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Posted in: Spondylolisthesis, and Surgery.

Mini ALIF or Mini TLIF for Low Grade Spondylolithesis with Pars Fracture at L5S1

Started by NicoleCogs on 05/02/2012 12:11pm

Hi! I have low grade spondylolithesis with a pars fracture at L5S1 and a slight tear of the disk. An Orthopedic surgeon recommended a mini ALIF (anterior entry) and a Neurosurgeon recommended a mini TLIF (posterior entry). From what I can see from research articles, the outcomes for these 2 procedures are very similar. I have also seen one that suggested that ALIF is better for L5S1. Any suggestions? I am currently scheduled for surgery in 5 weeks for the ALIF procedure and I need to know if there is a reason to consider the TLIF instead. Thanks!

Nicole

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Hi Nicole ,

I myself am having a plif on May 30 for grade 1 spondy and my l5-s1 disk is not there anymore ,so there are going in through my lower back ,im pretty sure a anterior means they go in through your front which i said i didnt want ,not sure what a mini plif is does that mean your not having rods and screws placed ?Ive been researching this for 8 mths and its more common then we think .I am still scared to death though of course .....i have 3 kids and im a single mom so im hopeing for the best .Hope i helped ...if u have any questions dont hesitate .R

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Hi Nicole,

If you have neurologic deficits, then, I would highly suggest that you accept the TLIF recommendation made by the neurosurgeon.

Here is a web link which I suggest you read: www.medifocus.com/abstracts.php?=RT015&ID=18316711 This is a study that was conducted in 2008 which 'concluded that, in light of the high complication rate of PLIF surgery, TLIF should be considered as the surgery of choice for fusion requiring a posterior approach to the vertebrae' (MediFocus Guide Spondylolisthesis, Last Update 14 Sep, 2010, p.46).

I had a successful TLIF with hardware performed at L5/S1 level in July last year. Given I had neurologic issues which involved daily intense sharp stabbing and burning neuropathic pain down my right leg (i.e. sciatica), a neurosurgeon was therefore the only choice.

I must say that, I am feeling absolutely wonderful and my pain levels are 95% better than they were before surgery! Without surgery intervention, the reality is that I would have continued having long term crippling pain not to mention more serious neurologic deficits (I.e. loss of muscle function; incontinence; decreased leg sensations; leg weakness; abnormal reflexes; paralysis; and further deterioration of my lumber spine area)

As with any surgery, you need to weigh up the risks verses the benefits [in my case, the benefits clearly outweighed the risks]. When considering spinal surgery, you also need to make sure that you select a suitably qualified and experienced orthopedic or neurosurgeon who has demonstrated expertise in successfully performing spinal surgery procedures as such careful selection will heavily influence the surgery outcome. Yes, there can be potential issues that may arise from surgery implications, though, having an experienced and well recognized surgeon can mitigate such risks.

Given your situation, I believe that you should undertake more research as well as talk with spinal professionals and spinal surgery patients before making a decision which you appear to be unsure about.

Please don't hesitate to ask any further questions. Keep in touch with your progress.

Take care & kind regards,

Robert.

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Hi Rhonda,

Not too long until your planned surgery now, how are you feeling? Do you have some aids available for when you return from hospital?

Out of interest, do you have any neurological symptoms?

I really hope that your kid's are old enough to give you a bit of assistance once you are discharged from hospital? I have girls who are 3 and 5 years of age, though, my wife tells me that having me home after my surgery was like having another kid to look after..ha, ha!!

Cheers,

Robert

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Hey Robert ;

I have muscle weakness ,and i find myself a bit confused sometimes ..more then usual ,not sure if that has anything to do with my back but maybe .I have major stiffness ,my butt and legs ache daily .....Im afraid to walk certain ways ,because my nerves get pinched if i do then the sciatica gets bad .I find im worse at mid afternoon ...night time .I cant wait to get this surgery done ..so i can start healing and know that i have the pain because im healing ...such a nuisance this is .Surgery is booked for may 30th and havent even heard from my surgeons secretary about pre-op ,blood taken ,brace nothing getting a bit frustrated .Talk soon .R

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Robert;

I have a walker a shower chair a bed bar,a grabber,hmmmmmm think thats it can u suggest anything else ,all your help is appreciated thanks ...im feeling very nervous and terrified actually ..ive stopped all my meds unless i really need a pain killer ....ive heard its sometimes difficult to get your pain manageable after surg if youve been on alot so i want mine manageable then lol .I also have a rasied toilet seat too ...I am a psw so i somewhat know what i would need .Its nice know ing i dont have to pay for the surgery or anything afterwards ..living in canada is great sometimes ,besides are weather lol

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Hi Rhonda,

Good luck with your surgery!

