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I TOOK THE ADVICE OF THIS FORUM AND...

AnonymousUserAAnonymousUser Posts: 49,731
edited 06/11/2012 - 8:24 AM in Back Surgery and Neck Surgery
I went to see Dr. Ullrich who is one of the doctors who runs this site. Had an hour and a half appointment today. I had posted last week questioning if it was a good idea for me to have back fusion done when I only have minimal sciatica, but severe pain at times. Most of you recommended a third opinion. The first two docs had recommended a TLIF. Dr. Ullrich seemed to be more conservative on back surgery so I opted to see him. His recommendation, 360 degree fusion with TLIF and ALIF!!! :jawdrop: His explanation that this surgery is more painful from the incisions, but gives you fusion almost immediately, made sense. The fusion rates are much higher and recovery according to him much quicker due to the fact that you are not waiting for bone to grow around the hardware as much because they put in an metal cage with bone inside. So I thought I was confused before... 8} He told me that I am already suffering with this pain and thought I would be back to work much sooner because the fusion is faster. He also said I would not need to wear a brace. He described the regular fusion as like stacking two coke cans together (the inside of the spine is basically hollow) and putting screws on the side. Imagine twisting the cans.. that is why those type fusions don't work as well. With the inserted metal cage, it is basically putting your disc back immediately when he inserts it, then stabilizes it from the back with the rods and screws. Sorry this is so long, 8> but I really value everyone's opinion here and wonder what you all think and if anyone here has had a 360 fusion done?
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Comments

  • that I would not be a good one to ask because I am a firm believer that you should never have surgery unless there is no other option and the pain is severe. Good luck.
  • I was just wondering if it is true to fuse almost immediatly after that type of surgery because I hadn't heard that before. Would it be a "solid" fusion? It kind of does make since to me but now I'm angry that I didn't have that option. It took me nearly 6 months just to start fusing. I too want to hear other people's opinions.
  • what you have already done to try to fix the sciatica. I am with painintheback on this one and unless you are at your wits end and have tried everything else first ......

    You dont say why this Dr has recommended surgery at all if it is sciatica. Is there an underlying problem such as DD or stenosis that is causing it????? Did he tell you that he cannot GUARANTEE that fusion will occur? No Dr can.

    As fusions go, each Dr has their favourite method and will be able to justify it (or sell it to you). See another surgeon and he will give you just a good a reason to have ALIF only etc. At the same time it does sound plausable.

    Carr- dont be concerned that you didn't get offered this method. A lot of Drs dont do it as it is a lot more invasive and maybe your Dr thought the surgery you had was best one for you.

    Blessings Sara O:)
  • I have sciatica, but it only goes to my butt and hips and not into my legs - yet. My L5-S1 has no disc space left at all and is grinding bone on bone to L5. L4-5 has a disc bulge/herniation pushing over my spinal cord and also has almost no intervertebral disc left, the only part you can see is a thin sliver and that thin piece is herniated out. The spine is stenosed at the L5-S1 area also. He said the rest of my back, "is the spine of a 16 year old" I am 46. When he places that cage into the intervertebral spaces, it is wedged in there, he says he won't be able to pull it out - well without a lot of pressure anyways. So you immediately have the spine portions that are now rubbing together, causing pain and also pinching on the nerves elevated up 6 mm. I agree with the other poster and think each doctor recommends what they think is best for you. The "problem" that I am having is that every doc is recommending something a little different. Even though this is more surgical op site pain, the pain in my back he said will be stabilized and hence pretty much gone. :D Fusion rates are much higher and according to him they have 90% reduction in pain in patients. I do have severe pain, to where it is affecting my very active life. I love to hike and do things outside and I can't hardly get out of bed in the morning. God has blessed me by not having this go to my legs yet, but the back pain is really making me miserable. I know that surgery is serious - that is why I am posting here to see if anybody else has had this done and why I am really researching it. I am not taking it lightly by any means.

