But first of all, I want to thank all of you who take the time to reply to post. Just reading the replies to the posts in this “Back Problems” section provides invaluable information to those of us that are having problems, getting ready for or getting through surgery, -particularly the replies of teteri66. Great info!
My surgery is scheduled for 4/26. I had my last pre-surgery appointment with my orthopedic surgeon yesterday. He is fellowship trained spine specialist. Originally the procedure for my 3 level (L2-5) surgery was TLIF. After doing some research I got the impression that ALIF could provide better fusion results. When I questioned him, he confirmed that based upon his experience that ALIF was better, -so we switched to ALIF.
I really think you need to leave that up to your surgeon. You want to take great care in selecting the surgeon and then I think you need to go with his/her recommendation. If a surgeon says he will do it one way and you absolutely do not want it that way, then I think you switch to a different surgeon.
In your case, in my layman's view, if I were doing it I would prefer ALIF to
TLIF, mainly due to its track record. TLIF is still relatively new, particularly with multi-level procedures...and there just isn't the data to indicate how it will be in five or ten years. Also, on a personal basis, I know too many people that ended up with unpleasant side effects from TLIF, so I am not a big fan...but, that's just me. All those who had successful TLIFs think it is the best way, I would imagine.
There are advantages and disadvantages to every approach. It depends on the patient's physical structure, and the doctor's ease with a procedure, among other things. My surgeries have all been through the back so all I can share with you is what I've read and what I've heard from others....
If you are pleased with your surgeon, then I wouldn't give it any more thought. I assume he will use rods and pedicle screws. How about cages?
The Following User Says Thank You to teteri66 For This Useful Post: CTWsr (04-01-2012)
Location: San Francisco, California, United States
Re: ALIF of TLIF?
teteri66 is right -- it really depends. I understand that ALIF has lower rates of failed fusion, but those rates could be skewed. Some folks cannot undergo an ALIF, such as those who have had previous abdominal surgeries, are overweight, etc., and those conditions could predispose them to non-fusion. My surgery was originally scheduled as an ALIF and PLIF (360) which is considered the very most stable, but the doctor was able to accomplish everything through the anterior approach and my bones are really strong, so the instrumentation was secure.
If you have any underlying abdominal issues, (mild IBS in my case), you might want to pay a visit to your treating doctor prior to the ALIF. My stomach was unhappy for about two weeks, more than after other surgeries, so not just due to the anasthesia. Honestly, apart from the stomach issues, my recovery has been easier than any of my three hip arthroscopies. I haven't had a TLIF to compare that recovery, but you are pretty much constantly lying on your back during recovery and lying on the incisions seems like it would be uncomfortable.
Now that you are set for surgery, put that nervous energy into getting the house ready and doing any core stabilizing exercises you can. Good luck!
The Following User Says Thank You to SweetPeainSF For This Useful Post: CTWsr (04-02-2012)
Teteri66, yes the ALIF if is with instrumentation that includes cages, rods and pedicle screws.
SweatPeainSF, there’s no reason to not do ALIF.
And thanks for your advice re: pre-surgery conditioning. In my first post I pointed out that after my visit with my orthopedic surgeon where my wife and I decided to use him, I requested and he provided a physical therapist with the specific goal of increasing my core strength. I also have been able to use my elliptical for cardio. I’ve been at it for about 5 months now. But, I have to admit that over the last month my situation has degraded to the point where the sciatic pain prevented me from strict adherence to my routine. Luckily over this past weekend, I got through both.
One last question: My insurance company during the precertification process requested that I get additional x-rays prior to approving the surgery. They took five x-rays, three with me standing sideways, -once in pretty much normal standing position, another bending forward and another arching backward. The remaining two x-rays were taken of me lying on my side. The radiology report is a follows:
LUMBOSACRAL SPINE VIEWS INCLUDING FLEXION-EXTENSION VIEWS
HISTORY: Spondylolisthesis. Pain
There is minimal anterior subluxation of L4 with respect to L5 and L3 with respect to L4 in the neutral position. This measures approximately 5 mm at the L4-L5 level and 4 mm at the L3-L4 level.
With extension, the subluxation increases to 6mm at L4-L5 and 5 or 6 mm at L3-L4.
With flexion, the L4 vertebral body is subluxed approximately 8 to 9 mm with respect to L5 and L3 is subluxed approximately 7 to 8 mm with respect to L4. There is on pars defect.
Facet joint osteoarthritis is present. There is no destructive lesion. Sacrum and SI joints are normal.
IMPRESSION: Degenerative spondylolisthesis at L3-L4 and L4-L5. This appears to be unstable with increase in the degree of spondylolisthesis with both flexion and extension. No pars defect.
Location: San Francisco, California, United States
Re: ALIF of TLIF?
It appears that the X-rays were taken to determine whether you have instability and the degree of the instability. The ones bending forward and backward are called flexion and extension X-rays. MRIs are usually taken just lying down, so the X-rays are helpful is determining whether your spondylolisthesis increases when you move around.
This is translating to laymen's terms, so please do not read this as technical terminology: When you are standing in a neutral position, your vertabrae are out of alignment (forward/backward) by 4-5 mm. When you bend backward (arch your back), the amount of misalignment increases to 6 mm. When you bend forward, the misalignment increases even more to between 7 and 9 mm.
Subluxation is similar to a dislocation, in that the joint exceeds the expected range of motion. Unlike a true dislocation, the bone is not completely out of the joint.
The Following User Says Thank You to SweetPeainSF For This Useful Post: CTWsr (04-20-2012)
The term for this type of misalignment is spondylolisthesis. The method that is used to assess "how bad" it is is a grading system that divides the degree of slippage into 4 stages -- 0-25% is Grade I, 25-50% is Grade II, 50-75% is Grade III and 75-100% is Grade IV (or the "worst").
So people understand what we're talking about, here is a really basic desciption of what a spondylolisthesis is.
When someone looks at a x-ray of the spine from the side, even though the spine has a curve to it, the edge of the spine lines up straight (the vertebrae are stacked one on top of the adjacent one so visually the line it forms, even though it is curving, appears to be even. (no little zig-zags).
With a spondylolisthesis, there is a displacement, or "slippage" of one vertebra over the top of the adjacent vertebra. It can be a small amount which usually doesn't cause any problems or it can be a large amount which usually involves nerve compression and can be very painful. It can create instability in the affected spinal segment. A spondylolisthesis usually occurs at L5-S1 or one level up at L4-L5...which makes sense since these are the two spinal segments that take the brunt of all movement of the body.
There are five types of spondylolisthesis -- you can be born with this condition or it can come about as the spine ages; it can come about as a result of sudden trauma....
A spondylolisthesis is not unusual among adolescent athletes who are involved in contact sports, and especially, sports that involve using the back in an extended position, such as gymnastics, diving and dancing.
Degenerative spondylolisthesis occurs more in "middle age" and gradually develops as the person ages.
It is not unusual for a surgery patient to develop a spondylolisthesis at the level above a lumbar fusion.
I believe with the numbers given in your MRI report that yours is a Grade I spondy. It would not be considered a reason to have surgery unless it is proven to be unstable. (Many people discover a spondylolisthesis when they have a MRI or X-ray for another purpose and it is found at the same time. In many cases it causes no problems at all and is not a pain generator.)
Hope this little layman's description helps you understand a spondylolisthesis a little bit better.