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Old 02-05-2013, 08:56 PM   #1
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xlif for L4-L5 plif for L5-S1

I'm scheduled for the both procedures mentioned in the title and I'm looking for some realistic recovery time and outcome.
I'm 43 years old and have been in constant pain for 6months, walking for more then 20mins is unbearable, I can barely lift my feet and tend to suffle!
This all just happened one day, I got out of bed and it felt like my spine was colapsing onto itself. MRI shows degenerative disk disease, buldging L4-L5 with anular tear & spondylosis.
Although I'm in a lot of pain I'm afraid that surgery will make things worse, especially after reading what some have been through!
I also have a fear of hospitals, so I'd like to hear how long others were hospitalized.
Thanks in advance

 
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Old 02-05-2013, 09:13 PM   #2
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Re: xlif for L4-L5 plif for L5-S1

Welcome to the board.

I'm sorry you are in need of surgery. Did you get several opinions before signing up for this project?

Did the surgeon explain why he is in effect performing two surgeries?

 
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Old 02-06-2013, 07:07 AM   #3
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Re: xlif for L4-L5 plif for L5-S1

I've had two opinions........Dr has said he believes surgery will give quaility back to my life.
I've been on leave from work since July as I can't stand for more then 20mins. Prior to July I was working 40+ hrs standing,bending twisting w/ no problem. I worked out 5 days a week doing weight trainig & pilates and almost over night that ended. I seriously got out of bed one morning & it felt like my spine was crashing down on itself, like I was being squeezed around my middle & there were 20lb weights on my legs

 
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Old 02-06-2013, 07:28 AM   #4
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Re: xlif for L4-L5 plif for L5-S1

Welcome! I am a recent newcomer to this site also. Sorry you are in such pain and facing surgery. There will probably be more senior members that will respond to you.

I have had four surgeries to my lower spine. The first was a laminectomy to L3 - L5 back in 2002 and that recovery was a couple of months and then I was back to work. The nerve pain took about a year and a half to subside, but then returned periodically until returning full force in 2010. Then had a discectomy at L4 but had complications when I awoke in recovery, had a blood clot in the spinal canal and a ruptured disc which resulted in another surgery 2 days later. The disc ruptured again and then I had a multi level 360 degree fusion of L3 through S1. That surgery was about 10 hours and has been a very long recovery. The long recovery could be due to the prior 2 surgeries being 6 or 7 months earlier and maybe the body had not fully recovered.

My only recommendations would be to get a second opinion, I did from a neuro. Also, get in the best physical shape you can and go into surgery with a positive attitude. Trust your surgeon to do the best job and face your therapy with a positive attitude. Therapy will hurt, but you have to do it to get better.

There is a wealth of great information on this site, so spend time to research and get educated on what you will face. You are young and should get through this ok. You may never be 100 percent of what you were and will have to protect your spine in the future. I hope this helps and if you have any questions I will try to answer for you.
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27 surgeries, 4 spine, 4 foot, 3 knee, 3 abdominal, 2 hand, & various others. Fibro, accelerated degenerative disease, Hashi Thyroiditis, & arthritis.

 
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Old 02-06-2013, 10:14 AM   #5
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Re: xlif for L4-L5 plif for L5-S1

I understand the need for surgery. What is being suggested is rather unusual. The norm would be to have either a PLIF or TLIF, not to do one segment one way and the second segment another way. I was just curious why the surgeon is suggesting doing it this way -- I just haven't heard of it before and wondered what the reason for it was....

Last edited by teteri66; 02-07-2013 at 06:18 AM.

 
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Old 02-06-2013, 12:06 PM   #6
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Re: xlif for L4-L5 plif for L5-S1

[QUOTE=teteri66;5128937]I understand the need for surgery. What is being suggested is rather unusual. The norm would be to have either a PLIF or TLIF, not to do one segment one way and the second segment from a completely different entry point. I was curious why the surgeon is suggesting doing it this way.[/QUOTE]

I was originally scheduled for just the xlif and when I called the hospital to pre-register I was told I was scheduled to have the xlif on L4-L5 % plif on L5-S1 of course my Drs out of town till 2/11......the day before my surgery! Not even his PA can explain why I'm scheduled for both.......sooooooo I have an appt at 10:30am the day before my surgery to discuss WHY both!
I'm just feeling so overwhelmed!
Because of a bad Dr who wasted 2mons telling me I had MS or Lupus & ins taking so long to approve tests I am now unemployeed!
I am truly hoping surgery will give me quality of life back!
I can't bear to live like this anymore!!!

 
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Old 02-06-2013, 04:17 PM   #7
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Re: xlif for L4-L5 plif for L5-S1

Did you see more than one spine surgeon?

Are you aware of anything "unusual" with your lower lumbar area? I just can't figure out why they would want to do two surgeries. It will make recovery more difficult and obviously I am not a doctor, but I just can't figure out why they would do this. While it is common to do a ALIF and PLIF, it is done for specific reasons that a PLIF and TLIF would not accomplish. Sorry to keep mentioning this, but it is just so odd and I am really curious to know their reasoning.