    Oh and by the way, he is the doctor for the Green Bay Packers - whoot! :))(
  • did they talk to you about ADR at all. From what it sounds like to me you may be a really good candidate for a disc replacement rather then a fusion (more confusion I know).

    Can anyone who has had ADR help here please?????

    Blessings Sara O:)
  • Hi hun,
    Glad you went to see another Dr.
    I guess I am also confused. I havn't seen anyone fuse faster because they had a 360. I have read it though. If your going to fuse you are, if your not your not. No matter what type of fusion you have.
    I also have a cage and well I did not fuse do to my arterial disease. But I did for my cervical.
    I mean I don't mean to add to your confusion either at all not meant for that. ;) ;)
    I'm just one to choose to let no one go through the front and the back. Unless the fusion is more levels.
    Just all my personal opinion. You choice from what you think will be best for yourself and what your comfortable with.
    I had no problem with just an incision in my back. As I had no staples or stiches which makes a HUGE difference. I had glue. Incision pain wise.

    I just have a hard time understanding why drs want to move everything around in the front in the ab area to get to the spine. HMMMM I guess no matter how much I read I will never understand it. I mean more muscles are cut etc. Recovery is recovery no matter how you look at it. I'v seen it to be harder on some people with those ab muscles being cut. HMMMMMMMM I'm very very lost :/ :/ :? :?

    I'm also thinking from sara's side. Did he discuss a ADR at all?? I know alot of insurance companies are up in the air about them.

    I WISH YOU THE BEST OF LUCK , and what ever you decide is fine with us!!!!! We are here to support you through everything!!!!
    >:D< >:D< >:D< >:D< >:D< >:D< >:D< >:D< >:D< >:D< O:) O:) O:) O:) O:) O:) O:) O:)


  • You discuss the L5-S1 and L4-L5. If he is going to fuse two levels, I am guessing that might be why he didn't discuss ADR. It hasn't yet been approved by the FDA at two levels. I also wanted to mention that I got 3 opinions and each Dr. had a different way to do the surgery for me as well. I know how confusing it can be. I just decided to go with the Dr. that I felt had the most skill and I felt most comfortable with.
  • The 360 is the gold standard here but not always necessary for everyone.

    My own sugeon was working towards it in stages but I have now fused and do not need that last ALIF however, having taken a very long way round (which was clearly done in an attempt to minimise trauma) I would go for the 360 now, first te round, had I been given the choice.

    In the end, my problems have really dragged on, and on, and on. I know it is a judgement call and none of us have that crystal ball.

    Good Luck.
  • I had my fusion done through the front and the back, with PLASTIC cages between my vertebrae (for future diagnostic testing reasons, plastic cages are better, and since they are only temporary stabilization, they don't need to be indestructible). The thing is, though, that the method of surgery won't determine how fast you fuse. If you ask most doctors, and do a lot of research, you'll see that it depends on each person's individual body. The method of surgery CAN determine how WELL the fusion holds. For example, ALIF gives you more surface space of fusion than with PLIF, generally. Where the hardware is placed can determine how you feel afterwards. For example, I can FEEL my hardware from the outside... I can touch the screws. Can't feel the rods, but I can touch the screws and sometimes feel them tugging on my muscles. Some people I know try to tell me I'm crazy and that's impossible, but it isn't. Doctor confirmed it already. Lol. But anyway, I think you should go with what you feel most comfortable with. Combining an anterior and posterior approach has higher success rates, statistically, because being realistic, you're getting the best of both worlds. It is, however, a harder recovery. I'm not on the boards much lately, but if you ever want to talk, you can send me a private message... I get notified by email :)