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Thank you for all of the responses. I appologize for not responding, there was a problem with my account. I had another MRI done and it was determined that the tingling and numbness is my legs were just due to swelling (typically at the end of the day). I went forward with the alif 3 weeks ago today. The first 2 weeks were tough, but I am making great improvements. I only needed a walker for about 2 weeks and now In an walk around the block on my own. I still have pain in my low back, but it is not the same pain as before. I did a lot of research and saw 3 surgeons for opinions. In my research, I found that a tlif and alif had similar, not statistically significant results, and some showed a slight benefit for alif at the L5S1 level. Also, I am young (26) and I found that the ALIF reduced the chances of spinal degeneration later in life with a faster recovery. I also really trusted the doctor. He is bery experienced and has very high sucess rates. I saw my doctor last week and the fusion is progressing nicely and he said that in 3 weeks I should be back to normal function- half way! Because they went in through the front they only had to cut one tendon and no major muscles. I had no complications and I lost less than a thimble full of blood. They removed part of the disk, put donor bone around the vertebrae and 2 titanium screws. Right now I'm just a bit nervous about finding the balance between trying to walk and move more each day, without overdoing it. It's a fine line. How fast has the progress/ healing moved for you since your surgery? My doc said I will be 100% back to normal in 3-4 months. Also, what did your doc say is a reasonable time to travel? There were multiple surgeons on my case and their opinions seemed to differ. Hope yours went well!

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Hey Nicole ....i am 4 and a half wks post op and i feel fabulous ...working out everyday ,no pain ,a bit of tightness in back but going away ,i have no pre op pain ...totally off all meds ...im finind that stretching and walking helps ev eryday ..i dont go back to see my surgeon until august 30th ....ice has been a great help for me i apply twice daily still .If u have anymore questions ,i be happy to chat lol.All and all im so glad i had my surgery .R

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R- Glad to hear that your doing so well! Thats encouraging and discouraging at the same time. I am just about 4 1/2 weeks post op and I am still off work and can't work out or walk more than about 15 minutes. I had a huge jump in progress around 2 1/2 weeks, so I'm waiting for my second wave! My doctor said no exercise for 4 months (until the bones have completely fused together). Did you just have the spondy or a broken/ fractured vertabra as well? Maybe that could be the difference between you and I? I'm trying really hard to be positive and not get too discouraged....

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Hi, I havnt read through all the comments but based on your post, I can't help but wonder why any surgeon would just "jump" right into any surgery without trying everything conventional first. Unless its like cauda equina and an emergent situation demands it. Have u tried chiropractic care? Acupuncture, physical therapy etc? You havnt mentioned your symptoms, so don't know if its pain, or nuerological deficits you are suffering from. I just know from my experience...no western dr is touching me without first going over and trying all conservative methods first!! I wish u the best!!

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Yup! Tried it all. Chricopractic worked for a few months but then made it worse, I had 2 facet injections, 1 epidural, anti-inflammatories, massage felt good for a day or so, and accupuncture didn't do anything at all. Ultimately, I had a broken bone that was not going to heal on its on. I am only 26 and without a surgery I was told that pregnancy would be painful and could be dangerous to my spinal column and could make the spondy worse (and another doctor told me I could only gain 20 pounds but I would be fine- I am already underweight so, a 20 pound weight gain for pregnancy would be unsafe), and I wouldn't be able to do international travel for work and I would have to be very careful with exercise and since I have fibromyalgia and I need to exercise daily, that would mean that I couldn't exercise for pain relief and I would be on medications the rest of my life. My spondy and fracture was unstable. The people that can put off surgery or don't need it have a stable spondy.

Believe me, there was no "jumping" to having surgery. It was a calculated decision and it was just a matter of which one. There was nothing easy about having surgery, the recovery was tough but better than a life time of pain. 7 weeks out, I'm glad I did.

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I didn't mean to sound preachy, or to undermine your decision!! I wish u the utmost best, I had just never in all my research, came across any dr who would perform surgery on a low grade spondylolisthesis case. I'm glad it helped you!! *hugs*

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I too had a low grade spondy and the did a level 1 fusion on me as well ....plus i have degenerative disk disease and my l5 was completely gone ,which was casuing most my pain ...now im perfect ...right back to normal and lost 20 pds since my surgery woot woot !!!So pleased with my results .Dont give up Nicole take one day at a time ...good luck hun .....R

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