a year) so I know I am probably in for a long haul. Still, anything has to be better than living in constant pain. What are your scars like, Carol, and are they healing?

Thanks again for the information and I will update after seeing the thoracic surgeon next week. I agree that they wouldn't send me there if they didn't think I was a candidate so it was helpful to hear what you had to say. I tend to get myself very worked up before doctors appointments so this has helped me calm down. I was so concerned that my surgeon would not believe my pain that I went to my appt without wearing my TENS unit or Lidoderm patches or anything and was in so much pain that I burst into tears when he walked in the room. I know it's not normal to think noone will believe that you are hurting (especially a surgeon), but there's a small part of me that believes that I can change the situation by thinking positively. If ONE more person tells me to try acupuncture or pilates I think I will clock them! By the way, I have tried both!

God-willing, we should all be so healthy soon we don't need these boards at all. Thanks for listening to me ramble on and for your supportive comments.

Best,
Schragie

Hello Schragie-
You sound like you have your head on straight - even if the spine holding it isn't very straight (he he). Seems you'll likely know to ask all the right questions. But to clarify - I did not have any bone harvested from my hip (iliec crest) for my (failed) fusion. I had spondy and severe stenosis with advanced degeneration of the facets. They removed a good deal of the back of my vertebra (L4-5) as part of the decompression (lami and forami). So, they used all that bone for the fusion. I was soooooooooo thrilled coming out of the anesthesia when they told me 'no bone harvest'. I thought I'd won the lottery! I was very worried about the pain from a harvest and, yes, I think some people have terrible pain for a very long time from the harvest site. In fact, I was so worried that I told my docs I gave them permission to harvest from several sites so they wouldn't have to go very deep at any one site. My doc was adament that he would not use donor bone because an autograft was so much better.
I have gotten some scan results just this past week that verify a failed fusion and a few other problems. However, I won't see my doc to discuss this and the solution until mid-March so I haven't asked all the questions that are burning a whole in my mind: did the use of this degenerative bone contribute to my problem? And so on.
Of course, many people have to use donor bone if their surgery requires more than can be harvested. And then there is BMP. So, a complex situation but now you have my story. The very best to you and thanks for chatting. Suzy-Q

Hi Schragie,
My scars, the first one was a biggie for me to adjust to. Never had any surgery before that, I was so glad it was in my back, harder to see,lol. My doc was able to cut the same scar in the back so I only have one back there, glad about that. The one in the front is taking some time to get used to, it really makes me feel line I might be less attractive to my hubby, I know thats not true for him, but it will take time to get used to. They are healing very well, I never had any pain with these last two, maybe cuz of all the pain meds,lol, and major pain in other places that took attention away from the scars. Since you had a fusion before you know the ropes a lil, I don't know the difference there might be with cervical compared with lumbar, but it can't be very different, pain wise at least. I'm sure you will do fine, please keep us updated. Good Luck.

Carol

Hey, Ladies:

I'm sorry that you didn't win the fusion lottery, Suzy. It actually didn't occur to me how much bone they would need and I would be interested to hear what your doc says to your question about using degenerative bone and whether it impacts fusion rates. If they do a lami on me in the end maybe they can reuse my bone too, although I would have the same concerns as you. In any event, I'm sorry you have to wait to see the doc I hope you have some relief soon.

As for the scars, Carol, thanks for telling me about yours. My hubby, like yours, won't care but it's going to be bothersome for me. My belly isn't the most...er...attractive thing about me but maybe it won't be soooo bad. It's not like I've worn a bikini in years anyway and am not into low-rise jeans or belly shirts. It's so much easier to focus on the scars than to picture myself being turned on a BBQ spit as they slice me open from different angles. Well, ya know what I mean! Ew! When I had my neck surgery, I had done some research but not nearly as much as I have done on the back. I was much less informed for that ordeal and by the time I needed to have it, it was scheduled really quickly so I didn't have time to think about the gory details. Plus, I had met my husband right before it and falling for him was a great distraction at the time.

I hope you all have a good week and thanks for writing.

Schragie

Hi,
I hear ya about the bikini days being long gone,lol. I always felt stupid for feeling so funny about the scars, thought maybe to much vanity may be sneaking in, it is nice to hear that someone else feels the same way, maybe i'm not so nutty. having the hots for someone can be a great way to not pay so close attention to a surgery, beats the heck out of watching tv,lol. My hubby and I will be married 20 yrs. this summer, so he knows all there is to know a guess a few scars aren't that much. We have our oldest son going to Iraq in about a week and a half, that will make those surgeries seem like nothing. I would appreciate anyone reading htis to please keep our son and all those in the war in their prayers, they are fighting for our rights to do things like have these boards to go to, and express our views publicly. Have a good week also.

Carol

Well, I finally decided on which surgery to have after seeing three surgeons, all with different opinions. I am going for a TLIF on L5-S1 with a cage and my own bone. I even scheduled a date (April 18). The surgeon I picked said an ALIF wasn't necessary because he felt he could handle my problem with the TLIF approach. I'm actually relieved that I don't have to have the additional incision, but the idea of a cage in my back is kind of freaking me out. It seems like an awful lot of hardware. I've read some of the threads here about cages and am trying not to overthink it because I have been trying to decide for months what to do. Plus now that I have decided to harvest my own bone (I asked the surgeon if we could use his, but he said no!) I feel a little better that my chances of fusion could be better. Suzy -- I'm curious: did you get to see your doc yet and ask about whether using your lami bone contributed to your failed fusion?
Schragie