    Keep us updated. It sounds like you HAVE reached your wits end, being that it is physically at the point it is at, even if you haven't had unbearable pain yet. The fact is is that it seems to be inevitable. If it's inevitable, get it over with now. That was my theory, and my surgeon's as well. Granted, I had been out of work a year and a half, and had already exhausted all options, including a less serious surgery. But my surgeon explained to me that since my disc was shot, over time, the disc space would get smaller and smaller and smaller. The sciatica was really bad. So I scheduled my fusion. Part of my decision was also related to the fact that I didn't know if I would have Masshealth (which I have had since I had my son, due to the fact that I was a single parent living on my own) which fully covers EVERYTHING, and I also didn't want to start a new career (decided I wouldn't be able to continue being a hairstylist/cosmetologist, because of the physically demanding aspects of i) and then have to take time off for surgery and possibly lose my job... By that time if I was working I would have different insurance or maybe none at all, etc, etc, etc... Right NOW was the right time for me. And if it is for you, DO IT. Regardless of what anyone else says. It's about you & what you feel most comfortable with.

    I wish you the best and def, def keep us updated :) I hope you find peace with whatever decision you make.
  • Is ADR the plastic disc? I asked about that. He told met that bone does not fuse well to plastic, that is why the insurance companies don't want to pay for it. I posted this before I read your post Lo so thanks so much for the info >:D< and encouraging words. You have been quite an inspiration to me. All of you have with all that you have been through. I guess I kind of figured if I am going to go through the pain of the surgery and recovery, I should think about doing the one that has the greatest success rate because it is more complete. I am pretty tough, but I have a feeling this thing is gonna kick my butt - literally. =))
  • anjuan said:
    You discuss the L5-S1 and L4-L5. If he is going to fuse two levels, I am guessing that might be why he didn't discuss ADR. It hasn't yet been approved by the FDA at two levels. I also wanted to mention that I got 3 opinions and each Dr. had a different way to do the surgery for me as well. I know how confusing it can be. I just decided to go with the Dr. that I felt had the most skill and I felt most comfortable with.
    Yes, a two level fusion is what all of the doctors have recommended, sorry I did not answer sooner. :)
  • and I am glad in the end I did. The only thing I would have done differently was not put up with the sciatica pain so long and seen a surgeon long before I did. I started to fuse quickly. I had previous surgeries so he wanted to do the work from the front and then remove scar tissue from the back.
    I think you need to pick the surgeon you feel most supported by and go with them. Have you asked the others about doing a 360? Maybe they would give you reasons as to why they think it would not be necessary. I think in the end you just have to be satisfied that you have asked all the questions you know to ask and then pick the surgeon and trust.
    julie
  • Hey there,

    I had a 2 level (L4-S1) 360 ALIF done about two years ago. The anterior approach is better for the surgeon since they can visualize much more of the spine. The cages are screwed into place with the BMP or graft material (depends on surgeon). I was then flipped over and rods and screws placed through a minimally invasive procedure called the Sextant System. I have 8 - 1" incisions on my back and one 8 inch incision on my abdomen.

    I think what the surgeon means about instant fusing is there is much more stabilization using the cages versus not. There is no such thing as bone being actually fused the minute it is put into the space (unless he is using quick setting concrete or something!).

    I would ask about the brace once again. My doctor did have me use a brace for the first six weeks for any time I was out of bed. I'm glad I had it because it gave me an extra level of stability.

    As with any procedure, there are disadvantages. You will most likely have some intestinal issues (constipation, big time!). But that will resolve with time.

    Hope this helps!

    Keith
    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • Regarding the fusing portion. I should have clarified better. :B After that cage is put in, it is not fused immediately - but rather it stabilizes the spine right away simply by being there where there was bone on bone before. It also needs to have time to have bone growth like the others. If a person has a problem with instability of their spine like me, this being put into place will instantly cause that part of the problem to be fixed and it just has to heal over with bone. I agree, I am going to ask him again about the brace. I just think I would feel better having it on too, more safe! Like I said, this is just my understanding of it and I know everybody has had different results and understands it differently. That is why this is so helpful to hear other people's point of view, those that have had it and those that have not. Thanks guys, any additional comments appreciated so much! >:D< :X
  • Hi -

    I had the anterior/posterior fusion surgery in July 2008. My surgeon was quite adamant because of my spondylolisthesis and the higher success rate of this approach. I thought anything that minimized the chance of having to have another surgery was a good idea!

