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Minimally invasive TLIF or Open TLIF ?

BadBackBBadBack Posts: 5
edited 06/11/2012 - 8:47 AM in Back Surgery and Neck Surgery

I am 27 years old. Injured my back 2 years ago. I had a MicroEndoscopic discectomy 6 months ago which gave me some relief. But i still have leg/back discomfort.
Finally after lot of thought, decided to go for fusion.
It will be L5-S1 MIS TLIF in Oct or Nov. I will be having this in chicago, IL. My doc gives 50-50 chance of succuss.

Got 2 additonal opinons and both recomend open TLIF. My first surgeon does lots of MIS TLIF's.
I am interested in knowing, which appoach has better outcomes. Quick recovery/short incisions, in MIS sound great, but ultimately the final succuss rate is important.

Anyone with MIS TLIF or Open TLIF, please share experience.




  • Hi there,

    Definitely get a few opinions. I'd like to ask why the doctor's are pushing a fusion? I only ask b/c you say you have discomfort. I find it interesting that discomfort would warrant a fusion.

    I'm glad the doctor is giving you an honest answer aboug 50-50 chance of feeling better. Most claim "success" at about 80% but success is that they are slightly better or more.

    Anyhow, I was considering a fusion after a failed microdiscectomy (but opted to try the revision and am generally pleased). I don't know that either surgery is better but they are different.

    MI TLIF goes in through a smaller incision. So the obvious pros are that you have less to recover from because the muscles are cut through.

    The Open TLIF has the pro of 'full vision' where the doctor has better actual site on the area and is sure to get the disc out before putting in the screws.

    That being said, the surgeon I selected for the revision actually preferred MI TLIF's where possible mainly for the patient's recovery sake. He had done several of them and told me that if I ever needed a fusion, he generally does MI TLIFs but depending on the patient may do Open. The things he looks at are how much scar tissue, how much disc is left, patient age and other health factors.

    Either way, the biggest part of the surgery is the screws and rods.

    on the MI TLIF, my surgeon would also do special nerve monitoring to ensure that when he was moving through the small place with more reliance on equipment to 'see', he would have the nerve monitors to ensure he was reducing risk to my nerve.

    The nerve monitors were actually used on my revision MicroD for the same reason.

    I hope this helps. I know it isn't much.
    Good luck.
  • Hey BadBack,
    You and I are in the same boat. I'm about to have a MI TLIF on Nov. 9th, I'm in Chicago (suburbs) also. I ended up switching surgeons in order to have a MI procedure. The neurosugeon that did my ACDF wanted to do a open PLIF.

    You can't go wrong with getting a second or third opinion. Many docs like open procedures because they can see better but there alot of surgeons very skilled at MI procedures and the post-op pain is supposed to be less. Chi' Town has some of the best MI spine surgeons around. Send me a PM if you want some names and numbers of other doctors.

  • DNice,Thanks for advice and information on MI TLIF. Great to know your second disc surgery worked.
    I have seen 3 doc's in total, 2 neuro and 1 ortho.
    All of them left choice to me. It was my personal decision to try fusion.
    I am in pain/discomfort, say 3/10. But that worst part is, it is present all the time. I cannot sit in most of the chairs comfortably for more than few minutes. Both my legs start burnings. Standing for few minutes gets leg pain. car driving brings back/hip pain. If i bend, i feel deep ach in the back.
    I am fully functional, but simple activities like flexing to pick remote makes my back very sore.
    My L5-S1 is drying and lost 50% of its height.
    I feel my back is going to break off if i do somethign physical.
    I am better than many other folks here who's condition are so straight and would warrant fusion. Every day i wish either my condition gets better or worse. Result: It just stays same, no matter what i do.
    Frustration/depression have also played major role for this decision.
    Anyhow, since i have made this big decision, i want to make sure i pick the right surgeon and procedure.

    ccope, i will send a PM.

