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XLIF Fusion with tall basket

j.howiejj.howie Brentwood, Ca., USAPosts: 1,730
edited 06/11/2012 - 8:38 AM in Back Surgery and Neck Surgery
Hi all,
I've tried to look up the "tall basket" in the XLIF fusion. And I haven't had any luck. I will find it out when I have my appoint. with the surgeon after my discogram and C.T Scan are done. But I would like to go in prepared with information and questions having a little bit of knowlage. Can anyone help???
Good luck, Jim :/
Click my name to see my Medical history
You get what you get, not what you deserve......I stole that from Susan (rip)
Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!


  • I had the XLIF procedure Jan 2010 after a post laminectomy procedure in 2007 seemed to fail. I am now 8 weeks post op and having burning down my entire left leg, stinging and tingling in my foot and big toe and I am frustrated and disappointed. Surgeon says may take 6 months to get better and"sometimes gets worse before it gets better". WTF that doesnt make sense !! Anyone with suggestions or similiar experience?
  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,730
    Sometimes they can get too close to the phosas mussel (spelling?) And that will cause the symptoms you are describing. It was in my disclosures for the surgery. It didn't happen to me. But I did read about it. And that is what I remember reading, That if it happens. It will likely get worse before it gets better.
    I do however, have a stinging or numbing, with pins and needles. On top of my feet. But it is intermittent. And not 24-7 If you type XLIF fusion or The Society of Lateral Access Surgery into the blue search box on the top of this page. It will take you to a lot of information on this surgery. And from there you can surf around different sites.
    Good luck, Jim
    Click my name to see my Medical history
    You get what you get, not what you deserve......I stole that from Susan (rip)
    Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!
  • Thanks Jim but I think the discomfort I am describing is related more to a neurological problem at the L4-5 nerve root. I had the same tingling and stinging sensation BEFORE the surgery and was told that I had a narrow foramen at L4-5 left and right side. Friend told me that he takes ELAVIL for diabetic neuropathy and it helped so I will ask my primary Dr about a RX for this.
  • If you are having nerve pain, you might want to try one of the "nerve" drugs like Neurontin (gabapentin) or its newer, big brother, Lyrica. Sometimes Cymbalta is also given for nerve pain.

    Sometimes when the nerve is decompressed, there is not immediate relief. As the nerve learns to function again, it can temporarily cause more nerve pain. I think that's what your doctor meant by it could get worse before it gets better. The nerve may have to go through some regrowth, which can be painful while it is learning how to fire and make a connection.

    You are still early in your recovery. Hopefully the pain will begin to let up soon, but it can take as long as a year, and sometimes even longer.
  • In case you want to do further research, it is the psoas muscle, and it can get damaged in other types of spine surgery too.

    For others who might be interested: "The biggest factor in back and hip pain is the psoas muscle. The number of problems caused by the psoas is quite astonishing. These include: low back pain, sacroiliac pain, sciatica, disc problems, spondylolysis, scoliosis, hip degeneration, knee pain, menstruation pain, infertility, and digestive problems. The list can also include biomechanical problems like pelvic tilt, leg length discrepancies, kyphosis, and lumbar lordosis."

    It is the major hip flexor, flexeing the hip and the spinal column...and is the major muscle involved with the process of walking. When you watch a dancer or an athlete, what allows them to perform is the psoas. It serves to level the pelvis, allowing for movement in all directs.

    It is also one of the few muscles that attaches to the spine but also wraps around into the pelvis. If one psoas muscle contracts, it can effect any or all of the mechanical functioning of the pelvis, and the lumbar, thoracic and cervical vertebrae. It can refer pain that is felt down the front of the thigh and also, and/or vertically along the lumbar and part of the thoracic spine. From the same article: "The psoas can torque your spine to the right or left, pull it forward and twist the pelvis into various distortions. Frequently one psoas will shorten and pull the spine and/or pelvis to our dominant side. The distortions of the spine and pelvis can also show up as a short or long leg. This all results in scoliosis, kyphosis, lordosis, trigger points, and spasms in back muscles trying to resist the pulling of the psoas.