    Good luck with whatever you decide!
  • Here are 4 links. Not sure if you have read these already or not. You probably have LOL

    1.Artifical disk replacement
    2.Artifical disk replacement advice
    3.ALIF
    4.TLIF

    http://www.spine-health.com/treatment/artificial-disc-replacement

    http://www.spine-health.com/treatment/artificial-disc-replacement/artificial-discs-and-disc-replacement-patients-advice-part-ii

    http://www.spine-health.com/treatment/back-surgery/anterior-lumbar-interbody-fusion-alif-surgery

    http://www.spine-health.com/treatment/spinal-fusion/tlif-back-surgery-indications-and-technique


    Your certainly right everyone is going to have a different opinion that is for sure. lol

    I meant to add to my other post also my surgery for a 2 level was only 2 hrs.
    I only had pain in the incision in my back for about a week or two then whew it went away. It still feels odd when I move. Or it pulls once in awhile. But thats it.
    My dr hates going through the front. Just because of all the muscles. The reason I am so against for myself is I'v already had 2 c sections and well I don't want this belly dropping anymore =)) .
    And I just remember the pain all to well like it was yesterday and it was 21 yrs ago #:S

    Good luck hun O:) O:) O:) O:) O:) Make sure you have your ducks in a row. ;)
  • I think the 360 becomes imperative when you are dealing with much instability, as I was. You may want to ask if he is familiar with XLIF which is a small incision in the side which is then combined with a small back incision to secure both front and back of the disc. I think each surgeon has their own method. My best advice is go with the surgeon that you feel most comfortable with but if you are dealing with instability definitely make sure it is a 360. I feel much more secure and stable though am still healing and dealing with the muscle stuff. Blessings to you in whatever choice you make.
  • I don't think they do many fusions anymore without cages, do they? I don't know....

    Anyway, about the brace. I have a soft velcro one that has hard support right around the spine area in the back. It's AMAZING! It is SO comfortable and when I don't use it, I can feel the difference within a short period of time. I feel much, much worse when I don't wear it. I am planning on keeping it to wear afterwards, for like, when I'm doing anything stressful on my body. It's not just made for post op patients, it's also for patients with DDD, herniated discs, etc. I don't know exactly what it's called but I think if you google BOA brace or something like that, you might find it.
  • that each surgeon will have their own tried and tested methods and prefences as well as live experiences with th epatients and then the outcomes...

    what I am trying to say i think is that it is not an exact science. You need to feel confident in the surgeon you have and the rationale they offer you to help solve your problems.

    I am sure there are some more commercially minded doctors and then some more caring ones and then some less confident (perhaps) or more strict (ie taking non smokers)

    trust your instincts and ask lots of questions.
  • TerriJV said:
    I just have a hard time understanding why drs want to move everything around in the front in the ab area to get to the spine. HMMMM I guess no matter how much I read I will never understand it. I mean more muscles are cut etc. Recovery is recovery no matter how you look at it. I'v seen it to be harder on some people with those ab muscles being cut.
    Hi Terri -
    The way my surgeon explained it, they don't have to cut the muscle in front, they can push them aside. In the back - they have to cut. So if this is correct, then that's definitely an advantage for anterior approach.
  • Hello,
    Dr. Ullrich was my second opinion and boy am I glad I saw him. He will be doing my 360 degree fusion including hardware. He will also be placing a titanium disc between the two levels. By the way folks, he is the man who invented this device, FDA approved and patented. He informed me of this because of his affiliation with it. If you want the website let me know. I also have a lot of instability that is why I need the ALIF/PLIF. I feel very confident in Dr. U and also very comfortable with him being fellowship trained. I won't need a brace either and hope to feel better right away, other than the incision pain. The front incision is horizontal and slightly to the lower and left of the navel so the major muscles in the abdomen are not cut. I have done tons of research om my procedure and I feel completely comfortable with the group of doctors working on me. They use a vascular surgeon to make the incision and get the best access for the surgeon. If you want I can keep you updated on my recover. Best Wishes
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