Last edited by teteri66; 02-07-2013 at 06:19 AM.

 
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Old 02-06-2013, 06:43 PM   #8
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Re: xlif for L4-L5 plif for L5-S1

Annular tear at L4-L5 diagnosis is lumbar spondylosis with myelopathy......whatever that means
The original neurosurgeon I saw never did anything other then look at my mri and tell me because I have Hashimoto's disease that hethaught I had either MS or Lupus and sent me to a Nueorologist who actually did a full nuero eval & nerve conductive test.....he looked at what the Neurosurgeon said, tossed his notes & said surgeon was "full of it" and referred me to this neurosurgeon......& here I am :/

Last edited by Administrator; 02-07-2013 at 02:25 AM.

 
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Old 02-06-2013, 09:07 PM   #9
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Re: xlif for L4-L5 plif for L5-S1

I am so very sorry for all you are going through. I don't mean to sound like a idiot, but what exactly is cliff and plif? I hurt my back 18yrs ago when I was only 26. I was a coach, physical Ed teacher and assistant athletic director at a small private school - which was actually the school I went to Hig School at. It happened when I was outside on lunch duty with the Middle schoolers. A completely out of the blue thing...the kids asked me to swing on the swings with them, unknown to them or me, the swing I got on was actually broken. So I swung for a few minutes and then one side of the seat fell out from under me and I went flying to the ground, feet up and landed on the hard ground smack on my low back. It took over a year for a dr to be able to tell me what was the matter with me - although I was in agony constantly and literally told the dr's it felt like something was sticking out in my low back. I had also been doing pt 3x's a week for over 6 months, wore a corset for 3 months had X-rays, mri, bone scan all to no avail . After 4 different dr's, I found one that said everything needed to diagnose me was in all the tests I had already had done. Anyway, I had a discectomy , fusion done at L5/S1 without hardware. Didn't start pt for about 4-5 months. 3 months of pt and I felt I couldn't do any more, the pain was too much so I had a ct scan done. The result- there wasn't a solid fusion. Soon a couple months later, back into surgery I had to go.this time, in order to make sure there wasn't going to be an issue with me actually achieving a successful fusion, the dr decided the best thing was to basically do 2 surgeries - an anterior/ posterior fusion of L5/S1 with a laminectomy, donor bone and more bone from my hip. That too was a VERY long surgery at 10hrs.
As far as recovery, things have probably changed in 18 yrs , especially as far as technic and how much they have to open you up...the more they open you, the longer the recovery will be. Back then, they had to do a 6" incision on my low back as well as a 6" incision on my abdomen which starts about 2" to the left of my belly button and goes down. My 1st surgery only had the incision in my back. Your body will need time to heal. It sounds like you had always kept yourself in very good shape prior to getting hurt, which is a really good thing. It's really important that you do not do things during the healing phase that you shouldn't . I found things I never thought of we're issues...reaching for a cereal bowl on the top shelf, trying to lift a gallon of milk, even a half gallon of OJ. Of course it's gonna seem like you suddenly drop things more than normal, only because you can't really bend to pick them up! Walking my big dogs was an issue. This may sound silly, but using the restroom...if the toilet is low is actually difficult as well. after my 1st surgery, i didnt do anything about that, but after the 2nd, I got one of those things that you put on the seat that makes it higher - boy, what a difference! You will initially be very tired, it can take a long while to get your energy back. Going through the anesthesia alone can be a lot for your body, especially if your under for a long time. I would definitely have that discussion about why he is choosing to do 2 different procedures while in there. My dr changed it to anterior/posterior , initially my 2nd surgery was supposed to only be anterior (through my stomach). A positive attitude goes a long way in your healing. Do you have a support system around that will be able to help you out at all? Take your time, don't rush things and don't be afraid to ask for help when needed.
Good luck with everything.

 
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Old 02-07-2013, 05:57 AM   #10
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Re: xlif for L4-L5 plif for L5-S1

If you have the opportunity, you might also want to get an evaluation by an orthopedic spine surgeon. Their fellowship training is almost identical to that of the neurosurgeon's but they sometimes have a slightly different approach.

Do you have the radiology report from your MRI?

Have you gone through all the conservative treatments without success? Fusion is a big surgery that for all intents and purposes is life-changing. It should not be undertaken unless there are no other options.

An annular tear of the disc is a rip in the outer layer (annulus fibrosis) of the disc. The disc is composed of two parts: a soft, gel-like inner that is called the nucleus, and the outer part of the disc is often compared to the belt on a radial tire. It is a tough layer made of concentric layers of collagen that circle the nucleus. There are no nerve fibers in the nucleus, but some of the outer layers contain them, and thus can be very painful when torn. When the tear goes all the way from the nucleus to the outer edge, the matter of the nucleus can leak out. If this material comes in contact with a spinal nerve, it can also cause pain from a chemical reaction that occurs.

