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Found this odd..... 360 or PLIF

AZmikeyAAZmikey Posts: 39
edited 06/11/2012 - 8:43 AM in Back Surgery and Neck Surgery
I have made the decision to move forward with surgery to have my L5-S1 fused. So I called the surgeon's office yesterday to schedule. His nurse asked if I had decided on a 360 or PLIF. I was a little dumbfounded..... A week and a half ago when I talked about surgery with the doctor, he said that it would be a PLIF. Of course we talked about risks of another incision, recovery etc, and I thought we were in agreement to only perform the PLIF.

Is this an odd question from the nurse? Am I missing something? Lastly..... I've seen many success stories for both a 360 and a PLIF. Any thoughts from the group as to the advantages of one over the other? My doctor said that the main advantage of the 360 is that he gets better access and can ensure things are cleaned out better and better access for putting the cage in. Long term success, at least for him, has been about the same for him.

Male 40
S1/S2 fused naturally
L5/S1 has the retro


  • Hello,

    I am not sure if it is odd for the nurse to be asking you this question or not. I am scheduled for a 360 fusion at L5-S1 on April 15th and this is something that I discussed at length with my doctor before making the decision. I had one doctor that just recommended the PLIF and one that recommended the 360. I decided to go with the 360 because the doctor that recommended it and is doing the surgery has been doing back surgeries for 35 years and is very successful at them. When I asked him for his honest opinion about what is best he said that in his patients he sees more stability and better long term outcomes with the 360. Of course, everyone is different with each situation and all doctors have different opinions about which procedure is best.

    Good luck with whatever procedure you choose to go with! I know it is a stressful and difficult decision to make.

  • I'm going for PLIF L2 to L5 next Wednesday. My thoughts are one incision is better than two (less chance of infection which scares the heck out of me).

    Every doc is different. When I checked out drs where I live I found out that none of them do the newer procedures (minimally invasive), they all still open you up like a can of sardines.

    I checked out drs from east to west to find out which procedure would be best for me and decided on
    Dr. who was with Cleveland Clinic and now has his own Spine Clinic in Ft. Lauderdale. He has done this several thousand times and has had great success. He also operated on me in 2003 (laminotony on L3-L4) so I have great faith in him.

    HOpe this helps with your decision. Marsha
  • I went in for a three-level PLIF, not even realizing there was the possibility of a 360. When I awoke after 9 hours of surgery, they informed me that they were unable to get my discs out through the scar tissue in my back, so they placed the rods and four days later went in through the front (I had lost too much blood for them to try and do it the same day). Recovery has been rough, but after nearly a year and a half, I finally feel as though I'm going to be okay.

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • Hi, I know very well what you are experiencing, I am 3 weeks post op 360 fusion and had the decision of which way to go. I will tell you what both surgeons told me but of coarse each individual is different. I too had retrospondylothises and a single level L5 S1 disc that was shot. My local surgeon(neuro) wanted to do a PLIF. I saw a orthopedic spine surgeon at HSS in NYC for a second opinion and he recommended a ALIF/discectomy PLF with hardware. He said due to being still fairly young(47) and with no other medical problems this would give the best outcome. He explained that when you place the cage toward the anterior portion of the spine this is where the most compression of you spine so you get better and also quicker fusion from the increase compression. It is also a quicker recovery, even though you have incisions front and back they were done minimally invasive so you are not cutting all the back muscles as much as you would with just a PLIF. When I went back to my original neuro surgeon and discussed my second opinion with him he agreed that it is a longer recovery from PLIF due to more extensive cutting of the muscles. He told me in his practice he would not do a 360 on me because of previous back surgery(microdiscectomy). Have you had any previous back surgery?

    I think it is key to find out how many 360 fusions this surgeon does weekly, monthly whatever just make sure he does them often. It also requires a vascular surgeon for the anterior portion of the surgery and you want to make sure he has experience with spinal access. This is the guy handling your internal organs and moving your major vessels in front of the spine so you want to make sure they are a good team. Do they do these with minimally invasive.

    So far I am doing excellent post op but I went to a big city to a surgeon who does over 400 spine surgeries a year, 80% of his work is fixing other peoples work(that was scary) and does 360 fusions every week. They do 360's local but not that many and the surgeon who does the anterior with him does not have the best track record for infection. I am a nurse so I had some advantage in that respect.

    If you dont have all your questions answered ask for another appointment and make sure you are comfortable with your answers or get another opinion. Good luck and you can PM me if you have any more questions. Lynette
  • Thanks for the responses. I mainly found it weird that the nurse would ask at time of scheduling, when the ortho and I had discussed the PLIF being the preferred way to go.

    As far as the 360 or PLIF, good feedback, some of it I have found here and there on this board over the last several months. My ortho will do about a hundred fusions this year, along with a few dozen 360's. He has done plenty of both in the past. I have seen a couple other ortho's and one said 360, another said PLIF and then my doctor is asking what I want. Though..... he suggest the PLIF. I think I'll talk with the nurse again on Monday. Everyone enjoy their weekend.
  • I'm surprised about your surgeries. When I spoke with my Dr. I specifically told him that I was worried about cutting nerves and muscles and he assure me that he just pushes them aside (no cutting). Now I'm worried and will have a looooong talk with him on Tuesday before my surgery on Wednesday. I've had surgeries before and know how hard it is to recover from muscles that have been severed and I chose him because he promised me that he would not have to cut muscles.

    Oh well....just another problem to worry about.

    Happy Easter to all! Marsha
  • SpineAZSpineAZ WiscPosts: 1,084
    My surgeon's medical assistant kind of did the same thing, calling me to say "we're in agreement for a PLIF with lateral incision on the hip?" I think she just wanted to be sure as I bet the notes showed discussion of the options the doctor and I discussed.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • They don't cut any nerves, at least not intentionally! But going in from the back, they have to detach the big muscles in the back to access the spine. I don't believe it is possible to just push them aside. Yes, you do that with the nerves, but I think the muscle is cut in an open surgery. At least, this is my understanding!!

    Happy Easter to you, too. And best wishes for your upcoming surgery. I am envious!!

  • Gwennie Is right about the nerve and muscle thing. The nerves are just moved as needed but I am pretty sure more intensive muscle work with a PLIF than with a 360.(if the surgeon is doing min. invasive technique)I'm sorry , don't want to cause you any more anxiety!!! Good luck next week


    I forgot to mention the nurse thing is probably just her reviewing the Dr.'s dictation and maybe he didn't make it clear in his notes that you had decided on PLIF. We as nurses rely on there dictation and she I'm sure just wants to be sure she sched it properly.

  • NOt happy about the muscle thing. My back muscles are shot as it is, so detaching them will make it much harder for me to recover. As I said before, I'm going to have a long talk with my Doc before surgery. Marsha
  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,730
    I've had both, And a XLIF. The pros have been mentioned. The most important being, The ability to get at everything for clean up.
    The major con, would be more muscles being cut, more nerve damage possibilities, and a longer more painful recovery. As for the surgery scheduler nurse. A lot of the time the Dr. will give a clear dictation. Other times a Dr. may just have notes for the nurse to make some sense of. And it becomes more formal later.
    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!
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