    The psoas can pull the spine downward, compressing the facet joints and the intervertebral discs of the lumbar spine. The pressure can cause the discs to degenerate, becoming thinner and less flexible. This degeneration makes the discs more susceptible to bulging or tearing, especially with twisting and bending movements. "

    It is one of the largest muscles in the body and one of the most important to movement...and yet, very seldom will you get a spinal specialist to talk about it or acknowledge that it could be the cause of at least some of the patient's pain!

    I don't know about the tall basket. I would assume it would be whatever is used as the disc spacer, like a cage is used in ALIF or PLIF...but, let us know when you find out!!
  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,730
    Gwennie, I had no idea that muscle is so important.And did so many functions. I'm so glad that the surgeon didn't touch mine!
    Jim #:S
    Click my name to see my Medical history
    You get what you get, not what you deserve......I stole that from Susan (rip)
    Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!
  • image

    I believe (just an educated guess) what is being referred to as a "tall cage" is simply the term that is used to differentiate between the cages used for TLIF, XLIF and PLIF.

    Image A is the TLIF
    Image B is the XLIF
    Image C is the PLIF

    As you can see, the cage used for the XLIF is far longer or "taller" than the other cages. The beauty of the XLIF is
    The XLIF allows for easier, less invasive
    true lateral access to the disc space. Lateral implantation also preserves the stabilizing ligaments, and the
    footprint of the device capitalizes on the biomechanical support of the ring apophysis, allowing its use without
    the need of additional supplementation.
    So as you can see, less insult to the body in regards to moving muscle or internal organs. Smaller incisions and a much larger cage with far greater surface area contact being made.

    In your case the only additional insult to your body was the fact you were laying on your IPG during the surgery. Of course the cool part being that you are getting a new IPG and some great reprogramming as a result.

    I hope this helps make it a little easier to understand.

  • Yeah, there's so much good stuff about it on the internet that I could hardly contain myself from going on and on!! I think it is the only muscle that is on what I think of as the "front side" of the body, but actually attaches at the spine. When people think one leg is longer than the other, it is often a dysfunctional psoas muscle.

    You should read up on it. Then you can impress all your friends with little trivia about it. Most people have never even heard of it!!

    I'll stop before I start to go on and on... @) ;) (even more)
  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,730
    "c" I asked my surgeon to see a model or schematic, like the one you showed but he just gave a description. Now THIS is what I wanted! But I will say for him. That he did give me a lot of time and tried to explain. But just not the detail I wanted.
    I do have to say, the Drs. that deal with patients that come to Spine Health forums, are amazed at the knowledge we have. And the questions we ask!
    The knowledge that people on the forums have collectively and share is a powerful tool for us the patients.
    Thanks, Jim
    Click my name to see my Medical history
    You get what you get, not what you deserve......I stole that from Susan (rip)
    Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!
  • Gwennie... I am on gabapentin 300mg tid with no significant help. I have tried Lyrica and Cymbalta but the nausea was too much for me. After my laminectomy may 2007 I had IMMEDIATE nerve pain relief but after 2 "flareups" and narrowing of the left and right neural foramina at L4-5 I chose the XLIF procedure. A plastic cage or basket filled with bone stem cells(osteocell) was inserted in the space where the disc was removed. The basket was slightly larger than the space(I was told) so that the foramen would be opened more, thereby giving more room for the nerve root to exit without being entrapped or crushed. All sounded good but still having problems at 7 weeks post op.
  • I totally understand. I am a very "visual" person and like to see the nuts and bolts of things in order to better understand them. I was hoping that this picture would help. Sounds like you have a very cool surgeon.

  • I'm also a visual person. My surgeon had all the hardware on the table. Most of it screwed into simulated skeleton pieces. Some just loose. When I asked about the screws he grabbed some out of a drawer and said here, this is what you're getting. I wished I hadn't asked. Those screws that hold the rods. Those puppies are long. I can appreciate why it hurts after surgery. Same with the Axial bolt. It ain't no screw, that thing is a bolt!
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