Annular tears can and do heal without surgical intervention, but many times there are other issues that require surgery, so it is taken care of at the same time.

You also said you were given a diagnosis of [B]spondylosis with myelopathy.[/B]. Was this on the written report? Spondylosis is degenerative disease of the spine (arthritis). It often comes as the spine ages. The term "myelopathy" is usually used in relation to the cervical spine. It is a degeneration of the spinal cord. It is not usually used in the lumbar region since the spinal cord runs from the top of the spine down to about the L1 level. It ends at the conus medullaris and from there on down to the sacrum, there is a thick bundle of nerves that early scientists thought resembled a horse's tail, thus its name, cauda equina. These nerves continue on down to the sacrum where it branches into two and forms the large sciatic nerves that go into each leg.

Myelopathy, at least in its most common usage, refers to the spinal cord (the area above L1-2) compression. In the area above the conus medullaris, it can result in paralysis. Below this level, I think your doctor is probably referring to stenosis. This may be the recommendation for the fusion, more than just the annular tear.

The spondylosis refers to spinal degeneration...so the doctor must feel that fusing the spine with halt the degeneration at these two segments.

If the post doesn't make sense, it is because our cable went out last night while I was writing this...so there has been a big lapse between when I started this and finished it...sorry.

 
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Old 02-07-2013, 06:16 AM   #11
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Re: xlif for L4-L5 plif for L5-S1

KG 5634 ~

You had ALIF/PLIF surgery. These are just shorthand for the names of the type of fusion surgeries and describe the entry into the body.

PLIF stand for posterior lumbar interbody fusion...etc.

ALIF/PLIF is also sometimes called a "360" fusion because it approaches the spine from both the front and the back side...and, as you mention, it is the most reliable way to insure that a complete fusion is accomplished.

The L4-5 segment is often done this way because it is the level of the spine that takes the most of the body's flexion and extension.

TLiFis a Transforaminal Lumbar Interbody Fusion also has the incision in the back but it removes the facet joints on one side rather than taking off the lamina as in PLIF. This way the surgeon can fuse from the anterior and posterior sides with one incision.

 
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Old 02-07-2013, 06:30 AM   #12
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Re: xlif for L4-L5 plif for L5-S1

I think I've figured out why the surgeon is doing both TLIF and PLIF....I still don't know why he isn't just doing a TLIF for both segments, but then it doesn't matter what I think.

The L4-L5 segment carries the majority of the spine's movement...and the TLiF puts bone graft on the anterior and posterior sides...so technically it is a stronger start to fusion than the posterior approach alone.

 
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Old 02-07-2013, 05:11 PM   #13
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Unhappy Re: xlif for L4-L5 plif for L5-S1

[QUOTE=teteri66;5129441]I think I've figured out why the surgeon is doing both TLIF and PLIF....I still don't know why he isn't just doing a TLIF for both segments, but then it doesn't matter what I think.

The L4-L5 segment carries the majority of the spine's movement...and the TLiF puts bone graft on the anterior and posterior sides...so technically it is a stronger start to fusion than the posterior approach alone.[/QUOTE]

He's not doing a TLIF........he's doing an XLIF extreme lateral interbody fusion on L4-L5
and a PLIF posterior lumbar interbody fusion on L5-S1
I just don't understand why he's not just using the PLIF to access all areas :/

 
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Old 02-07-2013, 08:36 PM   #14
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Re: xlif for L4-L5 plif for L5-S1

OK, that's what I was thinking yesterday...and then for some reason, this morning I was thinking TLIF. Well, I'm back to my original dismay then.

It makes no sense, and personally, I wouldn't agree to it. I know too many people that are very unhappy with the results from XLIF. They have to bisect the psoas muscle to perform XLIF...and the surgeon usually non-chalantly describes it as being painful for a week or two...but the people I know were laid up for a long time with horrendous hip and groin pain.

I would certainly ask why he's doing it that way before signing any papers.

When are you supposed to have this surgery?

 
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Old 02-08-2013, 02:57 PM   #15
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Re: xlif for L4-L5 plif for L5-S1

[QUOTE=teteri66;5129868]OK, that's what I was thinking yesterday...and then for some reason, this morning I was thinking TLIF. Well, I'm back to my original dismay then.

It makes no sense, and personally, I wouldn't agree to it. I know too many people that are very unhappy with the results from XLIF. They have to bisect the psoas muscle to perform XLIF...and the surgeon usually non-chalantly describes it as being painful for a week or two...but the people I know were laid up for a long time with horrendous hip and groin pain.

I would certainly ask why he's doing it that way before signing any papers.

When are you supposed to have this surgery?[/QUOTE]

Thats what I'm thinking!!!
I'm sheduled for surgery on Tues. 2/12
HOWEVER I'm meeting with my Dr on Mon......I want to know WHY two seperate procedures when it seems ALL dics could be accessed thru PLIF

 
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