    Good luck everybody...
  • Not to discourage you, but most everyone here who has gone through some sort of back surgery dreams of the days when their pain was only a nuisance and they were still fully functional.

    What type of conservative treatments have you tried? Just remember that a fusion is a permanent change to the structure of your spine. No reset button and no do-overs.

    Is there any risk of permanent nerve damage? Did the docs say whether you could wait on the fusion for a while?

    I do wish you all the best, just make certain you have really thought this through and are comfortable with your decision.

  • I also live in the chicago (burbs).
    I had my MI TLIF on 3/19/10. 2 level fusion.
  • Blazer, I just sent you a PM.

  • blazer,
    How are you feeling 6 months post OP? can you share your experience ?

  • haglandc,

    I agree with you. I know fusion is the end of line of treatment and there is no reset once done.
    I tried over 20 sessions of physio therapy, 10 chiro, 10 accup, yoga, i stretch every day, in last 3 months i had 2 nerve block, 2 ESI's, inversion table, decompression therapy, tried lyrica. Nothing works.
    Fortunately, there is no nerve compression, but the disc is bulged and touches nerves on both sides. Also it is drying. I Saw 3 reputed doc's and they suggested,
    1. If you can live with it, wait it out. I am 6 months out micro-endo surgery.
    2. if you cannot, try TLIF fusion. 1 gave 50/50 success rate, and wants to do MI TLIF. Other doc said, it would remove your leg issues and reduce back pain upto 85%, and he wants to do open TLIF. Interestingly 2nd doc says, scar tissue is not source of pain(don't know how far thts true). I have scar tissue from first MED.
    3rd doc says 3 months post-op fusion, i can resume all activities including football. Hard to believe.

  • BB...it's totally a personal decision.
    I will tell you that I am at a 3/10 which is far better than I was at a 6-8 out of 10.

    I have great days and not so great days.
    My leg is still numb and burns about 1x per week after I come home from work. I take 2 advil & 1 500MG tylenol in the am and again in the PM for minimum. I walk at least 30 mins a day and I do very basic core muscle toning (very basic). I still have prescription meds for my 'off-days' but they are after a 3 hour train ride or a plane ride or something.

    For the most part, I can sit for 30 mins and then get up to move. I will tell you I can sit for up to 3 hours but I know it's not healthy as it puts additional load on my lower back. But I can do it.

    Perhaps I've gotten used to the 3/10 pain. No one cal tell you what to do as far as fusion but I think several folks here want to caution you only because there are risks that you could get worse or stay the same after all that.

    I guess in my mind, I think ADR has some real potential but being in the US and being "younger", it's too risky now. I'd like to think if I can hold out, I might have more options other than fusion.

    However, I made that decision after many opinions and research. I also did a remote opinion from Cleveland Clinic (not sure I can mention that) because I knew they would provide some good information and they weren't going to take me on as a patient so it was nice to have a consult.

    Good luck with your decision. Let me know if you want to talk more about how I approached my decision.

    If you can't be talked out of the fusion, it may be that you are ready for it.
  • Badback, I would agree with your skepticism of any doctor who says that you can play football three months after a fusion. I believe that any reputable surgeon would tell you that your fusion will not be stable until 6 months minimum and potentially up to 2 years.

    Even then, I would question which activities would be intelligent choices so that you don't injure other disks above or below the fusion.

    Also, if one doctor is giving the success odds as 50/50, I would wonder if they really know what the problem is. My surgeon told me that my odds of success were 80-90%, but my so-called "successful fusion" failed to improve my pain and I'm at almost 9 months post-fusion.

    I feel for you. You have obviously tried very hard to resolve your pain through conservative treatment and when you get all of these conflicting viewpoints about surgery, it can be incredibly confusing.

    I can't give you advice as to what to do. I would simply suggest that you pick a reputable doctor -- one who you have confidence in, and one that has confidence in their recommendation (i.e., better than 50/50 odds).

    Best wishes,
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